{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T14:08:22Z","timestamp":1788617302961,"version":"build-2803163510"},"reference-count":24,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T00:00:00Z","timestamp":1675036800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","award":["20YVNR35460041"],"award-info":[{"award-number":["20YVNR35460041"]}],"id":[{"id":"10.13039\/100000968","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"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Oral nicotine pouches (NPs) that contain nicotine but no tobacco leaves are rapidly gaining popularity. However, there is limited research on NPs, including within priority populations. In the current study, we examined awareness of, susceptibility to, and use of NPs in young adults as well as comparative risk perceptions with smokeless tobacco.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>In 2021, 609 young adults (18\u201325 years) completed an online survey. Participants reported on NP awareness, susceptibility, and use as well as on comparative product perceptions for NPs versus smokeless tobacco. We ran unadjusted between-groups comparisons and an adjusted multinomial logistic regression to identify relationships between product perceptions and NP susceptibility and use.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>41.5% of participants had heard of NPs before. Participants were non-susceptible (66.2%), susceptible (23.5%), or had used NPs (10.3%). Comparative product perceptions between NPs and smokeless tobacco suggested that young adults, as a whole, expressed uncertainty about the relative risk\/benefit of using NPs versus smokeless tobacco. However, as expected, unadjusted and adjusted findings indicated that favorable perceptions of NPs versus smokeless tobacco were disproportionately observed among susceptible participants and NP users compared to non-susceptible individuals. Demographic differences were also observed (e.g., NP users were more likely than non-susceptible and susceptible individuals to have used smokeless tobacco).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Young adults reported awareness of, susceptibility to, and use of NPs, with findings indicating that favorable perceptions of NPs versus smokeless tobacco may contribute to NP susceptibility and use beyond known correlates like smokeless tobacco use. However, further research is needed to understand the full range of factors that are associated with NP susceptibility and use. It will be important to disentangle factors that are associated with potential positive public health impacts (e.g., switching from smokeless tobacco to exclusive NP use) from those associated with negative public health impacts (e.g., initiation among nicotine na\u00efve individuals).<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0281235","type":"journal-article","created":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T19:40:47Z","timestamp":1675107647000},"page":"e0281235","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":25,"title":["Awareness, susceptibility, and use of oral nicotine pouches and comparative risk perceptions with smokeless tobacco among young adults in the United States"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4865-1155","authenticated-orcid":true,"given":"Meghan E.","family":"Morean","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krysten W.","family":"Bold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle R.","family":"Davis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Kong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suchitra","family":"Krishnan-Sarin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepa R.","family":"Camenga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,1,30]]},"reference":[{"issue":"e1","key":"pone.0281235.ref001","first-page":"e145","article-title":"Tobacco companies introduce \u2018tobacco-free\u2019nicotine pouches.","volume":"29","author":"MO Robichaud","year":"2020","journal-title":"Tob Control"},{"issue":"9","key":"pone.0281235.ref002","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":"S Stanfill","year":"2021","journal-title":"Nicotine Tob Res"},{"key":"pone.0281235.ref003","first-page":"1","article-title":"Chemical characterization of tobacco-free \u201cmodern\u201d oral nicotine pouches and their position on the toxicant and risk continuums.","author":"D Azzopardi","year":"2021","journal-title":"Drug Chem Toxicol"},{"key":"pone.0281235.ref004","article-title":"Six-Week Actual Use Study to Evaluate the Impact of Oral Tobacco-Derived Nicotine Pouches on Cigarette Smoking and Smokeless Tobacco Product Use Behaviors.","author":"S McCaffrey","year":"2022","journal-title":"Research Square (pre-print)."},{"issue":"4","key":"pone.0281235.ref005","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1111\/ajad.13020","volume":"29","author":"N Plurphanswat","year":"2020","journal-title":"Am J Addict"},{"issue":"5","key":"pone.0281235.ref006","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":"AS Gentzke","year":"2022","journal-title":"MMWR Surveill Summ."},{"key":"pone.0281235.ref007","author":"H Cheng","year":"2022","journal-title":"Awareness and use of tobacco products among underage individuals: Findings from the Altria Client Services Underage Tobacco Use Survey 2020\u20132021."},{"key":"pone.0281235.ref008","author":"Truth Initiative","journal-title":"What is Zyn and what are oral nicotine pouches?"},{"issue":"7","key":"pone.0281235.ref009","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1080\/10826084.2018.1564330","article-title":"Predictors of smokeless tobacco susceptibility, initiation, and progression over time among adolescents in a rural cohort.","volume":"54","author":"BW Chaffee","year":"2019","journal-title":"Subst Use Misuse"},{"issue":"5","key":"pone.0281235.ref010","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1016\/j.amepre.2005.02.010","volume":"28","author":"CK Haddock","year":"2005","journal-title":"Am J Prev Med"},{"key":"pone.0281235.ref011","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.ypmed.2019.02.006","article-title":"Is susceptibility to E-cigarettes among youth associated with tobacco and other substance use behaviors one year later? Results from the PATH study.","volume":"121","author":"NE Nicksic","year":"2019","journal-title":"Prev Med."},{"issue":"5","key":"pone.0281235.ref012","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1037\/0278-6133.15.5.355","article-title":"Validation of susceptibility as a predictor of which adolescents take up smoking in the United States.","volume":"15","author":"JP Pierce","year":"1996","journal-title":"Health Psychol."},{"issue":"46","key":"pone.0281235.ref013","first-page":"1736","article-title":"Tobacco product use among adults\u2014United States, 2019.","volume":"69","author":"ME Cornelius","year":"2020","journal-title":"MMWR."},{"key":"pone.0281235.ref014","doi-asserted-by":"crossref","first-page":"109627","DOI":"10.1016\/j.drugalcdep.2022.109627","article-title":"Exploring factors associated with smokeless tobacco use among young people: A systematic scoping review.","volume":"9","author":"L Lund","year":"2022","journal-title":"Drug and Alcohol Dependence"},{"issue":"16","key":"pone.0281235.ref015","first-page":"8852","article-title":"Heated Tobacco Products and Nicotine Pouches: A Survey of People with Experience of Smoking and\/or Vaping in the UK.","volume":"18","author":"LS Brose","year":"2021","journal-title":"Int J Environ Res"},{"issue":"3","key":"pone.0281235.ref016","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1037\/a0032256","article-title":"The development and psychometric evaluation of the Smokeless Tobacco Expectancies Scale (STES).","volume":"25","author":"JC Gottlieb","year":"2013","journal-title":"Psychol Assess."},{"issue":"5","key":"pone.0281235.ref017","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1097\/PHH.0000000000000468","article-title":"Validity of a subjective financial situation measure to assess socioeconomic status in US young adults.","volume":"23","author":"VF Williams","year":"2017","journal-title":"J Public Health Manag Pract"},{"key":"pone.0281235.ref018","article-title":"Nicotine pouch product awareness, interest and ever use among US adults who smoke, 2021.","author":"M Hrywna","year":"2022","journal-title":"Tob Control."},{"issue":"5","key":"pone.0281235.ref019","first-page":"2685","article-title":"Differences in Young Adults\u2019 Perceptions of and Willingness to Use Nicotine Pouches by Tobacco Use Status.","volume":"19","author":"EA Vogel","year":"2022","journal-title":"Int J Environ Res"},{"issue":"5","key":"pone.0281235.ref020","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1080\/10810730.2015.1012237","article-title":"Risk perceptions of smokeless tobacco among adolescent and adult users and nonusers.","volume":"20","author":"ST Liu","year":"2015","journal-title":"J Health Commun"},{"issue":"1","key":"pone.0281235.ref021","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-021-11956-6","article-title":"Youth susceptibility to tobacco use: is it general or specific?.","volume":"21","author":"HG Cheng","year":"2021","journal-title":"BMC Public Health"},{"issue":"6","key":"pone.0281235.ref022","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1001\/jama.2021.10366","article-title":"Nicotine pouch unit sales in the US, 2016\u20132020","volume":"326","author":"KL Marynak","year":"2021","journal-title":"JAMA"},{"key":"pone.0281235.ref023","article-title":"\u201cTobacco-free\u201d Nicotine pouches: Risk perceptions, awareness, susceptibility, and use among young adults in the United States.","author":"M.E. Morean","journal-title":"Nic Tob Res"},{"key":"pone.0281235.ref024","article-title":"Effect of a \u2018tobacco-free nicotine\u2019claim on intentions and perceptions of Puff Bar e-cigarette use among non-tobacco-using young adults.","author":"J Chen-Sankey","year":"2021","journal-title":"Tob Control."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0281235","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T19:41:25Z","timestamp":1675107685000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0281235"}},"subtitle":[],"editor":[{"given":"Daniel","family":"Demant","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,1,30]]},"references-count":24,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1,30]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0281235","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,30]]}}}