Written by Hannah Harp
Spoon Feed
Among teenagers who use e-cigarettes, starting to use oral nicotine pouches lowers the risk of a sustained vaping habit.
You snus, you lose?
We’ve been around the block with e-cigarettes, but how much do you know about oral nicotine products (ONP)? One form comes as little pillow-mint shaped mesh pouches contain a combination of methylcellulose and nicotine salts, and when they’re kept between the gum and buccal mucosa, the nicotine is absorbed – same concept as nicotine gum when you use the chew-and-park method. They’ve become pretty popular among adolescents since 2020. Pouches come in a wide variety of strengths and flavors, but a standard pouch delivers 4-6mg of nicotine (about as much as 3-4 cigarettes).
This study of 703 adolescents asked, “If a teenager smokes e-cigarettes and also uses an ONP, are they more likely to decrease, maintain, or increase their level of vaping?”. Across 1,173 observations, nicotine pouch use in the past 6 months was associated with reduced odds of continued vaping (aRR 0.43; 95%CI 0.32–0.58) and lower vaping frequency (aIRR 0.43; 95%CI 0.26–0.72). Similar but weaker associations were observed for other ONPs (e.g., gums, lozenges), suggesting ONPs may not promote vaping persistence. There is some missing information that I hope we get in future studies – what are teens’ motivation for using ONP (e.g., curiosity, peer pressure, trying to vape less)? What strengths are being purchased, and how many pouches a day are used? For kids who haven’t started smoking e-cigarettes but have tried pouches, are they more likely to pick up vaping as well?
How does this change my practice?
This study suggests that switching to a pouch may be helpful when trying to reduce e-cigarette use in teenagers. There’s a lot we don’t know about how carcinogenic e-cigs and pouches are, but we certainly know about other bad stuff associated with e-cigs, so the product change may feel safer for some people. However, one pouch/day = 30-40 pulls of an e-cigarette, so I’m guessing most kids using these pouches are getting way more nicotine exposure than they do when vaping.
Source
Oral Nicotine Product Use and Vaping Progression Among Adolescents. Pediatrics. 2025 Jun 1;155(6):e2024070312. doi: 10.1542/peds.2024-070312. PMID: 40383543
