Abstract
Introduction: Tobacco-free oral nicotine pouches are an emerging product category. To date, there is little evidence on use among young people across countries. This study aimed to assess pouch use among young people in four countries with differing regulatory contexts.
Methods: Data were analysed from repeat cross-sectional surveys conducted in 2022, 2023 and 2024 with national samples of youth aged 16-19 and young adults aged 20-29 in Canada, England, the USA and New Zealand (NZ) (N=44 736). We assessed trends in awareness and use of nicotine pouches (2022-2024), as well as correlates and reasons for use (2024), using adjusted and unadjusted regression models.
Results: Across all countries, awareness of nicotine pouches increased among youth and young adults between 2022 and 2024 (all p<0.001). In 2024, approximately 5% of youth in Canada, the USA and NZ, and 10% in England, reported ever using pouches; past 30-day use ranged from 1.6% in NZ to 4.0% in England. Among young adults, ever use ranged from 9.1% (Canada) to 18.7% (England), and past 30-day use ranged from 3.0% (NZ) to 7.9% (USA). Across all countries, the prevalence of ever use did not change significantly between 2022 and 2023 among youth (p=0.18) or young adults (p=0.54), but increased from 2023 to 2024 among both age groups (p<0.001). Past 30-day use increased between 2022 and 2023 among youth (p=0.03) but not young adults (p=0.57), and increased from 2023 to 2024 among both (p<0.001). Use was more prevalent among males and those who used other tobacco/nicotine products. The most common reasons for using pouches among youth were curiosity, ease of use without being noticed and fun; and among young adults, were dealing with stress/anxiety, curiosity and less harmful than smoking.
Conclusions: Prevalence of nicotine pouch use among young people has increased in all four countries. Continued monitoring of these products is warranted.