The Use of Oral Nicotine Pouches in Adolescents: Systematic Review and Meta-Analysis

Oral nicotine pouches (ONPs) have recently gained popularity among adolescents. This systematic review and meta-analysis aims to address the literature gap and public health implications of ONP use. Specifically, it focuses on the use prevalence, user characteristics, associated factors, and co-use with other substances. Following a comprehensive database search conducted until September 2025, 14 eligible studies were identified after title/abstract and full-text screening using Rayyan Software. Quality and risk of bias were assessed using the Joanna Briggs Institute Critical Appraisal Tools for cross-sectional studies. Data analysis consisted of a descriptive synthesis and 2 random-effects meta-analyses to estimate the pooled prevalence of ever and current nicotine pouch use among adolescents, followed by sex-stratified subgroup analyses to compare prevalence between males and females. Analysis showed that the ever use of ONPs was more prevalent than the current use. Key user characteristics were male gender, older age, and Hispanic ethnicity. Furthermore, ONP use was strongly associated with the co-use of other tobacco products and substances. ONP use among adolescents reflects rising experimentation, demographic disparities, and emerging health risks, underscoring the urgent need for targeted regulation and research.