Oral Nicotine Product Use and Vaping Progression Among Adolescents

Use of flavored oral nicotine products (ONPs), including nicotine pouches and other ONPs (eg, gums and lozenges) is increasing among adolescents who use e-cigarettes (ie, vape). It is unknown whether ONP use is associated with vaping behaviors.

We used data from 6 semiannual waves of a prospective cohort of Southern California adolescents (2021-2024). Among participants who used e-cigarettes in the past 6 months at waves 1-5 (n = 703; mean age = 16 years), we examined the time-varying and time-lagged association of ONP use (any ONP, nicotine pouch, other ONPs [eg, gum or lozenges]) at waves 1-5 with subsequent vaping persistence and frequency 6 months later at waves 2-6.

Across a total of 1173 observations, there were 277(23.7%) observations of any past 6-month ONP use (17.4% nicotine pouch and 21.3% other ONPs). Past 6-month use (vs nonuse) of any ONP (risk ratio [RR] = 0.75; 95% CI, 0.62-0.91), nicotine pouches (RR = 0.43; 95% CI:, 0.32-0.58), and other ONPs (RR = 0.72; 95% CI, 0.59-0.89) was associated with lower likelihood of subsequent vaping persistence. Use of nicotine pouches was also inversely associated with past 30-day vaping frequency at follow-up (incidence rate ratio = 0.43; 95% CI, 0.26-0.72). In secondary analyses (examining ONP use in the past 30 days and restricted to youth reporting past 30-day e-cigarette use at exposure waves), only inverse associations of nicotine pouch use with vaping persistence remained.

Youth nicotine pouch use was associated with a lower likelihood of continued vaping and lower vaping frequency 6 months later. ONP use might not increase vaping, and nicotine pouches may serve as a partial nicotine substitute for youth who vape.