The Potential Impact of Oral Nicotine Pouches on Public Health: A Scoping Review

Introduction:
This text provides a scoping review of oral nicotine pouches (ONPs), a new class of nicotine products, and their potential public health impact. The review summarizes evidence on ONP product characteristics, use patterns, beliefs and perceptions, toxicity, and marketing and sales.

Key Points:

* Sixty-two studies were included in the review, with 17 funded by the tobacco industry.
* Most studies were from the United States, and use prevalence estimates varied widely.
* Nationally representative U.S. studies suggest current youth ONP use below 1.5% and lifetime use below 2.5% through 2023.
* Adult use estimates were largely limited to populations with a history of tobacco use and varied widely by age and tobacco/nicotine product use status.
* Industry advertising expenditures for ONPs have grown, suggesting increasing interest by tobacco companies in promoting ONPs.
* Higher lifetime ONP use was observed in younger adult males, current and lifetime SLT users, current smokers, and dual cigarette and ENDS users.
* Among U.S. adolescents, higher lifetime ONP use was observed in male and non-Hispanic White populations.
* More independent studies are needed to confirm industry-funded findings on the harm of ONPs relative to SLT.

Main Message:
The review provides an initial assessment of the potential role of ONPs in harm reduction and aims to determine unintended consequences of their use (youth uptake and dual-use) and identify populations that disproportionately use the product. This information is essential for tobacco regulatory bodies in determining the net public health impact of nicotine pouches. The review highlights the need for more independent research to confirm industry-funded findings and for regulators to consider the potential for ONPs to appeal to youth and young adults, as well as their potential role in encouraging dual-use.

Nargiz Travis, Kenneth E Warner, Maciej L Goniewicz, Hayoung Oh, Radhika Ranganathan, Rafael Meza, Jamie Hartmann-Boyce, David T Levy, The Potential Impact of Oral Nicotine Pouches on Public Health: A Scoping Review, Nicotine & Tobacco Research, Volume 27, Issue 4, April 2025, Pages 598–610, https://doi.org/10.1093/ntr/ntae131