Nicotine Pouch Patterns of Use in a 10-Week Prospective Study

Nicotine pouch (NP) product use has increased in the US, but limited data are available on how NPs are used and if they affect the use of other tobacco and/or nicotine products (TNPs), specifically transition away from more harmful TNPs such as cigarettes.

This prospective, observational study gathered information on daily use patterns of combustible and non-combustible TNPs (cigarettes, cigars, pipe tobacco, hookah, e-cigarettes, oral smokeless tobacco (ST)) and reasons for use among current adult NP users (n=346, ≥18 years old during the 2017-2018 study period) recruited with canister stickers in the 11 states where ZYN™ (NP-Z) was first sold. All analyses performed were descriptive in nature; values are provided as percentages with 95% confidence intervals, means with standard deviations, or medians with ranges, as appropriate.

The proportion of participants who used NP-Z and smoked cigarettes at least one day a week at baseline decreased from 15.9% (12.0-19.8%) to 8.1% (5.2-11.0%) over the study period. Nearly half of them stopped smoking by week 10 (8.1% (5.2-11.0%) to 4.9% (2.6-7.2%)). Among those who used NP-Z and moist snuff, use of the latter declined from 15.0% (11.2-18.8%) to 7.5% (4.7-10.3%). Overall, 24.0% (19.5-28.5%) of participants who used NP-Z and other TNPs at baseline reported exclusive NP-Z use by the end of the 10-week study.

Patterns of use among early NP-Z adopters indicate that NPs can be acceptable replacements for other TNPs, particularly cigarettes and oral ST.