Oral Nicotine Pouch Initiation and Characteristics of Use Among US Adolescents and Young Adults, 2022-2024.

Abstract

<b>Objectives.</b> To determine whether oral nicotine pouches (ONPs) are used by young people to initiate nicotine use. <b>Methods.</b> Incidence rate ratios (IRRs) for nicotine initiation using ONPs or other products were calculated among nicotine-naïve respondents (aged 15-30 years) using 5 waves (2021-2024) of a national, probability-based cohort survey (n = 6411) in the United States. Other past 30-day product use and primary reason for using ONPs were assessed. <b>Results.</b> Of 2539 nicotine-naïve respondents at wave 3 (W3), 320 (12.6%) initiated any nicotine use by wave 5 (W5). Of these, 7% initiated nicotine using ONPs and 6% used ONPs and another product. Nicotine initiation with ONPs was higher for W3-W5 respondents (2022-2024) compared with W1-W3 respondents (2021-2023; IRR = 2.10; <i>P</i> = .007). Among all respondents who started using ONPs in W3 through W5 (n = 790), 63.2% currently used another tobacco product at W3, W4, or W5 (e-cigarettes, 53.9%; cigarettes, 24.7%; cigars, 11.8%). Self-reported reasons for ONP use included physiological effects, harm reduction, and peer use. <b>Conclusions.</b> Initiation of nicotine use with ONPs was relatively low, but poly use of ONPs with other products is common. Strengthened regulation of the nicotine product market is needed. (<i>Am J Public Health</i>. Published online ahead of print August 6, 2026:e1-e4. https://doi.org/10.2105/AJPH.2026.308601).