Oral Nicotine Pouch Initiation and Characteristics of Use Among US Adolescents and Young Adults, 2022-2024

Objectives. To determine whether oral nicotine pouches (ONPs) are used by young people to initiate nicotine use. Methods. Incidence rate ratios (IRRs) for nicotine initiation using ONPs or other products were calculated among nicotine-naïve respondents (aged 15-30 years) using 5 waves (2021-2024) of a national, probability-based cohort survey (n = 6411) in the United States. Other past 30-day product use and primary reason for using ONPs were assessed. Results. Of 2539 nicotine-naïve respondents at wave 3 (W3), 320 (12.6%) initiated any nicotine use by wave 5 (W5). Of these, 7% initiated nicotine using ONPs and 6% used ONPs and another product. Nicotine initiation with ONPs was higher for W3-W5 respondents (2022-2024) compared with W1-W3 respondents (2021-2023; IRR = 2.10; P = .007). Among all respondents who started using ONPs in W3 through W5 (n = 790), 63.2% currently used another tobacco product at W3, W4, or W5 (e-cigarettes, 53.9%; cigarettes, 24.7%; cigars, 11.8%). Self-reported reasons for ONP use included physiological effects, harm reduction, and peer use. Conclusions. Initiation of nicotine use with ONPs was relatively low, but poly use of ONPs with other products is common. Strengthened regulation of the nicotine product market is needed. (Am J Public Health. Published online ahead of print August 6, 2026:e1-e4. https://doi.org/10.2105/AJPH.2026.308601).