Nicotine Pouch Patterns of Use in a 10-Week Prospective Study

Background: Nicotine pouch (NP) product use has increased in the US, but limited data are available on how NPs are used and if they affect the use of other tobacco and/or nicotine products (TNPs), specifically transition away from more harmful TNPs such as cigarettes. Methods: This prospective, observational study gathered information on daily use patterns of combustible and non-combustible TNPs (cigarettes, cigars, pipe tobacco, hookah, e-cigarettes, oral smokeless tobacco (ST)) and reasons for use among current adult NP users (n=346, ≥18 years old during the 2017-2018 study period) recruited with canister stickers in the 11 states where ZYN™ (NP-Z) was first sold. All analyses performed were descriptive in nature; values are provided as percentages with 95% confidence intervals, means with standard deviations, or medians with ranges, as appropriate. Results: The proportion of participants who used NP-Z and smoked cigarettes at least one day a week at baseline decreased from 15.9% (12.0-19.8%) to 8.1% (5.2-11.0%) over the study period. Nearly half of them stopped smoking by week 10 (8.1% (5.2-11.0%) to 4.9% (2.6-7.2%)). Among those who used NP-Z and moist snuff, use of the latter declined from 15.0% (11.2-18.8%) to 7.5% (4.7-10.3%). Overall, 24.0% (19.5-28.5%) of participants who used NP-Z and other TNPs at baseline reported exclusive NP-Z use by the end of the 10-week study. Conclusion: Patterns of use among early NP-Z adopters indicate that NPs can be acceptable replacements for other TNPs, particularly cigarettes and oral ST.