Nicotine Pouch Use Surges Among US Adult Tobacco Users, Study Finds

A national study led by the University of Cincinnati shows that nicotine pouch adoption among adult tobacco users in the United States increased sharply between 2021 and 2024. Published in the journal Addiction, the research documents a rapid transition of oral nicotine pouches from a niche product into a mainstream consumer category.

Lead investigator Ashley Merianos, PhD, analyzed repeated cross-sectional data from YouGov surveys involving nationally representative samples of adult tobacco users. The findings reveal a marked shift in consumption patterns over the three-year study window.

Usage Metric	2021 Prevalence	2024 Prevalence
Ever Use (Tried at least once)	16.4%	31.1%
Current Use	3.0%	10.2%

Nicotine pouches contain a powdered blend of nicotine, flavorings, and other ingredients. Users position the pouch between the lip and gum, allowing saliva to release nicotine that is absorbed directly through the oral mucosa without burning tobacco or inhaling vapor.

Demographic Drivers and Poly-Tobacco Risks

The survey data identified clear demographic divides in product uptake. Adoption was most prevalent among men and adults aged 21 to 45, whereas adults over 60 reported minimal interest.

Existing tobacco consumption was the strongest predictor of nicotine pouch use. Smokeless tobacco users—including consumers of traditional dip and Swedish snus—showed the highest crossover rates. Rather than replacing older products, pouches often serve as an additional nicotine source in daily routines.

“Our data show that what was once considered a niche nicotine product is becoming a mainstream product among U.S. adult tobacco users. Nicotine pouches are often marketed as tobacco-free alternatives, but there are still important unanswered questions regarding their long-term health effects and addiction potential.”

— Ashley Merianos, PhD, University of Cincinnati

Dr. Merianos noted that poly-tobacco use presents distinct public health challenges: “Dual- and poly-tobacco use remain important concerns, as our study showed that many nicotine pouch users also report using other tobacco products.”

Brain Development and Unanswered Health Questions

The concentration of pouch use among young adults aged 21 to 24 raises specific medical concerns. The human brain undergoes development until approximately age 25, and exposure to stimulants like nicotine during this window can affect neural circuits managing attention, impulse control, and mood regulation.

“We don’t yet know the long-term health consequences, and we also don’t know the long-term addiction potential,” said Dr. Merianos. “If a young adult who has never smoked or used smokeless tobacco starts using nicotine pouches, will they become addicted to nicotine? And will they then switch to other products? That’s what we’re trying to figure out in the long term.”

Surveillance and Clinical Preparedness

The study was conducted in collaboration with researchers from Texas Tech University and the National Institutes of Health. The research team emphasized that health authorities must actively track emerging nicotine categories as tobacco manufacturers alter marketing strategies and product formulations.

With pouch sales expanding nationwide, the authors urge medical providers to routinely screen patients for oral nicotine use and stay informed about both the known pharmacological impacts and the unresolved safety questions surrounding these products.

Journal reference: Merianos, A. L., et al. (2026). Nicotine pouches: Correlates and changes in use in the United States between 2021 and 2024. Addiction. DOI: 10.1111/add.70671. https://onlinelibrary.wiley.com/doi/10.1111/add.70671

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Matthew Ma

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With over a decade of experience in the e-cigarette industry, Matthew Ma is a seasoned expert in both the manufacturing and usage aspects of vaping products. His extensive background has provided him with a deep understanding of the intricacies and evolving dynamics of e-cigarettes.