{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T05:55:07Z","timestamp":1781502907276,"version":"3.54.1"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"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>Nicotine pouches (NP) are emerging as a potentially safer alternative to tobacco smoking. However, data on NP users with a history of tobacco smoking are limited. We assessed the patterns of NP use, user characteristics, and perceptions among adults with a history of cigarette smoking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A cross-sectional survey was conducted using a self-administered questionnaire to enroll adults with a history of regular cigarette smoking. Data on sociodemographics, smoking history, NP use patterns, and NP-related urges and perceptions were collected. Group differences were analyzed using \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      tests, and multivariable logistic regression identified factors associated with high-intensity NP use.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 711 adults with a history of combustible cigarette smoking were included, of whom 693 were analyzed. Among them, 560 were current users of NP who had ceased cigarette smoking (NP users) and 133 were current cigarette smokers who had not adopted NP (non-users). We found no difference between the two groups in gender, educational status, income, marital status, years of smoking, and time to first cigarette (all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;gt;\u202f0.05). A total of 236 NP users (42.1%) reported high-intensity NP use (\u226510 pouches\/day) and a total of 363 NP users (64.8%) used their first NP within 30\u202fmin of waking. About half of the NP users reported reduced craving intensity (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f312; 55.7%), and experienced milder withdrawal symptoms (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f245; 43.8%) compared with smoking. A total of 339 (60%) rated NP as extremely or very effective for smoking cessation. Higher cigarette per day (CPD) was associated with increased odds of high-intensity NP use (\u226510 pouches\/day): 21\u201330 CPD (OR\u202f=\u202f2.70; 95% CI: 1.62\u20134.50) and &amp;gt;30 CPD (OR\u202f=\u202f3.15; 95% CI: 1.40\u20137.10).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The present findings suggest that adults with a history of cigarette smoking report NP use patterns that appear broadly similar to their prior smoking behaviors. Users reported that cravings and withdrawal symptoms during NP use were similar to or lower than those recalled during smoking. Although most users viewed NP as effective for cessation, it may instead serve as an alternative nicotine source rather than a cessation tool.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1806892","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T05:33:36Z","timestamp":1781501616000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Patterns and characteristics of nicotine pouch use among adults with a history of cigarette smoking"],"prefix":"10.3389","volume":"14","author":[{"given":"Hajed M.","family":"Al-Otaibi","sequence":"first","affiliation":[{"name":"Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University","place":["Jeddah, Saudi Arabia"]},{"name":"Respiratory Therapy Unit, King Abdulaziz University Hospital, King Abdulaziz University","place":["Jeddah, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malik A.","family":"Althobiani","sequence":"additional","affiliation":[{"name":"Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University","place":["Jeddah, Saudi Arabia"]},{"name":"Respiratory Therapy Unit, King Abdulaziz University Hospital, King Abdulaziz University","place":["Jeddah, Saudi Arabia"]},{"name":"UCL Respiratory, University College London","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"ref1","article-title":"Organization, Ministry of Health (Saudi Arabia), Centers for Disease Control and Prevention. Global Adult Tobacco Survey (GATS): Saudi Arabia 2019 fact sheet. Geneva: World Health Organization.","author":"World Health","year":"2020"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1607656","DOI":"10.3389\/fpubh.2025.1607656","article-title":"Investigating oral nicotine pouch use among adults in Riyadh, Saudi Arabia: prevalence, awareness, susceptibility, and associated symptoms","volume":"13","author":"Alkharaan","year":"2025","journal-title":"Front Public Health"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"98","DOI":"10.3390\/healthcare14010098","article-title":"Awareness, perceptions, and use of oral nicotine pouches among Jazan University students in Saudi Arabia: a cross-sectional study","volume":"14","author":"Al Bahhawi","year":"2026","journal-title":"Healthcare (Basel)"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"60","DOI":"10.18332\/tid\/203510","article-title":"Exploring the effect of nicotine pouches on users' health in Saudi Arabia: a cross-sectional study","volume":"23","author":"Elsokkary","year":"2025","journal-title":"Tob Induc Dis"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"tobaccocontrol-2019-055321","DOI":"10.1136\/tobaccocontrol-2019-055321","article-title":"Tobacco companies introduce 'tobacco-free' nicotine pouches","volume":"29","author":"Robichaud","year":"2020","journal-title":"Tob Control"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1136\/tc-2022-057280","article-title":"Levels of nicotine and tobacco-specific nitrosamines in oral nicotine pouches","volume":"33","author":"Mallock","year":"2024","journal-title":"Tob Control"},{"key":"ref7","doi-asserted-by":"publisher","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":"ref8","doi-asserted-by":"publisher","first-page":"e2242235","DOI":"10.1001\/jamanetworkopen.2022.42235","article-title":"Nicotine pouch sales trends in the US by volume and nicotine concentration levels from 2019 to 2022","volume":"5","author":"Majmundar","year":"2022","journal-title":"JAMA Netw Open"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1136\/tc-2024-059017","article-title":"Keeping pace with nicotine pouch market developments","volume":"35","author":"Alexandrou","year":"2024","journal-title":"Tob Control"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1641308","DOI":"10.3389\/fpubh.2025.1641308","article-title":"Nicotine pouches: a narrative review of the existing literature","volume":"13","author":"Al-Otaibi","year":"2025","journal-title":"Front Public Health"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"29758","DOI":"10.1038\/s41598-025-15070-0","article-title":"Prevalence, safety, and role of nicotine pouches in smoking cessation among smokers and the public in Saudi Arabia","volume":"15","author":"Alwafi","year":"2025","journal-title":"Sci Rep"},{"key":"ref12","first-page":"tc-2024-059145","volume-title":"Advertising the Leading US Nicotine Pouch Brand: a Content Analysis of ZYN Advertisements from 2019 to 2023. Tob Control","author":"Lyu","year":"2025"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1150","DOI":"10.1093\/ntr\/ntae047","article-title":"Using pod-based e-cigarettes and nicotine pouches to reduce harm for adults with low socioeconomic status who smoke: a pilot randomized controlled trial","volume":"26","author":"Avila","year":"2024","journal-title":"Nicotine Tob Res"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1111\/add.16355","article-title":"Evaluating the effects of nicotine concentration on the appeal and nicotine delivery of oral nicotine pouches among rural and Appalachian adults who smoke cigarettes: a randomized cross-over study","volume":"119","author":"Keller-Hamilton","year":"2024","journal-title":"Addiction"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"tc-2024-059094","DOI":"10.1136\/tc-2024-059094","article-title":"Effects of oral nicotine pouches on cigarette smoking behaviour and tobacco harm exposure: a randomized pilot trial in adults","author":"Fucito","year":"2025","journal-title":"Tob Control"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1001\/jama.2024.10686","article-title":"Prevalence of nicotine pouch use among US adults","volume":"332","author":"Dai","year":"2024","journal-title":"JAMA"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1093\/ntr\/ntae131","article-title":"The potential impact of oral nicotine pouches on public health: a scoping review","volume":"27","author":"Travis","year":"2025","journal-title":"Nicotine Tob Res"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.1111\/j.1360-0443.1991.tb01879.x","article-title":"The Fagerstr\u00f6m test for nicotine dependence: a revision of the Fagerstr\u00f6m tolerance questionnaire","volume":"86","author":"Heatherton","year":"1991","journal-title":"Br J Addict"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1716","DOI":"10.1016\/j.addbeh.2005.12.015","article-title":"The Fagerstr\u00f6m test for nicotine dependence-smokeless tobacco (FTND-ST)","volume":"31","author":"Ebbert","year":"2006","journal-title":"Addict Behav"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"111985","DOI":"10.1016\/j.isci.2025.111985","article-title":"Observational studies of exposure to tobacco and nicotine products: best practices for maximizing statistical precision and accuracy","volume":"28","author":"Cohen","year":"2025","journal-title":"iScience"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1093\/ntr\/ntad179","article-title":"A cross-sectional survey on oral nicotine pouches: characterizing use-motives, topography, dependence levels, and adverse events","volume":"26","author":"Dowd","year":"2024","journal-title":"Nicotine Tob Res"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"112428","DOI":"10.1016\/j.drugalcdep.2024.112428","article-title":"Patterns of nicotine pouch use among young Australians","volume":"264","author":"Jongenelis","year":"2024","journal-title":"Drug Alcohol Depend"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18332\/tid\/207914","article-title":"Knowledge, perceptions, and usage patterns of nicotine pouches among Saudi medical students: a cross-sectional study","volume":"23","author":"Alshahrani","year":"2025","journal-title":"Tob Induc Dis"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1179173X251414230","DOI":"10.1177\/1179173X251414230","article-title":"Patterns and perception of nicotine pouches use among adults in Saudi Arabia","volume":"19","author":"Alghamdi","year":"2026","journal-title":"Tob Use Insights"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"e0332962","DOI":"10.1371\/journal.pone.0332962","article-title":"What are the characteristics of people who use nicotine pouches and what types of pouches are being used? Data from an online cross-sectional survey of UK adults","volume":"20","author":"East","year":"2025","journal-title":"PLoS One"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"173","DOI":"10.18203\/issn.2454-2156.IntJSciRep20221344","article-title":"Assessing consumer use and behaviour patterns of oral nicotine pouches in a multi-country study","volume":"8","author":"Prasad","year":"2022","journal-title":"Int J Sci Rep"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"109136","DOI":"10.1016\/j.drugalcdep.2021.109136","article-title":"Awareness, use and perceptions of cigarillos, heated tobacco products and nicotine pouches: a survey among Dutch adolescents and adults","volume":"229","author":"Havermans","year":"2021","journal-title":"Drug Alcohol Depend"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"42","DOI":"10.18001\/TRS.1.1.5","article-title":"Appeal and impact of characterizing flavors on young adult small cigar use","volume":"1","author":"Sterling","year":"2015","journal-title":"Tob Regul Sci"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"113050","DOI":"10.1016\/j.drugalcdep.2026.113050","article-title":"Randomized studies assessing the effect of flavor on pharmacokinetic and subjective parameters for dry and moist nicotine pouches","volume":"279","author":"Staaf","year":"2026","journal-title":"Drug Alcohol Depend"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1007\/s00213-025-06961-1","article-title":"Nicotine delivery from and user reactions to nicotine pouches compared to cigarettes","author":"Przulj","year":"2025","journal-title":"Psychopharmacology"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1186\/s12954-024-01064-0","article-title":"Smoking reduction using an electronic nicotine delivery system (ENDS) with nicotine delivery similar to combustible cigarettes","volume":"21","author":"Rose","year":"2024","journal-title":"Harm Reduct J"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"ntag017","DOI":"10.1093\/ntr\/ntag017","article-title":"Comprehensive dose-response assessment can improve the precision and accuracy of cross-sectional studies of dual-use","volume":"29","author":"Cohen","year":"2026","journal-title":"Nicotine Tob Res"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1007\/978-3-540-69248-5_2","article-title":"Nicotine chemistry, metabolism, kinetics and biomarkers","volume":"192","author":"Benowitz","year":"2009","journal-title":"Handb Exp Pharmacol"},{"key":"ref34","first-page":"621","article-title":"Nicotine metabolite ratio as a predictor of cigarette consumption","volume-title":"Nicotine Tob Res","author":"Benowitz","year":"2003"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1146\/annurev.pharmtox.48.113006.094742","article-title":"Pharmacology of nicotine: addiction, smoking-induced disease, and therapeutics","volume":"49","author":"Benowitz","year":"2009","journal-title":"Annu Rev Pharmacol Toxicol"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"11","DOI":"10.18332\/tpc\/207753","article-title":"Assessing the gastrointestinal and psychological impacts of nicotine pouch use among adults in Saudi Arabia: a cross-sectional study","volume":"11","author":"Al-Nafisi","year":"2025","journal-title":"Tob Prev Cessat"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"286","DOI":"10.3390\/healthcare14030286","article-title":"Nicotine negatively affects its users' health and psychology in Saudi Arabia: a cross-sectional study","volume":"14","author":"Aldali","year":"2026","journal-title":"Healthcare"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"e32","DOI":"10.1136\/tc-2022-057734","article-title":"Nicotine pouches: a summary of regulatory approaches across 67 countries","volume":"33","author":"Duren","year":"2024","journal-title":"Tob Control"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1806892\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T05:33:38Z","timestamp":1781501618000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1806892\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,15]]},"references-count":38,"alternative-id":["10.3389\/fpubh.2026.1806892"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1806892","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,15]]},"article-number":"1806892"}}