Nicotine Pouch and E-Cigarette Use and Co-Use Among US Youths in 2023 and 2024
Level 4 - case-series / case-control
Repeated cross-sectional survey design
OpenAlex W4409962435 · doi:10.1001/jamanetworkopen.2025.6739
What was done
This cross-sectional study analyzed data from the school-based Monitoring the Future survey administered to a nationally representative sample of US 10th and 12th graders in 2023 and 2024 (n = 10,146; 48.2% male, 47.3% female; 51.6% 10th grade, 48.4% 12th grade). Researchers evaluated self-reported lifetime, past-12-month, and past-30-day use of nicotine pouches and e-cigarettes, as well as exclusive use and dual-use patterns across sociodemographic factors including sex, race/ethnicity, 4-year college plans, grade, and population density.
What was found
Nicotine pouch use significantly increased from 2023 to 2024 across all timeframes: lifetime use increased from 3.0% to 5.4% (risk ratio [RR], 1.76; 95% CI, 1.30–2.40), past-12-month use rose from 2.4% to 4.6% (RR, 1.95; 95% CI, 1.39–2.74), and past-30-day use doubled from 1.3% to 2.6% (RR, 2.05; 95% CI, 1.33–3.16). E-cigarette use showed no significant change for lifetime use (28.5% vs 26.7%) or past-30-day use (13.4% vs 11.8%), but past-12-month use decreased from 20.0% to 17.6%. Overall nontobacco nicotine prevalence remained stable across years as increases in exclusive pouch use and dual use offset decreases in exclusive e-cigarette use. Pouch use was more prevalent among males, rural youths, non-Hispanic White youths, 12th graders, and those without 4-year college plans.
Why it matters
These findings document a rapid market expansion and doubling of past-month nicotine pouch adoption among US adolescents between 2023 and 2024. Although overall youth nontobacco nicotine prevalence remained flat, nicotine pouches are increasingly substituting for or supplementing e-cigarette use.
Limits
The study is restricted to in-school 10th and 12th graders, omitting younger adolescents and non-enrolled youths. Outcomes rely entirely on self-reported survey responses subject to recall and social desirability biases, and the cross-sectional design cannot track individual-level transition trajectories between products over time.
Cited by
- contradicts Nicotine pouch use among youth quadrupled between 2022 and 2025, and lifetime use among 12th graders rose from 7% to 10% in a single year.