Researchers Urge Awareness and Regulation Amid Surging Popularity Fueled by Social Media
A concerning new trend is emerging among American youth: the use of oral nicotine pouches has nearly doubled among high school students between 2023 and 2024. This sharp increase, revealed in a significant new study by researchers at the University of Southern California (USC), published in JAMA Network Open, raises alarms among public health officials about a rapidly growing trend among adolescents.
Analyzing survey data from over 10,000 10th and 12th graders participating in the nationally representative Monitoring the Future survey, the researchers found that the percentage of teens reporting ever having used nicotine pouches jumped significantly, from 3.0% in 2023 to 5.4% in 2024. Beyond just experimentation, the study also documented notable increases in more regular use, including rises in past-30-day and past-12-month usage rates, suggesting a move towards more consistent consumption among some adolescents.
"This growing public health issue needs more attention," stated Dae-Hee Han, PhD, the study's first author and a postdoctoral scholar at the Keck School of Medicine of USC. "Like flavored e-cigarettes when they first emerged, use of this new oral nicotine product is becoming more widespread, particularly among adolescents."
Context: "Zynfluencers" and Regulatory Landscape
This sharp rise coincides with the surging popularity of nicotine pouch brands like Zyn, heavily promoted on social media platforms through a wave of young influencers, sometimes dubbed "Zynfluencers." These online personalities often associate pouch use with positive attributes like confidence, focus, and masculinity, potentially masking the inherent risks of nicotine addiction. This trend has prompted calls for stricter regulation from health organizations such as the American Heart Association and the Campaign for Tobacco-Free Kids.
The regulatory environment surrounding these products is complex. In January 2025, the U.S. Food and Drug Administration (FDA) authorized the marketing of several Zyn flavored nicotine pouch products specifically for adults aged 21 and older. The FDA's rationale centered on the potential for these products to serve as a less harmful alternative for adult smokers currently using combustible cigarettes. However, it's crucial to note that nicotine pouches are not FDA-approved as official smoking cessation products like nicotine gum or patches. Adding another layer of complexity, a separate 2024 USC study found that very few U.S. adults (less than 1%) reported using nicotine pouches, raising significant questions about who constitutes the primary market for these rapidly proliferating products.
Trends in Use: Vaping Declines Slightly, Dual Use Increases
Interestingly, the USC study found that while nicotine pouch use soared, teen vaping (e-cigarette use) saw a slight decrease during the same period. Past-12-month vaping dropped from 20% in 2023 to 17.6% in 2024 among surveyed students. However, the data also revealed a concerning increase in dual use – teens using both e-cigarettes and nicotine pouches. In 2024, 3.6% reported using both products in the past year, up from 2.1% in 2023. This co-use raises concerns about potentially higher levels of nicotine exposure and dependence.
The study also identified demographic disparities. Nicotine pouch use was significantly higher among male students, non-Hispanic white students, and those living in rural areas. Researchers noted this user profile closely resembles that of traditional smokeless tobacco users, suggesting that prevention efforts need to be specifically tailored for these groups and may require different approaches than anti-vaping campaigns.
Health Concerns and Calls for Action
Although marketed as tobacco-free, nicotine pouches deliver nicotine, a highly addictive substance. The long-term health effects of using these products, especially starting in adolescence, remain largely unknown. Documented side effects include mouth sores and gum irritation. More broadly, health experts consistently warn that nicotine exposure during adolescence can harm the developing brain, potentially leading to long-term issues with learning, memory, and attention.
"Parents, teachers, and pediatricians should be aware that teen nicotine pouch use is increasing across the nation," urged Adam Leventhal, PhD, the study's senior author and executive director of the USC Institute for Addiction Science. "To reverse this trend, we need to heighten public awareness about pouches and educate youth about them. Policymakers might also consider ramping up regulation of the booming pouch market—including cinnamon, fruit and other attractive flavors—to protect youth."
Data Interpretation and Future Research Needs
The researchers highlighted a nuance in data interpretation relevant to the FDA's authorization decision. While the FDA partly relied on data from the National Youth Tobacco Survey (NYTS), which found a non-statistically significant increase in past-month teen pouch use between 2023 and 2024, both the NYTS and the USC-led Monitoring the Future survey did find significant increases in lifetime use among high school students during that period. The USC researchers argue that tracking lifetime and past-year use is critical for understanding experimental use trends, an aspect potentially underemphasized in the FDA's decision rationale.
Continued surveillance in 2025 and beyond is deemed essential to monitor the real-world effects of the FDA's marketing authorizations. The USC researchers advocate for future studies examining long-term use patterns, initiation factors, the impact of varying nicotine concentrations, potential health consequences, and the effectiveness of different prevention and regulatory strategies, especially for high-risk groups like rural youth and dual users.
"Nicotine pouches are relatively new, so we need time to collect data on prevalence, policy, and prevention," concluded Dr. Han.
