Rates of oral nicotine pouch experimentation, initiation, and cessation by other tobacco product use and sociodemographic characteristics among U.S. adults, 2022–2024
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Importance
Oral nicotine pouches (ONPs) are tobacco-leaf-free nicotine products that have experienced a substantial increase in sales in recent years.
Objective
To determine how ONP experimentation, initiation, and cessation rates differ by other tobacco product use and sociodemographic characteristics.
Design
Nationally representative longitudinal cohort study; data from Waves 7 and 8 (2022–2024) of the Population Assessment of Tobacco and Health (PATH) Study.
Setting
US civilian, non-institutionalized population.
Participants
Adults in Waves 7 and 8 of PATH. Of 27,800 eligible participants, 24,640 with complete information on the exposure and outcome were included.
Exposures
Other tobacco product use (cigarette-only, electronic nicotine delivery system [ENDS]-only, smokeless tobacco [SLT]-only, and multiproduct use) and sociodemographic characteristics (sex, race and ethnicity, age, and educational attainment).
Main Outcomes
Hazard rates and ratios of transitioning between never, current, and non-current ONP use, defined by ever and past-30-day use, overall and by exposure group. Rates are estimated in univariable weighted multistate transition models.
Results
Among 24,640 participants, 23,555 (96.7%) never used, 802 (2.5%) non-currently used, and 283 (0.8%) currently used ONPs in 2022. From 2022–24, ONP initiation was higher among those using cigarettes only (HR 3.34, 95% CI 1.59–7.02), ENDS only (HR 9.68, 95% CI 2.89–32.5), SLT only (42.4, 95% CI 22.3–80.7), or multiple products (HR 18.4, 95% CI 7.11–47.8) compared to those who did not use these tobacco products. Those who used cigarettes only (HR 3.02, 95% CI 1.24–7.34), ENDS only (HR 2.03, 95% CI 1.11–3.71), or multiple products (HR 2.61, 95% CI 1.12–6.09) discontinued ONPs at higher rates than those using no other products. Men had higher ONP initiation and lower cessation rates than women, adults ages 35+ years had lower initiation rates than those ages 18–24, and non-Hispanic Black participants had higher cessation rates than non-Hispanic White participants.
Conclusions and Relevance
Initiation of ONPs was higher among those who used other tobacco products, highlighting the need to investigate whether ONPs replace these products or lead to poly-tobacco use. Higher cessation rates among those using cigarettes only or ENDS only may suggest experimentation rather than sustained use.
Key Points
Question
How do rates of oral nicotine pouch (ONP) experimentation, initiation, and cessation depend on other tobacco product use and sociodemographic characteristics?
Findings
Among 24,640 adults in a nationally representative longitudinal cohort study, individuals using other tobacco products experimented with and initiated ONPs at higher rates than those not using other tobacco products, but all except those using only smokeless tobacco also discontinued ONPs at higher rates.
Meaning
Adults using other tobacco products were more likely to experiment with but not necessarily continue to use ONPs in this period in which ONPs were recently introduced.
