Knowledge and consumption of nicotine pouches among adult smokers in the United States in 2021

Nicotine pouches, whose current consumption remains low, are nevertheless one of the fastest growing categories of nicotine products on the American market. A study published in the journal Tobacco Control[1] assesses awareness and use of these products among adult smokers in the United States in 2021.

The study surveyed a sample of more than 1,000 current U.S. adults who smoke between January and February 2021 about awareness of, use of, or interest in nicotine pouches.

Oral nicotine pouches are a new product in the tobacco industry's portfolio that are typically offered in a variety of flavors. These products are sold in pouches similar to snus (snus is a moist smokeless tobacco powder that is typically placed under the upper lip, and does not require spitting unlike chewing tobacco) and are consumed in a similar manner. The difference is not in the method of consumption but in the nature of the product: instead of containing tobacco leaves, they are filled with white powder containing nicotine.

These products first entered the U.S. market around 2015. Their distribution expanded in 2019 and 2020. Recent industry projections suggest continued accelerated growth in this product category.

Knowledge and consumption that remain marginal for the moment

In terms of product knowledge, at the beginning of 2021, 29.2% of respondents had already seen or heard of nicotine pouches. This knowledge differed considerably by age group, with smokers aged 18 to 44 being twice as likely to be familiar with these products as older smokers. This knowledge was also significantly higher among those who had already used chewing tobacco.

Data collected from US adolescents in 2019 reported low past-30-day nicotine pouch use. 1.5% of adolescents aged 16–19 years fell into this category. More recently, data collected from adults who currently smoke cigarettes and who recently quit smoking in four countries, including the United States, indicated a very low current prevalence of nicotine pouch use (0.8% of adolescents aged 16–19 years).

In this study, approximately 5.6% of smokers surveyed had ever tried nicotine pouches. Compared with those aged 45 and over, those aged 18 to 44 were nearly 3 times more likely to have ever used these products. The odds of ever using these pouches were also significantly higher among those who had previously tried to quit smoking with the help of prescription medication or advice to quit from a healthcare professional (AOR=4.18).

A product which nevertheless requires some monitoring

For the authors of the study, these results suggest that knowledge and consumption of nicotine pouches among adult smokers need to be integrated into surveys on the consumption of tobacco products and other nicotine-based products, in particular in order to better understand the characteristics of this consumption which may be associated with other products.

According to the authors, continued monitoring of overall trends in nicotine pouch prevalence is also important given recent sales growth and brand expansion in the general category of new oral nicotine products. To date, much of the research on these products has been funded by the nicotine industry. In addition to monitoring of these products, independent research is also needed on the perceived risks of these products, the actual risks of these products, the motivations for their use, and the contexts of use in various population groups. Further research should also clarify whether nicotine pouch use is associated with quit attempts, cessation, or harm reduction for smokers, or whether pouches may facilitate dual use and delay quitting or quit attempts.

In early 2021, the American organization Truth Initiative warned of the popularity of flavoured nicotine pouches among young people[2]. Available in many flavors, the product is considered highly addictive and can represent a gateway to tobacco products. Manufacturers communicate about these products to the media, on social networks or at events. They present them as being "safer" and consumable everywhere, regardless of the location. In doing so, they do not mention their potential health risks and their addictive nature in order to attract a new, often young, clientele.

Keywords: Nicotine pouch, United States, adults,

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[1] Hrywna M, Gonsalves NJ, Delnevo CD, et al Nicotine pouch product awareness, interest and ever use among US adults who smoke, 2021Tobacco Control Published Online First: 25 February 2022. doi: 10.1136/tobaccocontrol-2021-057156