Prevalence and Characteristics of Oral Nicotine and Tobacco Product Use among US Adults

Abstract Introduction Whether demographic and tobacco use characteristics differ between adults using new non-tobacco oral nicotine products (ONPs; e.g., nicotine pouches and other ONPs [e.g., gums, lozenges]) versus those using oral tobacco products (e.g., snus and other smokeless tobacco) is unknown but important to tobacco control. Methods Using cross-sectional nationally representative data from n=29,705 United States (US) adults (≥18y) in wave 7 (2022-2023) of the Population Assessment of Tobacco and Health Study, we compared weighted distributions of sociodemographic and tobacco use characteristics among those reporting past 30-day use of non-tobacco ONPs and oral tobacco products. Results Prevalence of past 30-day use was 1.4% for nicotine pouches, 0.66% for other ONPs, 0.95% for snus, and 2.4% for other smokeless tobacco products excluding snus. Adults who used nicotine pouches were more likely than those who used smokeless tobacco to be 18-24-year-olds (36.6%[95%CI:29.5-44.3] vs. 16.8%[95%CI:13.1-21.3]), be female (21.8%[95%CI:15.5-29.7] vs. 8.6%[95%CI:6.4-11.4]), have a college degree (35.2%[95%CI:27.8-43.3] vs. 15.9%[95%CI:12.1-20.7]), live in the Western US (29.5%[95%CI:22.6-37.5] vs. 16.0% [95%CI:12.1-21.0]), and currently vape nicotine (37.4%[95%CI:29.1-46.5] vs. 21.7%[95%CI:17.4-26.7]), and more likely to have a college degree than those who used snus (15.7%[95%CI:10.3-23.3]). Adults who used other ONPs were more likely to be female (48.7%[95%CI:37.8-59.7]) than all other use groups, and more likely to smoke cigarettes (53.5%[95%CI:43.1-63.5]) than those who used nicotine pouches (29.8%[95%CI:22.9-37.9]) or smokeless tobacco (33.1%[95%CI:27.5-39.2]). Conclusions ONP use may be expanding to populations who may otherwise not have used oral tobacco, including younger, female, and higher socioeconomic status populations.