Patterns of tobacco product use among US adults who use nicotine pouches and the association between nicotine pouch use and tobacco product use cessation

INTRODUCTION: Nicotine pouch sales have substantially increased in the US. We examined the patterns of dually using nicotine pouches with other tobacco products, and whether nicotine pouch use was associated with tobacco product use cessation. METHODS: A nationally representative sample of US adults (≥21 years) participated in an online survey in 2024 and provided information about their tobacco use behaviours in 2023 and 2024, along with demographics. This analysis was restricted to those who reported using any tobacco products in 2023 (n=1460). Data were weighted to be nationally representative. Predictive marginal probability differences (PMPDs) were used to examine the association between nicotine pouch use in 2023 and tobacco product use cessation in 2024. RESULTS: In 2023, 12.0% of US adults who used tobacco products reported currently using nicotine pouches with another tobacco product. Among those who used nicotine pouches dually with at least one other tobacco product in 2023, none switched to exclusive nicotine pouch use in 2024 and 47.1% continued dual-use, 10.1% stopped using all tobacco products and 42.8% stopped using nicotine pouches in 2024. US adults who dual-used nicotine pouches with other tobacco products in 2023 had lower probabilities than those who did not dual-use to quit tobacco product use in 2024 (10.1% vs 23.7%; PMPD=-15.2%, 95% CI -20.8% to -9.6%). CONCLUSIONS: Among US adults who dually used nicotine pouches with other tobacco products, none completely switched to exclusive nicotine pouch use. Nicotine pouch use was also not associated with increased probabilities of quitting tobacco product use.