Urban–rural disparities in oral nicotine pouch sales and flavors in the United States

Lei Xu; Saber Feizy; Megan E. Roberts; Ce Shang; Brittney Keller-Hamilton; Darren Mays; Shyanika W. Rose; Yanyun He

doi:10.1016/j.drugpo.2026.105178

Urban–rural disparities in oral nicotine pouch sales and flavors in the United States

Lei Xu
, Saber Feizy
, Megan E. Roberts
, Ce Shang
, Brittney Keller-Hamilton
, Darren Mays
, Shyanika W. Rose
, Yanyun He

Producción científica: Article › revisión exhaustiva

Resumen

Background As oral nicotine pouches (ONPs) gain popularity in the United States, the extent to which product attributes, such as price and flavor, affect sales remains unclear. Examining urban–rural differences is particularly important given longstanding disparities in smokeless tobacco use and tobacco-related health outcomes across these settings, yet little is known about whether ONP sales and attribute preferences differ between urban and rural areas. Objectives This study aims to examine how ONP sales are associated with product attributes and sales locations (rural vs. urban), and whether the associations between sales and attributes differ by urban/rural locations. Methods We linked 2021 NielsenIQ retail sales data with the National Center for Health Statistics county-level urban/rural classifications. Flavors were grouped as implicit (marketed without explicit flavor names), mint/menthol, fruity, or other. Multivariable linear regression models were used by regressing ONP sales on product attributes, rural/urban status, and their interactions. Results In 2021, 88% of total ONP sales occurred in urban areas, compared with 12% in rural areas. ONP sales per 1000 population were 16% higher in rural than urban areas ( p < 0.001). Compared to the sales of implicitly flavored ONPs, sales of mint/menthol, fruit, and other flavors were approximately 23-fold, 4-fold, and 7-fold higher, respectively. These flavor-related differences were less pronounced in rural counties than in urban counties. The price elasticity of demand was –0.66 ( p < 0.001) in urban areas and –0.33 ( p < 0.001) in rural areas. Conclusions ONP sales exhibit significant urban–rural disparities, with rural areas showing higher per capita sales overall, but urban areas showing stronger preferences for flavored products and greater price responsiveness. As a result, regulatory measures targeting flavors or pricing may have a greater impact in urban areas compared to rural ones.

Idioma original	English
Número de artículo	105178
Publicación	International Journal of Drug Policy
Volumen	150
DOI	https://doi.org/10.1016/j.drugpo.2026.105178
Estado	Published - abr 2026

Nota bibliográfica

Publisher Copyright:
© 2026 The Author(s).

Financiación

This study was funded by the National Cancer Institute of the National Institutes of Health and Food and Drug Administration (FDA) through grant U54CA287392 The Ohio State University (OSU) Tobacco Center of Regulatory Science (TCORS) (PI: Wagener and Shields). Dr He is funded by the OSU TCORS Pilot project (PI: He). Research reported in this publication was supported in part by grant U54DA058256 from the National Institute on Drug Abuse (NIDA) and the FDA Center for Tobacco Products (CTP). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the FDA.

Financiadores	Número del financiador
Food and Drug Administration
National Childhood Cancer Registry – National Cancer Institute
Author National Institute on Drug Abuse DA031791 Mark J Ferris National Institute on Drug Abuse DA006634 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA026117 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA028162 Elizabeth G Pitts National Institute of General Medical Sciences GM102773 Elizabeth G Pitts Peter McManus Charitable Trust Mark J Ferris National Institute on Drug Abuse
U.S. Food and Drug Administration	U54CA287392
Ohio Water Resources Center, Ohio State University	U54DA058256

ODS de las Naciones Unidas

Este resultado contribuye a los siguientes Objetivos de Desarrollo Sostenible

Good health and well being

ASJC Scopus subject areas

Medicine (miscellaneous)
Health Policy

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10.1016/j.drugpo.2026.105178

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title = "Urban–rural disparities in oral nicotine pouch sales and flavors in the United States",

abstract = "Background As oral nicotine pouches (ONPs) gain popularity in the United States, the extent to which product attributes, such as price and flavor, affect sales remains unclear. Examining urban–rural differences is particularly important given longstanding disparities in smokeless tobacco use and tobacco-related health outcomes across these settings, yet little is known about whether ONP sales and attribute preferences differ between urban and rural areas. Objectives This study aims to examine how ONP sales are associated with product attributes and sales locations (rural vs. urban), and whether the associations between sales and attributes differ by urban/rural locations. Methods We linked 2021 NielsenIQ retail sales data with the National Center for Health Statistics county-level urban/rural classifications. Flavors were grouped as implicit (marketed without explicit flavor names), mint/menthol, fruity, or other. Multivariable linear regression models were used by regressing ONP sales on product attributes, rural/urban status, and their interactions. Results In 2021, 88\% of total ONP sales occurred in urban areas, compared with 12\% in rural areas. ONP sales per 1000 population were 16\% higher in rural than urban areas ( p < 0.001). Compared to the sales of implicitly flavored ONPs, sales of mint/menthol, fruit, and other flavors were approximately 23-fold, 4-fold, and 7-fold higher, respectively. These flavor-related differences were less pronounced in rural counties than in urban counties. The price elasticity of demand was –0.66 ( p < 0.001) in urban areas and –0.33 ( p < 0.001) in rural areas. Conclusions ONP sales exhibit significant urban–rural disparities, with rural areas showing higher per capita sales overall, but urban areas showing stronger preferences for flavored products and greater price responsiveness. As a result, regulatory measures targeting flavors or pricing may have a greater impact in urban areas compared to rural ones.",

keywords = "Flavor, Oral nicotine pouch, Price elasticity, Sales disparity, Urban-rural classification",

author = "Lei Xu and Saber Feizy and Roberts, \{Megan E.\} and Ce Shang and Brittney Keller-Hamilton and Darren Mays and Rose, \{Shyanika W.\} and Yanyun He",

note = "Publisher Copyright: {\textcopyright} 2026 The Author(s).",

year = "2026",

month = apr,

doi = "10.1016/j.drugpo.2026.105178",

language = "English",

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T1 - Urban–rural disparities in oral nicotine pouch sales and flavors in the United States

AU - Xu, Lei

AU - Feizy, Saber

AU - Roberts, Megan E.

AU - Shang, Ce

AU - Keller-Hamilton, Brittney

AU - Mays, Darren

AU - Rose, Shyanika W.

AU - He, Yanyun

PY - 2026/4

Y1 - 2026/4

N2 - Background As oral nicotine pouches (ONPs) gain popularity in the United States, the extent to which product attributes, such as price and flavor, affect sales remains unclear. Examining urban–rural differences is particularly important given longstanding disparities in smokeless tobacco use and tobacco-related health outcomes across these settings, yet little is known about whether ONP sales and attribute preferences differ between urban and rural areas. Objectives This study aims to examine how ONP sales are associated with product attributes and sales locations (rural vs. urban), and whether the associations between sales and attributes differ by urban/rural locations. Methods We linked 2021 NielsenIQ retail sales data with the National Center for Health Statistics county-level urban/rural classifications. Flavors were grouped as implicit (marketed without explicit flavor names), mint/menthol, fruity, or other. Multivariable linear regression models were used by regressing ONP sales on product attributes, rural/urban status, and their interactions. Results In 2021, 88% of total ONP sales occurred in urban areas, compared with 12% in rural areas. ONP sales per 1000 population were 16% higher in rural than urban areas ( p < 0.001). Compared to the sales of implicitly flavored ONPs, sales of mint/menthol, fruit, and other flavors were approximately 23-fold, 4-fold, and 7-fold higher, respectively. These flavor-related differences were less pronounced in rural counties than in urban counties. The price elasticity of demand was –0.66 ( p < 0.001) in urban areas and –0.33 ( p < 0.001) in rural areas. Conclusions ONP sales exhibit significant urban–rural disparities, with rural areas showing higher per capita sales overall, but urban areas showing stronger preferences for flavored products and greater price responsiveness. As a result, regulatory measures targeting flavors or pricing may have a greater impact in urban areas compared to rural ones.

AB - Background As oral nicotine pouches (ONPs) gain popularity in the United States, the extent to which product attributes, such as price and flavor, affect sales remains unclear. Examining urban–rural differences is particularly important given longstanding disparities in smokeless tobacco use and tobacco-related health outcomes across these settings, yet little is known about whether ONP sales and attribute preferences differ between urban and rural areas. Objectives This study aims to examine how ONP sales are associated with product attributes and sales locations (rural vs. urban), and whether the associations between sales and attributes differ by urban/rural locations. Methods We linked 2021 NielsenIQ retail sales data with the National Center for Health Statistics county-level urban/rural classifications. Flavors were grouped as implicit (marketed without explicit flavor names), mint/menthol, fruity, or other. Multivariable linear regression models were used by regressing ONP sales on product attributes, rural/urban status, and their interactions. Results In 2021, 88% of total ONP sales occurred in urban areas, compared with 12% in rural areas. ONP sales per 1000 population were 16% higher in rural than urban areas ( p < 0.001). Compared to the sales of implicitly flavored ONPs, sales of mint/menthol, fruit, and other flavors were approximately 23-fold, 4-fold, and 7-fold higher, respectively. These flavor-related differences were less pronounced in rural counties than in urban counties. The price elasticity of demand was –0.66 ( p < 0.001) in urban areas and –0.33 ( p < 0.001) in rural areas. Conclusions ONP sales exhibit significant urban–rural disparities, with rural areas showing higher per capita sales overall, but urban areas showing stronger preferences for flavored products and greater price responsiveness. As a result, regulatory measures targeting flavors or pricing may have a greater impact in urban areas compared to rural ones.

KW - Flavor

KW - Oral nicotine pouch

KW - Price elasticity

KW - Sales disparity

KW - Urban-rural classification

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DO - 10.1016/j.drugpo.2026.105178

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SN - 0955-3959

VL - 150

JO - International Journal of Drug Policy

JF - International Journal of Drug Policy

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Urban–rural disparities in oral nicotine pouch sales and flavors in the United States

Resumen

Nota bibliográfica

Financiación

ODS de las Naciones Unidas

ASJC Scopus subject areas

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