Perceived neighborhood disadvantage and current nicotine pouch use among U.S. youth

Nicotine pouches (NPs) are emerging nicotine products that appeal to youth due to their discreet use, tobacco-free formulation, and flavor availability. However, given their recent introduction to the market, little is known about how neighborhood environments may influence US youth NP use.

We imputed cross-sectional data from the 2023 National Youth Tobacco Survey (n = 22,069, ages 9 + years) and developed a neighborhood risk score (range: 1-4) by averaging 10 items related to neighborhood disorder, safety, and disadvantage. To estimate associations between the risk score and current (past 30-day) NP use, we fit logistic regression models adjusted for sociodemographic, school, environmental, and behavioral characteristics.

The prevalence of current NP use was 1.6% (95% CI=1.0-2.1). The mean neighborhood risk score was 1.6 (95% CI=1.6-1.7) and was higher among youth who currently used NPs (mean=2.1, 95% CI=1.8-2.3) vs. those who did not (mean=1.6, 95% CI=1.6-1.7). Adjusted results showed that for each unit increase in neighborhood disadvantage, the odds of current NP use increased by 77% (95% CI=1.08-2.91). Further, specific neighborhood items included in the risk score, such as violence and vandalism, were associated with NP use.

This study found that youth living in high-risk neighborhoods had higher odds to use NPs, highlighting the influence of environmental factors on novel tobacco/nicotine use. The findings support the need for community-level prevention strategies to address youth use of emerging tobacco/nicotine products.