{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T18:06:48Z","timestamp":1780423608029,"version":"3.54.1"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      This study employed a three-product agent-based model (ABM) to evaluate the potential population-level effects of granting market authorization for\n                      <jats:italic>on!<\/jats:italic>\n                      <jats:sup>\u00ae<\/jats:sup>\n                      nicotine pouches, an oral tobacco-derived nicotine product. Previous research has typically relied on simplified two-product models comparing cigarette use in a \u201cBase Case\u201d with a \u201cModified Case\u201d scenario, limiting the ability to reflect real-world multi-product tobacco use patterns. To address this, the ABM in this study incorporated cigarettes and smokeless tobacco (ST) products in the Base Case and added the\n                      <jats:italic>on!<\/jats:italic>\n                      <jats:sup>\u00ae<\/jats:sup>\n                      nicotine pouches as the Test Product in the Modified Case.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Developed in MATLAB\n                      <jats:sup>\u00ae<\/jats:sup>\n                      version 9.2, the model consisted of a transition sub-model, which simulated annual changes in product use based on national survey data and Test Product-specific studies, and a mortality sub-model, which linked survival outcomes to product transitions using an excess relative risk estimate of 5% for the Test Product relative to cigarettes. The simulation ran over an 80-year time horizon, predicting individual-level agent dynamics and annual transitions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Model outputs indicated that introducing the Test Product could prevent approximately 476,000 premature deaths, reduce cigarette prevalence by 0.6 percentage points, and ST product use by 0.3 percentage points, while increasing Test Product use by 1.6 percentage points.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      These findings suggest that regulatory authorization of\n                      <jats:italic>on!<\/jats:italic>\n                      <jats:sup>\u00ae<\/jats:sup>\n                      nicotine pouches could yield a net public health benefit by lowering all-cause mortality and reducing the prevalence of use of tobacco products associated with greater health risks.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1772045","type":"journal-article","created":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T07:06:05Z","timestamp":1772003165000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Investigating the population health impact of an oral tobacco\u2013derived nicotine pouch product utilizing a three-product tobacco use population model"],"prefix":"10.3389","volume":"14","author":[{"given":"Raheema","family":"Muhammad-Kah","sequence":"first","affiliation":[{"name":"Center for Research and Technology, Altria Client Services LLC","place":["Richmond, VA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thaddaeus","family":"Hannel","sequence":"additional","affiliation":[{"name":"Center for Research and Technology, Altria Client Services LLC","place":["Richmond, VA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lai","family":"Wei","sequence":"additional","affiliation":[{"name":"Center for Research and Technology, Altria Client Services LLC","place":["Richmond, VA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Cheng","sequence":"additional","affiliation":[{"name":"Center for Research and Technology, Altria Client Services LLC","place":["Richmond, VA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sucharitha","family":"Iyer","sequence":"additional","affiliation":[{"name":"Center for Research and Technology, Altria Client Services LLC","place":["Richmond, VA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamadi","family":"Sarkar","sequence":"additional","affiliation":[{"name":"Center for Research and Technology, Altria Client Services LLC","place":["Richmond, VA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.1186\/s12889-022-13441-0","article-title":"Estimating the public health impact had tobacco-free nicotine pouches been introduced into the us in 2000","volume":"22","author":"Lee","year":"2022","journal-title":"BMC Public Health"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1136\/tobaccocontrol-2017-053759","article-title":"Potential deaths averted in USA by replacing cigarettes with E-cigarettes","volume":"27","author":"Levy","year":"2018","journal-title":"Tob Control"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1093\/ntr\/ntw158","article-title":"The application of a decision-theoretic model to estimate the public health impact of vaporized nicotine product initiation in the United States","volume":"19","author":"Levy","year":"2017","journal-title":"Nicotine Tob Res"},{"key":"ref4","volume-title":"A computational model assessing population impact of a new tobacco product. 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