{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:52:02Z","timestamp":1791305522934,"version":"4.3.1"},"reference-count":39,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["K01DA055696"],"award-info":[{"award-number":["K01DA055696"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Cancer Institute and Food and Drug Administration\u2019s Center for Tobacco Products","award":["U54CA287392"],"award-info":[{"award-number":["U54CA287392"]}],"id":[{"id":"https:\/\/ror.org\/04c42gq36","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R00CA260718"],"award-info":[{"award-number":["R00CA260718"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Oral nicotine pouch (ONP) sales are growing in the United States, yet little is known about how they are used (eg, use topography). To inform assessments of ONPs\u2019 abuse liability, toxicity, and health effects, we examined typical ONP use behaviors and topographies among adults who use ONPs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted 16 virtual focus groups (two to nine participants each) with 44 adults who reported using ONPs at least some days per week: 16 adults with no history of cigarette smoking or smokeless tobacco (SLT) use and 28 adults with a history of cigarette smoking or SLT use. Participants completed an online survey and semi-structured focus group interview. Quantitative data were summarized descriptively, and qualitative transcripts underwent thematic analysis with a comparative approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Participants were 33 (SD\u2009=\u200911) years old on average and had used ONPs for 1.7 (SD\u2009=\u20091.5) years on average, 18% were women, and 82% used ONPs daily. Topography behaviors varied, with participants describing differing preferences for upper versus lower lip placement, frequent ONP movement around the mouth versus static \u201cparking,\u201d use of multiple ONPs simultaneously, and consecutive ONP additions without removal, ie, \u201cstacking.\u201d Participants described strategies to titrate nicotine delivery through placement techniques, use duration, and stacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ONP use patterns vary among established users. Future evaluations of abuse liability, toxicity, and health effects should consider effects across different use topographies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications<\/jats:title>\n                    <jats:p>This study provides the first in-depth qualitative characterization of real-world oral nicotine pouch use topography, revealing behaviors like extended use durations, lip placement, moisture manipulation, and stacking that all diverge from standardized clinical protocols. These findings can inform the design of human laboratory studies and switching trials by guiding participant instructions that better reflect natural use. Regulatory assessments of nicotine exposure and product effects, including those conducted to support the Food and Drug Administration's (FDA's) evaluation of oral nicotine pouch products, should account for the range of use topographies identified here.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ntr\/ntag211","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T12:02:05Z","timestamp":1789473725000},"source":"Crossref","is-referenced-by-count":0,"title":["A qualitative assessment of oral nicotine pouch use topography"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1243-1778","authenticated-orcid":false,"given":"Patrick M","family":"Tomko","sequence":"first","affiliation":[{"name":"Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, The Ohio State University , Columbus, OH 43214 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and Health Promotion, College of Public Health, The Ohio State University , Columbus, OH 43210 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelsea F","family":"Cooper","sequence":"additional","affiliation":[{"name":"Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, The Ohio State University , Columbus, OH 43214 ,","place":["USA"]},{"name":"Division of Epidemiology, College of Public Health, The Ohio State University , Columbus, OH 432104 ,","place":["USA"]},{"name":"Department of Public Health, Ohio Wesleyan University , Delaware, OH 43015 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma E","family":"Jankowski","sequence":"additional","affiliation":[{"name":"Division of Epidemiology, College of Public Health, The Ohio State University , Columbus, OH 432104 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leanne","family":"Atkinson-Keen","sequence":"additional","affiliation":[{"name":"Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, The Ohio State University , Columbus, OH 43214 ,","place":["USA"]},{"name":"Division of Epidemiology, College of Public Health, The Ohio State University , Columbus, OH 432104 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sriya","family":"Suraapaneni","sequence":"additional","affiliation":[{"name":"Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, The Ohio State University , Columbus, OH 43214 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4315-649X","authenticated-orcid":false,"given":"Marielle C","family":"Brinkman","sequence":"additional","affiliation":[{"name":"Center for Tobacco Research, The Ohio 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