Comparing Risk Profiles of Nicotine Pouch and Smokeless Tobacco Use in U.S. Adolescents: A Machine Learning Analysis

Area of Science:

• Public Health
• Adolescent Health
• Tobacco Control

Background:

• Nicotine pouches (NP) and smokeless tobacco (ST) are increasingly used by adolescents.
• Understanding the distinct and shared risk profiles of NP and ST use is crucial for targeted interventions.

Purpose of the Study:

• To identify and compare risk profiles associated with adolescent nicotine pouch (NP) and smokeless tobacco (ST) use.
• To determine key predictors for NP and ST initiation in adolescents.

Main Methods:

• Utilized data from the Population Assessment of Tobacco and Health (PATH) Study (N=10,604).
• Employed penalized logistic regression to identify top predictors for NP and ST use.
• Included over 70 variables across conceptual domains in predictive models.

Main Results:

• NP and ST use were strong reciprocal predictors, sharing correlates like other substance use behaviors.
• Exposure to NP-related social media content was a significant predictor for NP use.
• Models demonstrated strong performance with high AUROC values (0.946 for NP, 0.890 for ST).

Conclusions:

• Social media exposure is a key correlate of adolescent nicotine pouch use.
• Enhanced social media monitoring and stricter advertising enforcement are recommended.
• Development of targeted counter-marketing initiatives addressing online influences is warranted.