Patterns and characteristics of nicotine pouch use among adults with a history of cigarette smoking

Nicotine pouches (NP) are emerging as a potentially safer alternative to tobacco smoking. However, data on NP users with a history of tobacco smoking are limited. We assessed the patterns of NP use, user characteristics, and perceptions among adults with a history of cigarette smoking.

A cross-sectional survey was conducted using a self-administered questionnaire to enroll adults with a history of regular cigarette smoking. Data on sociodemographics, smoking history, NP use patterns, and NP-related urges and perceptions were collected. Group differences were analyzed using χ² tests, and multivariable logistic regression identified factors associated with high-intensity NP use.

A total of 711 adults with a history of combustible cigarette smoking were included, of whom 693 were analyzed. Among them, 560 were current users of NP who had ceased cigarette smoking (NP users) and 133 were current cigarette smokers who had not adopted NP (non-users). We found no difference between the two groups in gender, educational status, income, marital status, years of smoking, and time to first cigarette (all p > 0.05). A total of 236 NP users (42.1%) reported high-intensity NP use (≥10 pouches/day) and a total of 363 NP users (64.8%) used their first NP within 30 min of waking. About half of the NP users reported reduced craving intensity (n = 312; 55.7%), and experienced milder withdrawal symptoms (n = 245; 43.8%) compared with smoking. A total of 339 (60%) rated NP as extremely or very effective for smoking cessation. Higher cigarette per day (CPD) was associated with increased odds of high-intensity NP use (≥10 pouches/day): 21-30 CPD (OR = 2.70; 95% CI: 1.62-4.50) and >30 CPD (OR = 3.15; 95% CI: 1.40-7.10).

The present findings suggest that adults with a history of cigarette smoking report NP use patterns that appear broadly similar to their prior smoking behaviors. Users reported that cravings and withdrawal symptoms during NP use were similar to or lower than those recalled during smoking. Although most users viewed NP as effective for cessation, it may instead serve as an alternative nicotine source rather than a cessation tool.