Rates of oral nicotine pouch experimentation, initiation, and cessation by other tobacco product use and sociodemographic characteristics among U.S. adults, 2022-2024
- 1University of Michigan
Abstract
ImportanceOral nicotine pouches (ONPs) are tobacco-leaf-free nicotine products that have experienced a substantial increase in sales in recent years.
ObjectiveTo determine how ONP experimentation, initiation, and cessation rates differ by other tobacco product use and sociodemographic characteristics.
DesignNationally representative longitudinal cohort study; data from Waves 7 and 8 (2022-2024) of the Population Assessment of Tobacco and Health (PATH) Study.
SettingUS civilian, non-institutionalized population.
ParticipantsAdults in Waves 7 and 8 of PATH. Of 27,800 eligible participants, 24,640 with complete information on the exposure and outcome were included.
ExposuresOther 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 OutcomesHazard 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.
ResultsAmong 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 RelevanceInitiation 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 PointsO_ST_ABSQuestionC_ST_ABSHow do rates of oral nicotine pouch (ONP) experimentation, initiation, and cessation depend on other tobacco product use and sociodemographic characteristics?
FindingsAmong 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.
MeaningAdults 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.
Related
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- A Randomized Factorial Trial of Varenicline, Nicotine Lozenges, and Smartphone Medication Adherence Reminders for Smoking Cessation: Protocol for the COMBO II Study.
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BibTeX
@misc{roberts2026rates,
title = {{Rates of oral nicotine pouch experimentation, initiation, and cessation by other tobacco product use and sociodemographic characteristics among U.S. adults, 2022-2024}},
author = {O. K. Roberts and L. M. Sanchez-Romero and E. Jimenez-Mendoza and J. Jeon and N. Travis and R. Mistry and R. Meza and D. T. Levy and A. F. Brouwer},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.05.26364785},
url = {https://www.medrxiv.org/content/10.64898/2026.10.05.26364785v1},
note = {CC BY-NC},
}
RIS
TY - UNPB
TI - Rates of oral nicotine pouch experimentation, initiation, and cessation by other tobacco product use and sociodemographic characteristics among U.S. adults, 2022-2024
AU - O. K. Roberts
AU - L. M. Sanchez-Romero
AU - E. Jimenez-Mendoza
AU - J. Jeon
AU - N. Travis
AU - R. Mistry
AU - R. Meza
AU - D. T. Levy
AU - A. F. Brouwer
PY - 2026
DA - 2026/10/05
PB - medRxiv
DO - 10.64898/2026.10.05.26364785
UR - https://www.medrxiv.org/content/10.64898/2026.10.05.26364785v1
AB - ImportanceOral nicotine pouches (ONPs) are tobacco-leaf-free nicotine products that have experienced a substantial increase in sales in recent years. ObjectiveTo determine how ONP experimentation, initiation, and cessation rates differ by other tobacco product use and sociodemographic characteristics. DesignNationally representative longitudinal cohort study; data from Waves 7 and 8 (2022-2024) of the Population Assessment of Tobacco and Health (PATH) Study. SettingUS civilian, non-institutionalized population. ParticipantsAdults in Waves 7 and 8 of PATH. Of 27,800 eligible participants, 24,640 with complete information on the exposure and outcome were included. ExposuresOther 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 OutcomesHazard 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. ResultsAmong 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 RelevanceInitiation 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 PointsO_ST_ABSQuestionC_ST_ABSHow do rates of oral nicotine pouch (ONP) experimentation, initiation, and cessation depend on other tobacco product use and sociodemographic characteristics? FindingsAmong 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. MeaningAdults 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.
ER -