Nicotine pouches maintain the nicotine market for tobacco companies

Nicotine pouches (like ZYN and on!) are being touted by some advocates as a “harm reduction” alternative to smoking cigarettes. Kelvin Choi and colleagues examined whether this happens in real life in their new paper “Patterns of tobacco product use among US adults who use nicotine pouches and the association between nicotine pouch use and tobacco product use cessation.” They found that dual use of nicotine pouches were commonly used in combination with other tobacco products. They found that, in contrast to what harm reductionists hoped, “Among US adults who dually used nicotine pouches with other tobacco products none completely switched to exclusive nicotine pouch use. Nicotine pouch use was also not associated with increased probabilities of quitting tobacco product use.”

This use pattern is exactly what the tobacco companies have been working to achieve As Dorie Apollonio and I reported in our 2017 paper “Tobacco Industry Research on Nicotine Replacement Therapy: ‘If Anyone Is Going to Take Away Our Business It Should Be Us’”:

In the 1990s, after pharmaceutical companies began selling prescription NRT, tobacco companies found that many smokers used NRT to supplement smoking rather than to quit. In 2009, once the Food and Drug Administration began regulating tobacco, tobacco companies restarted their plans to capture the nicotine market. Although the tobacco industry initially viewed NRT as a threat, it found that smokers often combined NRT with smoking rather than using it as a replacement and began marketing their own NRT products.

In other words, pouches are being used to maintain the market, including cigarettes, rather than replace them or promote cessation.

Here is the abstract:

Introduction: Nicotine pouch sales have substantially increased in the US. We examined the patterns of dually using nicotine pouches with other tobacco products, and whether nicotine pouch use was associated with tobacco product use cessation.

Methods: A nationally representative sample of US adults (≥21 years) participated in an online survey in 2024 and provided information about their tobacco use behaviours in 2023 and 2024, along with demographics. This analysis was restricted to those who reported using any tobacco products in 2023 (n=1460). Data were weighted to be nationally representative. Predictive marginal probability differences (PMPDs) were used to examine the association between nicotine pouch use in 2023 and tobacco product use cessation in 2024.

Results: In 2023, 12.0% of US adults who used tobacco products reported currently using nicotine pouches with another tobacco product. Among those who used nicotine pouches dually with at least one other tobacco product in 2023, none switched to exclusive nicotine pouch use in 2024 and 47.1% continued dual-use, 10.1% stopped using all tobacco products and 42.8% stopped using nicotine pouches in 2024. US adults who dual-used nicotine pouches with other tobacco products in 2023 had lower probabilities than those who did not dual-use to quit tobacco product use in 2024 (10.1% vs 23.7%; PMPD=-15.2%, 95% CI -20.8% to -9.6%).

Conclusions: Among US adults who dually used nicotine pouches with other tobacco products, none completely switched to exclusive nicotine pouch use. Nicotine pouch use was also not associated with increased probabilities of quitting tobacco product use.

The full citation is: Choi K, Jewett B, Hamilton-Moseley KR, Zarei K, Hacker K, Phan L. Patterns of tobacco product use among US adults who use nicotine pouches and the association between nicotine pouch use and tobacco product use cessation. Tob Control. 2026 Mar 3:tc-2025-059832. doi: 10.1136/tc-2025-059832. Epub ahead of print. PMID: 41775635. It is available here.