A recent comprehensive study conducted by researchers at the University of Southern California (USC) reveals a striking surge in the use of nicotine pouches among American high school students. These small, discreet sachets containing nicotine and various additives are placed between the lip and gum. According to findings published in JAMA Network Open, usage of nicotine pouches among U.S. teenagers nearly doubled between 2023 and 2024, signaling a burgeoning public health challenge that parallels earlier e-cigarette epidemics.
The investigation utilized data from the Monitoring the Future survey, which annually assesses substance use patterns among thousands of adolescents nationwide. This particular iteration surveyed over 10,000 10th and 12th graders and uncovered that in 2024, 5.4% of these students reported ever using nicotine pouches, up from 3% the previous year. Further, there was a notable increase in the frequency of past 30-day and past-year use, underscoring a trend toward more consistent consumption of these products by youth.
Interestingly, while nicotine pouch use climbed, the prevalence of e-cigarette vaping among teens saw a slight decline during the same period. The proportion of surveyed adolescents who used e-cigarettes in the past year dropped from 20% in 2023 to 17.6% in 2024. However, an important nuance emerged: dual usage of both nicotine pouches and e-cigarettes rose, with 3.6% of respondents reporting co-use in the past 12 months in 2024, compared to 2.1% in 2023. Such dual consumption behavior raises concerns about compounded nicotine exposure and addiction risks.
Demographic analysis revealed disparities in nicotine pouch use. Male students, those identifying as non-Hispanic white, and teenagers residing in rural areas were disproportionately more likely to use these products. This risk profile mirrors the traditional user base of smokeless tobacco, such as chewing tobacco, suggesting that nicotine pouches may be tapping into a demographic historically vulnerable to tobacco-related harms. This calls for tailored prevention strategies specifically designed for these high-risk groups.
The broader context for these findings includes the recent authorization by the U.S. Food and Drug Administration (FDA) permitting the marketing of flavored Zyn nicotine pouches to adults aged 21 and older. The FDA’s decision was based on the premise that these products may pose a less harmful alternative to combustible tobacco cigarettes for adult smokers seeking to quit. However, unlike nicotine replacement therapies such as gum or patches, these pouches are not officially approved as cessation aids. This regulatory stance raises critical questions about accessibility and inadvertent uptake among adolescents.
Adding complexity to the issue, social media platforms have played a significant role in propelling the popularity of nicotine pouches. The rise of “Zynfluencers,” young individuals promoting use of these products by linking them to traits like masculinity, confidence, and enhanced cognitive performance, amplifies their cultural reach and potential appeal to youth. Public health organizations, including the American Heart Association and the Campaign for Tobacco-Free Kids, have issued urgent calls for regulatory measures targeting this emerging product category to curb youth exposure and uptake.
The potential long-term health implications of nicotine pouch use remain largely unknown, as these products are relatively new on the market. Nicotine itself is a potent neurotoxin with established addictive properties, and adolescent exposure may interfere with brain development, particularly in regions responsible for learning, memory, and attention. Preliminary reports have also documented users experiencing oral health issues such as mouth sores and gum irritation, raising concerns about mucosal damage with chronic use.
While the national National Youth Tobacco Survey (NYTS) also tracked nicotine pouch trends, its findings diverged slightly from the USC-led research. NYTS data indicated that increases in past-month use were not statistically significant, although lifetime use rose markedly. The FDA’s marketing authorization for Zyn pouches primarily considered the NYTS data, which has garnered criticism for overlooking the significant increase in experimental and lifetime use evidenced by other surveys. This discrepancy highlights the importance of using multiple data sources to accurately assess youth nicotine product trends.
Looking forward, researchers emphasize the necessity of continued surveillance to monitor the impact of the FDA’s regulatory decisions on youth nicotine pouch use. Investigations planned for 2025 and beyond will aim to clarify patterns of initiation, product concentration, long-term health consequences, and the effectiveness of prevention policies. Emphasis will also be on understanding dual-use behaviors, particularly among vulnerable rural populations, to better inform tailored intervention strategies.
Experts warn that the current landscape of nicotine pouch availability, especially with enticing flavors such as cinnamon and fruit, poses substantial challenges for youth prevention. Unlike traditional tobacco products, these pouches are easy to conceal and use discreetly, facilitating experimentation and regular consumption without detection. Should marketing to adults continue without stringent safeguards, the risk of adolescent exposure and normalization of nicotine use could intensify.
The USC study not only illuminates a rapidly evolving nicotine product ecosystem among American youth but also urges heightened public awareness and policy action. As Dr. Dae-Hee Han, lead author, points out, “Nicotine pouches are relatively new, so we need time to collect data on prevalence, policy, and prevention.” Equally, co-author Adam Leventhal stresses the urgency for comprehensive education of parents, teachers, and pediatricians to combat the rising tide of teen nicotine use and mitigate its potential for addiction and harm.
This research was funded through significant support from the National Cancer Institute, the Food and Drug Administration, and the National Institute on Drug Abuse. Collaborative efforts across institutions, including USC, University of Michigan, and University of Nebraska Medical Center, highlight the interdisciplinary approach necessary to confront this emerging public health threat.
In sum, as nicotine pouches carve a foothold in youth culture, with marketing and social trends fueling their ascent, public health stakeholders face an urgent imperative. The delicate balance between harm reduction for adult smokers and safeguarding adolescents from nicotine addiction hangs in the balance. Robust regulatory oversight, coupled with targeted prevention efforts informed by ongoing scientific research, will be crucial to curbing the spread of this novel nicotine delivery system among the nation’s youth.
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Subject of Research: People
Article Title: Nicotine Pouch and E-Cigarette Use and Co-Use among US Youth in 2023 and 2024
News Publication Date: 30-Apr-2025
Web References:
– https://monitoringthefuture.org/
– https://newsroom.heart.org/news/public-policies-are-vital-to-prevent-the-use-of-popular-oral-nicotine-products
– https://www.tobaccofreekids.org/what-we-do/global/nicotine-pouches
– https://www.fda.gov/news-events/press-announcements/fda-authorizes-marketing-20-zyn-nicotine-pouch-products-after-extensive-scientific-review
– https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831999
References: JAMA Network Open (USC Study, 2025)
Keywords: Tobacco, Public Health, Addiction, Substance Related Disorders, United States Population
