Rutgers study finds nicotine pouches may help reduce tobacco harm, but youth use raises concern

Nicotine pouches may offer a path to reduced tobacco harm for adults who have recently quit smoking or vaping, according to new Rutgers Health research that provides the first national estimate of daily nicotine pouch use in the United States.

The study, published in JAMA Network Open, found that while only 2.5% of adults reported using the products, most were current or former tobacco users who may be turning to pouches as a less harmful alternative. Use among tobacco-naïve adults — those who had never used tobacco — was virtually nonexistent.

“Our results suggest that adults may be using nicotine pouches for harm reduction given that use is highest among those that have recently quit another tobacco product or e-cigarettes,” said Cristine D. Delnevo, director of the Rutgers Institute for Nicotine and Tobacco Studies and a distinguished professor at the Rutgers School of Public Health.

The findings come as tobacco companies turn increasingly to smoke-free products like Zyn and Velo amid declining cigarette sales. In January, the U.S. Food and Drug Administration authorized marketing of Zyn, the first nicotine pouch to receive such approval. Still, the FDA does not allow pouches to be marketed as cessation aids, even if some users adopt them for that purpose.

Researchers analyzed data from the U.S. Census Bureau’s 2022–2023 Tobacco Use Supplement, which surveyed more than 110,000 adults nationwide. They found that non-Hispanic white men were the most likely to report using pouches, and the highest prevalence of daily use was among people who had recently quit smoking or vaping.

But experts cautioned that questions remain about the long-term health effects of oral nicotine products. Nicotine itself is not carcinogenic, but it is addictive and can harm cardiovascular health by raising blood pressure and posing other risks.

Evidence also points to gradual growth among young people. The Centers for Disease Control and Prevention reported that 1.8% of U.S. middle and high school students used nicotine pouches in 2024, up from 1.1% in 2022.

“We should always keep a watchful eye on youth tobacco-use behaviors, including use of multiple products, substitution with other products or alternative methods of finding and using flavored tobacco and nicotine products,” Delnevo said.

Still, she added, there may be public health benefits if tobacco users switch entirely to pouches. “People who have never used tobacco products should not suddenly be using nicotine pouches,” Delnevo said. “But for people who smoke or use other nicotine products and don’t want to stop using nicotine, switching completely from the more harmful product and moving down the risk continuum with nicotine pouches is a likely good for public health.”

Mary Hrywna, an associate professor in the Department of Health Behavior, Society and Policy at Rutgers, echoed that point.

“As nicotine pouches gain increased attention in the U.S., many agree that we need to better understand who is using these products and how,” Hrywna said. “This study offers a snapshot of use patterns that is informative and, at least for now, somewhat reassuring.”