Awareness and use of oral nicotine pouches among youth and young adults, 2022–2024: repeat cross-sectional surveys in Canada, England, the USA and New Zealand
Level 4 - case-series / case-control
Repeat cross-sectional survey design (graded by design analogy)
OpenAlex W4416959706 · doi:10.1136/bmjph-2025-003457
What was done
Data were analyzed from repeat cross-sectional surveys conducted in 2022, 2023, and 2024 across Canada, England, the USA, and New Zealand. The sample included 44,736 youth (aged 16–19) and young adults (aged 20–29). Investigators evaluated trends in awareness and use (ever-use and past 30-day use) from 2022 to 2024, along with correlates and self-reported reasons for use in 2024 using adjusted and unadjusted regression models.
What was found
Awareness increased significantly across all four countries from 2022 to 2024 (p < 0.001). In 2024, ever-use among youth was approximately 5% in Canada, the USA, and New Zealand, and 10% in England, with past 30-day use ranging from 1.6% (New Zealand) to 4.0% (England). Among young adults in 2024, ever-use ranged from 9.1% (Canada) to 18.7% (England), and past 30-day use ranged from 3.0% (New Zealand) to 7.9% (USA). Between 2022 and 2023, ever-use remained stable (youth p = 0.18, young adults p = 0.54), but past 30-day use increased among youth (p = 0.03). Both ever-use and past 30-day use increased significantly across both age groups from 2023 to 2024 (p < 0.001). Use was higher among males and users of other nicotine/tobacco products. Top reasons for use were curiosity, discreet use, and fun among youth, versus stress/anxiety relief, curiosity, and perceived lower harm among young adults.
Why it matters
This study provides multi-country surveillance data showing that oral nicotine pouch uptake is accelerating among adolescents and young adults across diverse regulatory environments.
Limits
The study relies on self-reported survey data, which is vulnerable to recall and reporting bias. Because the design is cross-sectional rather than longitudinal, it cannot determine whether pouch use leads to nicotine dependence or serves as a gateway to or substitute for combustible tobacco.
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.