Tobacco marketing exposure and lifetime and current nicotine pouch use among US youth, 2022

Objective: The rising popularity of nicotine pouches among youth necessitates an understanding how marketing exposure influences their use, to inform regulation. This study examines the associations of tobacco marketing exposures with nicotine pouch use among adolescent students in the United States. Methods: We analyzed data from 26,860 middle and high-school students in the United States who participated in the 2022 National Youth Tobacco Survey. The survey was administered during January–May 2022. Weighted logistic regressions with and without covariates (i.e., sociodemographic characteristics, other tobacco product use, and social media use) were used to evaluate the relationships between exposure to a variety of tobacco product advertisement modes (television/streaming/movies; Internet; newspapers/magazines; and convenience store/supermarket/gas station/kiosk/shopping center) and lifetime and current use of nicotine pouch products. Results: Nicotine pouches were used by 1 % of middle and high school youth ever in their lifetime in the United States. Most current use was of flavored products and 16 % of youth who used nicotine pouches purchased the product themselves. Controlling for other factors, exposure to tobacco advertising in newspapers/magazines was associated with higher likelihood of lifetime (aOR = 1.74, CI = 1.06–2.84) and current (aOR = 4.37, CI = 2.23–8.53) nicotine pouch use. Additionally, odds of lifetime and current use were highest among youth who also used smokeless tobacco, followed by e-cigarettes, and cigarettes. Conclusions: This study demonstrates that tobacco marketing exposure is associated with youth nicotine pouch use. In addition, nicotine pouches appeal especially to youth who use smokeless tobacco, e-cigarettes, and cigarettes suggesting the potential for dual/poly use.