Awareness and use of oral nicotine pouches among youth and young adults, 2022–2024: repeat cross-sectional surveys in Canada, England, the USA and New Zealand
Bibliographic record
Abstract
Introduction: Tobacco-free oral nicotine pouches are an emerging product category. To date, there is little evidence on use among young people across countries. This study aimed to assess pouch use among young people in four countries with differing regulatory contexts. Methods: Data were analysed from repeat cross-sectional surveys conducted in 2022, 2023 and 2024 with national samples of youth aged 16-19 and young adults aged 20-29 in Canada, England, the USA and New Zealand (NZ) (N=44 736). We assessed trends in awareness and use of nicotine pouches (2022-2024), as well as correlates and reasons for use (2024), using adjusted and unadjusted regression models. Results: Across all countries, awareness of nicotine pouches increased among youth and young adults between 2022 and 2024 (all p<0.001). In 2024, approximately 5% of youth in Canada, the USA and NZ, and 10% in England, reported ever using pouches; past 30-day use ranged from 1.6% in NZ to 4.0% in England. Among young adults, ever use ranged from 9.1% (Canada) to 18.7% (England), and past 30-day use ranged from 3.0% (NZ) to 7.9% (USA). Across all countries, the prevalence of ever use did not change significantly between 2022 and 2023 among youth (p=0.18) or young adults (p=0.54), but increased from 2023 to 2024 among both age groups (p<0.001). Past 30-day use increased between 2022 and 2023 among youth (p=0.03) but not young adults (p=0.57), and increased from 2023 to 2024 among both (p<0.001). Use was more prevalent among males and those who used other tobacco/nicotine products. The most common reasons for using pouches among youth were curiosity, ease of use without being noticed and fun; and among young adults, were dealing with stress/anxiety, curiosity and less harmful than smoking. Conclusions: Prevalence of nicotine pouch use among young people has increased in all four countries. Continued monitoring of these products is warranted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".