Young males, prior cigarette or e-cigarette users most likely to use oral nicotine pouches, Hollings researcher finds

The nicotine industry is constantly innovating, delivering new products to the market – and that keeps public health researchers busy as they work to understand the implications of each new offering.

A team from MUSC Hollings Cancer Center has just published a paper in JAMA Network Open describing oral nicotine pouch usage – one of the first papers to look at how common this product is.

Hollings researcher Amanda Palmer, Ph.D., a research instructor in the Department of Public Health Sciences, led the study.

“These products were introduced just a few years ago, so they're still pretty new, and a lot of the surveys have only recently started tracking usage,” she said. “So all of these data are really new in terms of what the use prevalence is. But it’s good to have that baseline for future research because – like we saw with e-cigarettes – these novel products really seem to be taking off. And that can have some important implications for public health.”

Oral nicotine pouches are similar to Swedish snus, but they use a synthetically-produced, crystalized nicotine salt powder – similar to what’s used in nicotine replacement medications like gum and lozenges – rather than actual tobacco leaves. The powder is in a small pouch that is placed between the lip and the gum, where the nicotine is then absorbed into the body. Popular brand names include Zyn, Rogue and Lucy.

Palmer and her team analyzed survey data from the 2022-2023 Population Assessment of Tobacco and Health (PATH) Wave 7, a nationally representative survey that started in 2013. Wave 7 was the first version of the study to ask about oral nicotine pouch usage.

Those most likely to use oral nicotine pouches were males in late adolescence or early adulthood.

“The highest odds of use were among people who were already using or had in the past used other tobacco products like cigarettes, e-cigarettes or smokeless tobacco,” Palmer said.

Although overall usage was low – less than 1% of adolescents and 3.34% of adults reported ever using oral nicotine pouches – the few other reports that exist as reference points seem to indicate that usage is increasing.

If people are using these oral nicotine pouches as a way to  transition away from combustible cigarettes completely, that could be a beneficial use.

“From what we know right now, the nicotine pouches are pretty safe. And they might even be safer than e-cigarettes,” Palmer said. “And so that would be a good move for public health, if people who smoke switched to something like a nicotine pouch.”

“Public health has done a really great job at putting out messaging that smoking is one of the most harmful things you can do for your health, and that quitting has all of these great benefits,” she continued. “Unfortunately, quitting smoking is still really hard to do, and I think a lot of people have these health concerns and are looking for alternative approaches to improving their health.”

Still, the long-term outcomes of the product are unknown. And many are offered in flavors, like citrus or wintergreen, and flavored tobacco products are known to attract young people.

“Just like with e-cigarettes, these also contain nicotine, which is addictive,” Palmer said. “There can be some negative outcomes from that. Not only from a health standpoint, but there's psychological distress that can come with nicotine dependance. There are social problems. There's financial strain. So we want to also monitor some of the potentially aversive effects of pouches and potentially come up with ways to mitigate some of those risks for people.”

She noted that the MUSC Health Tobacco Treatment Program, housed at Hollings, has already fielded calls from people looking for help to stop using oral nicotine pouches.

“They were finding it hard to quit, even though they had quit other tobacco products in the past and switched to the pouches. So that's something that we definitely want to keep track of and study in the future,” she said.

About MUSC Hollings Cancer Center

MUSC Hollings Cancer Center is South Carolina’s only National Cancer Institute-designated cancer center with the largest academic-based cancer research program in the state. With more than 230 faculty cancer scientists from20 academic departments, it has an annual research funding portfolio of more than $50 million and sponsors more than 200 clinical trials across the state. Hollings specialists include surgeons, medical oncologists, radiation oncologists, radiologists, pathologists, psychologists and other clinical providers equipped to provide the full range of cancer care from diagnosis to survivorship. Hollings offers state-of-the-art cancer screenings, diagnostics, therapies and surgical techniques within its multidisciplinary clinics. Dedicated to preventing and reducing the cancer burden statewide, the Hollings Office of Community Outreach and Engagement works with community organizations to bring cancer education and prevention information to affected populations throughout the state. For more information, visit hollingscancercenter.musc.edu.