Youth nicotine pouch use and dual use with e-cigarettes increased from 2023 to 2024, highlighting the need for stronger prevention and regulation efforts.
Nicotine pouch, dual e-cigarette use increases among youth | Image Credit: © Saepul - © Saepul - stock.adobe.com.
From 2023 to 2024, youth use of nicotine pouch and dual use with e-cigarettes increased in the United States, warranting further surveillance, regulation, and preventive efforts, according to research published in JAMA Network Open.1
The study investigators, led by Dae-Hee Han, PhD, of the Department of Population and Public Health Sciences at the University of Southern California, Los Angeles, noted that a marketing sector shift of flavored commercial products without tobacco leaves has recently expanded, potentially luring youth to more nicotine products.
"With e-cigarettes... brands used marketing strategies to distance e-cigarettes from unfavorably viewed tobacco-containing products," wrote Han and investigators. "E-cigarettes ultimately generated a unique non-tobacco sector of the commercial nicotine market that re-attracted youths to nicotine use. The commercial non-tobacco nicotine market recently expanded to oral nicotine pouches, which share characteristics with e-cigarettes."
The investigative team noted that pouches are often sold in fruit, mint, and candy flavors in addition to being widely marketed on social media platforms that are highly-engaged by youth.2
Since comprehensive epidemiologic analyses of patterns and trends among youth use of these products is limited, the investigators sought to estimate use prevalence from 2023 to 2024.
The cross-sectional study used data from surveys conducted in schools with a nationally-representative sample of adolescents in 10th and 12th grades from 2023 to 2024. The study's primary outcomes were lifetime, past-12-month, and post-30-day, self-reported use of nicotine pouch, e-cigarette, and co-use patterns, defined as exclusive pouch without e-cigarettes, exclusive e-cigarette without pouches, or dual use. Answer format for the surveys were yes or no.
In all, there were 10,146 study participants (48.2% male), of whom 51.6% were in 10th grade.
In 2023 vs 2024, nicotine pouch use increased, respectively, for:
E-cigarette use did not change significantly from 2023 to 2024 for lifetime use (28.5% [95% CI, 26.3%-30.7%] vs 26.7% [95% CI, 24.3%-29.3%]) and past-30-day use (13.4% [95% CI, 11.8%-15.2%] vs 11.8% [95% CI, 10.2%-13.7%]). However, results revealed a decrease for past-12-month use (20.0% [95% CI, 18.1%-22.0%] vs 17.6% [95% CI, 15.7%-19.7%]).
"From 2023 to 2024, exclusive nicotine pouch and pouch plus e-cigarette dual use generally increased, whereas exclusive e-cigarette use decreased, collectively constituting no significant change in the prevalence of any non-tobacco nicotine use across years," wrote the investigators.
Regarding demographic comparisons, collapsed comparisons revealed that males reported higher nicotine pouch use prevalence compared to females. Conversely, female individuals reported higher e-cigarette use.
Regarding race and ethnicity, rural vs urban and non-Hispanic White vs Hispanic youths were more likely to use each product, with larger differences for pouches than e-cigarettes.
Across all study data, nicotine pouch and e-cigarette use prevalence was higher among youth in 12th grade compared to 10th graders and those without 4-year college plans vs those with a multiple-year plan.
"In this cross-sectional study, commercial nontobacco nicotine use in US 10th and 12th graders shifted from 2023 to 2024, marked by a doubling in nicotine pouch past-30-day use, an increase in pouch plus e-cigarette dual use, and a decrease in exclusive e-cigarette use," stated the authors. "Prioritizing surveillance, regulation, and prevention addressing pediatric nicotine pouch use warrants consideration," they concluded.
References:
1. Han D, Harlow AF, Miech RA, et al. Nicotine Pouch and E-Cigarette Use and Co-Use Among US Youths in 2023 and 2024. JAMA Netw Open. 2025;8(4):e256739. doi:10.1001/jamanetworkopen.2025.6739
2. Travis N, Warner KE, Goniewicz ML, et al. The potential impact of oral nicotine pouches on public health: a scoping review. Nicotine Tob Res. 2025;27(4):598-610. doi:10.1093/ntr/ntae131
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