Some brands of nicotine pouches, a type of tobacco product which contain a powder that users dissolve between their lip and gum, have been available to adults over 21 for legal sale in the United States since 2016. Although the Food and Drug Administration gave approval for one brand to market 20 nicotine pouch products, the agency specified in its news release that they are not approved as a way to help tobacco users quit. (In contrast with pouches, there are multiple nicotine patches — placed on the skin that gradually releases small, controlled doses of nicotine to help curb withdrawal symptoms — that have been FDA approved to help people quit tobacco.)
Indeed, many brands have touted pouches as a way for smokers to quit over the past few years, but recently published data in the journal Tobacco Control from researchers at the Dornsife School of Public Health and the National Institutes of Health suggest it’s not a particularly effective way of doing so.
Sales of nicotine pouches — the fastest growing form of commercial tobacco purchased in the United States — rose from 126 million in August 2019 to 808 million in March 2022, with more than $8 billion in sales in 2023. The most recent data on nicotine pouch use, from 2022, found that 2.9% of U.S. adults reported ever using nicotine pouches (0.4% of them using them currently). In 2024, 1.8% of middle and high schoolers reported using nicotine pouches.
Currently, the U.S. FDA’s review of pending license applications from other brands looking to sell pouches has slowed due to health concerns, such as an association with gastrointestinal symptoms, such as ulcers and gum soreness, and cardiovascular concerns such as elevated heart rate.
To discuss the findings, senior author Lilianna Phan, PhD, an assistant professor in the Dornsife School of Public Health, recently answered some questions for the Drexel News Blog.
Your study found that U.S. adults who used nicotine pouches with other tobacco products had a lower probability of quitting tobacco a year later than those who did not use pouches with other products to quit tobacco. What’s the main message here for tobacco users?
These numbers suggest that people who use nicotine pouches with other tobacco products have a higher chance of continuing dual-using nicotine pouches with other tobacco products than switching to using nicotine pouches exclusively, or quitting tobacco use all together.
It is even more alarming that compared to people who do not dual use nicotine pouches with other tobacco products, those who dual use are less likely to give up tobacco (23.7% vs. 10.1%).
Together, these numbers indicate that nicotine pouches, as currently regulated as a leisure tobacco product, are ineffective in promoting giving up all tobacco among adults at the population level. An additional concern about using multiple tobacco products is that it can potentially increase the health risks of tobacco use and may also represent high nicotine dependence.
A recent opinion piece in the BMJ alleges that smoking is experiencing “a pop culture revival.” What are the health effects from tobacco?
Cigarette smoking and use of newer tobacco products like e-cigarettes/vapes and nicotine pouches are indeed being glamorized in media, like in movies, tiktok trends, and other forms of social media. This 1990’s nostalgia and general positive depictions in media, while it may seem harmless, can normalize commercial tobacco use. Research shows that exposure to tobacco imagery is associated with increased interest and initiation of tobacco use, which is critical to consider for preventing tobacco use among young people.
Commercial tobacco use remains the leading cause of preventable disease and death. It is associated with multiple cancers, coronary heart disease and lung diseases. It also impacts health in other ways, including potentially harming one’s reproductive health, lowering physical performance, increasing risk of type 2 diabetes, and increasing pre-mature aging, just to name a few. Second– and third-hand smoke exposure can also cause these deleterious health effects in individuals who do not smoke cigarettes themselves, especially children.
Roughly one of out of 10 adults (11%) say they smoked cigarettes in the past week, an all-time low, according to a 2024 gallup poll. That same poll said that 18% of adults aged 18 to 29 vape. As they are not smoked, are e-cigarettes harmful and addictive?
The all-time low of cigarette smoking is noteworthy and is a testament to tremendous tobacco control efforts these past decades. However, I greatly appreciate you raising attention to the higher prevalence of e-cigarette use/vaping among young adults in today’s ever evolving tobacco marketplace – initiation of these other tobacco products among young people can impede the reach and impact of reducing the U.S. cigarette smoking prevalence.
E-cigarette use/vaping is not risk-free (Centers for Disease Control and Prevention, American Lung Association, American Cancer Society). E-cigarettes/vapes contain chemicals that can potentially cause lung disease, heart disease and cancer. While there is still a lot to learn about the long-term health effects of e-cigarettes, studies have shown that while people who smoke cigarettes switching to exclusive e-cigarette use/vaping may expose themselves to lower toxicant levels, vaping is still associated with some of the same diseases as cigarette smoking.
E-cigarettes/vapes also contain nicotine, a highly addictive chemical that impacts brain development and your brain’s reward system during the critical developmental stages of youth and young adulthood. For example, it can change one’s brain chemistry so that you compulsively crave tobacco and also impact your cognitive processing (e.g., attention, memory, reasoning, decision-making).
What’s the major take-home message from your team’s findings for tobacco users looking to quit?
Quitting commercial tobacco is one of the best things you can do to improve your health. There is clear evidence that FDA-approved medications, like nicotine replacement therapy and other prescription medications (bupropion, and varenicline), together with behavioral counseling, can help people successfully quit commercial tobacco. These, and in combination, remain the most effective method to quit any and all tobacco use for good.
Those interested in quitting tobacco may want to visit the NIH’s site that offers resources that may help.
Anything else you’d like to add?
Tobacco and e-cigarette companies are using many of the same old tactics to entice people to use these addictive products, including the effort they deployed to confuse people about the harm of secondhand smoke, and the JUUL racketeering case. Previous research also shows how industry may be now a part of writing the policies, instead of opposing regulations. Tobacco companies may also see “harm reduction” as a money-making strategy, not truly for public health.
Reporters interested in talking with Phan should contact Greg Richter, an assistant director of media relations, at 215-895-2614 or gdr33@drexel.edu.
