{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:15:40Z","timestamp":1791202540163,"version":"4.2.0"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>This manuscript examines prevalence of awareness and use of nicotine pouches among U.S. middle and high school students by sociodemographic characteristics and other tobacco product use and characterizes nicotine pouch and other tobacco product use behaviors among current nicotine pouch users.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aims and Methods<\/jats:title>\n                  <jats:p>Data are from the 2021 National Tobacco Youth Survey, a cross-sectional, school-based survey of middle and high school students (N = 20 413; overall response rate: 44.6%), which included questions on nicotine pouches in 2021 for the first time. Prevalence estimates, 95% confidence intervals, and estimated population counts were assessed for nicotine pouch awareness, ever use, and current (past 30 days) use, and for use behaviors related to nicotine pouches (frequency of use, flavor(s) used) and other tobacco products (ever, current, frequency of use) among current nicotine pouch users.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Over one-third of students (35.5%) had ever heard of nicotine pouches. An estimated 1.9% (490 000) reported ever using them, while 0.8% (200 000) reported current use. Among current nicotine pouch users, 61.6% reported flavored nicotine pouch use, 64.2% reported current e-cigarette use, and 52.6% used multiple (\u22652) tobacco products. Current use of nicotine pouches was common among current smokeless tobacco users (41.3%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Overall, in 2021, while relatively few students had ever tried nicotine pouches or currently used them, more than one-third had heard of them. Current nicotine pouch users tended to use other tobacco products, particularly e-cigarettes and smokeless tobacco. Given previous rapid increases in youth uptake of e-cigarettes, it is important to continue monitoring nicotine pouch use among young people.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Implications<\/jats:title>\n                  <jats:p>This study\u2019s findings provide an important baseline for future monitoring of nicotine pouch awareness and use among middle and high school students. Emerging tobacco products, particularly those that are flavored, widely available, discreet, and inexpensive have the potential to attract youth. Given the potential of these products to appeal to young people, ongoing monitoring of nicotine pouch use behaviors is important to inform public health and regulatory efforts.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ntr\/ntad080","type":"journal-article","created":{"date-parts":[[2023,6,9]],"date-time":"2023-06-09T13:47:56Z","timestamp":1686318476000},"page":"1610-1613","source":"Crossref","is-referenced-by-count":46,"title":["Nicotine Pouch Awareness and Use Among Youth, National Youth Tobacco Survey, 2021"],"prefix":"10.1093","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9834-659X","authenticated-orcid":false,"given":"Renee D","family":"Kramer","sequence":"first","affiliation":[{"name":"Division of Population Health Science, Office of Science , Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eunice","family":"Park-Lee","sequence":"additional","affiliation":[{"name":"Division of Population Health Science, Office of Science , Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristy L","family":"Marynak","sequence":"additional","affiliation":[{"name":"Office on Smoking and Health , U.S. Centers for Disease Control and Prevention, Atlanta, GA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2709-0806","authenticated-orcid":false,"given":"Jamal T","family":"Jones","sequence":"additional","affiliation":[{"name":"Division of Population Health Science, Office of Science , Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4146-6897","authenticated-orcid":false,"given":"Michael D","family":"Sawdey","sequence":"additional","affiliation":[{"name":"Division of Population Health Science, Office of Science , Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen A","family":"Cullen","sequence":"additional","affiliation":[{"name":"Division of Population Health Science, Office of Science , Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,6,6]]},"reference":[{"issue":"9","key":"2023081908300572400_CIT0001","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."},{"issue":"22","key":"2023081908300572400_CIT0002","doi-asserted-by":"crossref","first-page":"23312331","DOI":"10.1001\/jama.2021.19056","article-title":"Nicotine pouch unit sales in the US from 2016 to 2020\u2014reply","volume":"326","author":"Marynak","year":"2021","journal-title":"JAMA."},{"issue":"8","key":"2023081908300572400_CIT0003","doi-asserted-by":"crossref","first-page":"1420","DOI":"10.1093\/ntr\/ntaa239","article-title":"Examining market trends in smokeless tobacco sales in the United States: 2011\u20132019","volume":"23","author":"Delnevo","year":"2021","journal-title":"Nicotine Tob Res."},{"issue":"E1","key":"2023081908300572400_CIT0004","doi-asserted-by":"crossref","first-page":"tobaccocontrol-2019-055321","DOI":"10.1136\/tobaccocontrol-2019-055321","article-title":"Tobacco companies introduce \u201ctobacco-free\u201d nicotine pouches","volume":"29","author":"Robichaud","year":"2019","journal-title":"Tob Control."},{"key":"2023081908300572400_CIT0005","doi-asserted-by":"crossref","first-page":"tobaccocontrol-2021-057156","DOI":"10.1136\/tobaccocontrol-2021-057156","article-title":"Nicotine pouch product awareness, interest and ever use among US adults who smoke, 2021","author":"Hrywna","year":"2022","journal-title":"Tob Control."},{"issue":"9","key":"2023081908300572400_CIT0006","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1093\/ntr\/ntab040","article-title":"Patterns of non-cigarette tobacco and nicotine use among current cigarette smokers and recent quitters: findings from the 2020 ITC four country smoking and vaping survey","volume":"23","author":"Li","year":"2021","journal-title":"Nicotine Tob Res."},{"key":"2023081908300572400_CIT0007","volume-title":"E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General","author":"National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health","year":"2016"},{"issue":"1","key":"2023081908300572400_CIT0008","doi-asserted-by":"crossref","first-page":"1518","DOI":"10.1186\/s12889-020-09572-x","article-title":"E-cigarettes use in the United States: reasons for use, perceptions, and effects on health","volume":"20","author":"Sapru","year":"2020","journal-title":"BMC Public Health."},{"issue":"5","key":"2023081908300572400_CIT0009","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 \u2014 national youth tobacco survey, United States, 2021","volume":"71","author":"Gentzke","year":"2022","journal-title":"MMWR CDC Surveill Summ."},{"issue":"5","key":"2023081908300572400_CIT0010","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1136\/tobaccocontrol-2020-056446","article-title":"Oral nicotine marketing claims in direct-mail advertising","volume":"31","author":"Czaplicki","year":"2022","journal-title":"Tob Control."},{"issue":"1","key":"2023081908300572400_CIT0011","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1093\/ntr\/ntac204","article-title":"\u201cTobacco-free\u201d nicotine pouches: risk perceptions, awareness, susceptibility, and use among young adults in the United States","volume":"25","author":"Morean","year":"2023","journal-title":"Nicotine Tob Res."},{"issue":"8","key":"2023081908300572400_CIT0012","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1093\/ntr\/ntaa275","article-title":"Tobacco advertising features that may contribute to product appeal among US adolescents and young adults","volume":"23","author":"Moran","year":"2021","journal-title":"Nicotine Tob Res."},{"issue":"1 June 16","key":"2023081908300572400_CIT0013","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.drugalcdep.2016.04.008","article-title":"E-cigarette advertising exposure and implicit attitudes among young adult non-smokers","volume":"163","author":"Pokhrel","year":"2016","journal-title":"Drug Alcohol Depend."},{"issue":"1","key":"2023081908300572400_CIT0014","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.jadohealth.2013.07.016","article-title":"Cigarette packaging: Youth perceptions of \u201cnatural\u201d cigarettes, filter references, and contraband tobacco","volume":"54","author":"Czoli","year":"2014","journal-title":"J Adolesc Health."},{"issue":"5","key":"2023081908300572400_CIT0015","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1136\/tobaccocontrol-2015-052560","article-title":"Adolescents\u2019 and adults\u2019 perceptions of \u201cnatural,\u201d \u201corganic\u201d and \u201cadditive-free\u201d cigarettes, and the required disclaimers","volume":"25","author":"Byron","year":"2016","journal-title":"Tob Control."},{"issue":"6","key":"2023081908300572400_CIT0016","doi-asserted-by":"crossref","first-page":"e20182741","DOI":"10.1542\/peds.2018-2741","article-title":"A Public health crisis: electronic cigarettes, vape, and JUUL","volume":"143","author":"Walley","year":"2019","journal-title":"Pediatrics."},{"issue":"3","key":"2023081908300572400_CIT0017","doi-asserted-by":"crossref","first-page":"e2022056586","DOI":"10.1542\/peds.2022-056586","article-title":"Adolescent use of flavored non-tobacco oral nicotine products","volume":"150","author":"Harlow","year":"2022","journal-title":"Pediatrics."},{"key":"2023081908300572400_CIT0018","volume-title":"2021 National Youth Tobacco Survey: Methodology Report","author":"Office on Smoking and Health","year":"2021"},{"key":"2023081908300572400_CIT0019","author":"Centers for Disease Control and Prevention","year":"2022"},{"key":"2023081908300572400_CIT0020","author":"Northerner Scandinavia Inc","year":"2022"},{"issue":"106284","key":"2023081908300572400_CIT0021","doi-asserted-by":"crossref","first-page":"106284","DOI":"10.1016\/j.ypmed.2020.106284","article-title":"Patterns of tobacco use and nicotine dependence among youth, United States, 2017\u20132018","volume":"141","author":"Gomez","year":"2020","journal-title":"Prev Med."},{"issue":"2","key":"2023081908300572400_CIT0022","first-page":"S4","article-title":"Symptoms of tobacco dependence among middle and high school tobacco users","volume":"47","author":"Apelberg","year":"2014","journal-title":"Prev Med."},{"issue":"45","key":"2023081908300572400_CIT0023","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.15585\/mmwr.mm7145a1","article-title":"Tobacco product use among middle and high school students \u2014 United States, 2022","volume":"71","author":"Park-Lee","year":"2022","journal-title":"MMWR Morb Mortal Wkly Rep."},{"issue":"11","key":"2023081908300572400_CIT0024","doi-asserted-by":"crossref","first-page":"64686468","DOI":"10.3390\/ijerph19116468","article-title":"Examining the survey setting effect on current e-cigarette use estimates among high school students in the 2021 National Youth Tobacco Survey","volume":"19","author":"Chen-Sankey","year":"2022","journal-title":"Int J Environ Res Public Health."}],"container-title":["Nicotine and Tobacco Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ntr\/advance-article-pdf\/doi\/10.1093\/ntr\/ntad080\/50522000\/ntad080.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ntr\/article-pdf\/25\/9\/1610\/51173667\/ntad080.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ntr\/article-pdf\/25\/9\/1610\/51173667\/ntad080.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T08:30:24Z","timestamp":1692433824000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ntr\/article\/25\/9\/1610\/7190719"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,6]]},"references-count":24,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,6,6]]},"published-print":{"date-parts":[[2023,8,19]]}},"URL":"https:\/\/doi.org\/10.1093\/ntr\/ntad080","relation":{},"ISSN":["1469-994X"],"issn-type":[{"value":"1469-994X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,9,1]]},"published":{"date-parts":[[2023,6,6]]}}}