{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T16:12:01Z","timestamp":1787847121119,"version":"build-2784847793"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T00:00:00Z","timestamp":1661299200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","award":["U54DA036151"],"award-info":[{"award-number":["U54DA036151"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010628","name":"Center for Tobacco Products","doi-asserted-by":"publisher","award":["U54DA036151"],"award-info":[{"award-number":["U54DA036151"]}],"id":[{"id":"10.13039\/100010628","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["U54DA036151"],"award-info":[{"award-number":["U54DA036151"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000038","name":"U.S. Food and Drug Administration","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000038","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Nicotine pouches containing synthetic nicotine or tobacco-derived nicotine (TDN) are available in the United States. Synthetic nicotine pouches are often marketed as \u201ctobacco-free nicotine\u201d (TFN), which may alter risk perceptions and product appeal. This study examined young adults\u2019 perceptions of TFN versus TDN pouches and the associations between product perceptions and TFN pouch awareness, susceptibility, and use, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims and Methods<\/jats:title>\n                    <jats:p>In total 630 young adults (18\u201325 years) completed an online Qualtrics panels survey in 2021. Participants were informed that TFN pouches contain synthetic nicotine as opposed to TDN. Participants reported on comparative risk perceptions for TFN versus TDN pouches and on TFN pouch awareness, susceptibility, and use. Unadjusted between-group comparisons and adjusted binary logistic regressions were run to examine relationships between product perceptions and TFN pouch awareness, susceptibility, and use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Participants were aware of (37.3%), susceptible to (29.2%), or had used TFN pouches (3.8%). In unadjusted comparisons, TFN pouch awareness, susceptibility, and use were associated with disproportionately perceiving TFN pouches as less harmful or otherwise better than TDN pouches. In adjusted models, relationships between favorable perceptions and both TFN pouch awareness and susceptibility remained significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The descriptor \u201ctobacco-free\u201d may impact risk perceptions and the appeal of nicotine pouches among young adults. While no direct relationship was observed between TFN perceptions and TFN pouch use in the adjusted model, perceptions remained related to product awareness and susceptibility, which may be linked to future use. Continued surveillance is needed to fully determine how the term \u201ctobacco-free\u201d on product packaging and advertising impacts longitudinal public health outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications<\/jats:title>\n                    <jats:p>Nicotine pouches originally contained TDN. Today, numerous brands of synthetic nicotine pouches, which are often marketed as \u201ctobacco-free,\u201d are available on the market. We informed participants that \u201ctobacco-free nicotine\u201d pouches contain synthetic nicotine and examined comparative risk perceptions (i.e. tobacco-free vs. TDN pouches) and TFN pouch awareness, susceptibility, and use. Perceiving tobacco-free nicotine pouches as less harmful than tobacco-derived pouches was associated with product awareness, susceptibility, and use in unadjusted models and with awareness and susceptibility in adjusted models. Restricting the term \u201ctobacco-free\u201d may become necessary if the term inaccurately reduces product risk perceptions or increases product appeal.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ntr\/ntac204","type":"journal-article","created":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T08:17:45Z","timestamp":1661329065000},"page":"143-150","source":"Crossref","is-referenced-by-count":52,"title":["\u201cTobacco-free\u201d Nicotine Pouches: Risk Perceptions, Awareness, Susceptibility, and Use Among Young Adults in the United States"],"prefix":"10.1093","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4865-1155","authenticated-orcid":false,"given":"Meghan E","family":"Morean","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Yale University School of Medicine , New Haven, CT ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krysten W","family":"Bold","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Yale University School of Medicine , New Haven, CT ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9436-9575","authenticated-orcid":false,"given":"Danielle R","family":"Davis","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Yale University School of Medicine , New Haven, CT ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9269-3435","authenticated-orcid":false,"given":"Grace","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Yale University School of Medicine , New Haven, CT ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suchitra","family":"Krishnan-Sarin","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Yale University School of Medicine , New Haven, CT ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepa R","family":"Camenga","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Yale University School of Medicine , New Haven, CT ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,8,24]]},"reference":[{"issue":"e1","key":"2026041420122105900_CIT0001","first-page":"e145","article-title":"Tobacco companies introduce \u2018tobacco-free\u2019nicotine pouches","volume":"29","author":"Robichaud","year":"2020","journal-title":"Tob Control."},{"issue":"6","key":"2026041420122105900_CIT0002","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1001\/jama.2021.10366","article-title":"Nicotine pouch unit sales in the US, 2016-2020","volume":"326","author":"Marynak","year":"2021","journal-title":"JAMA."},{"issue":"4","key":"2026041420122105900_CIT0003","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1111\/ajad.13020","article-title":"Initial information on a novel nicotine product","volume":"29","author":"Plurphanswat","year":"2020","journal-title":"Am J Addict."},{"issue":"9","key":"2026041420122105900_CIT0004","doi-asserted-by":"crossref","first-page":"1590","DOI":"10.1093\/ntr\/ntab030","article-title":"Characterization of total and unprotonated (free) nicotine content of nicotine pouch products","volume":"23","author":"Stanfill","year":"2021","journal-title":"Nicotine Tob Res."},{"key":"2026041420122105900_CIT0005","first-page":"1","article-title":"Chemical characterization of tobacco-free \u201cmodern\u201d oral nicotine pouches and their position on the toxicant and risk continuums","volume":"1","author":"Azzopardi","year":"2021","journal-title":"Drug Chem Toxicol."},{"issue":"4","key":"2026041420122105900_CIT0006","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1093\/ntr\/ntab198","article-title":"The new nicotine pouch category: a tobacco harm reduction tool?","volume":"24","author":"Patwardhan","year":"2022","journal-title":"Nicotine Tob Res."},{"issue":"5","key":"2026041420122105900_CIT0007","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.ss7105a1","article-title":"Tobacco product use and associated factors among middle and high school students\u2014National Youth Tobacco Survey, United States, 2021","volume":"71","author":"Gentzke","year":"2022","journal-title":"MMWR Surveill Summ."},{"key":"2026041420122105900_CIT0008","article-title":"What is Zyn and what are oral nicotine pouches?","author":"Truth Initiative.","year":"2021"},{"key":"2026041420122105900_CIT0009","author":"Zyn. 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