Retail availability of oral nicotine pouches in 3 US cities: A geographic analysis.

Introduction: Sales of oral nicotine pouches (ONPs), including brands such as Zyn, on!, Velo, and Rogue, have risen precipitously in the US. One potential driver of ONP use may be exposure to the products and their marketing in local tobacco retailers. This study examines the prevalence and correlates of ONP availability in a large, representative sample of tobacco retailers in three major US cities.

Methods: In 2023, research staff visited a stratified, random sample of 20% of licensed tobacco retailers in San Francisco, New York City (NYC), and Philadelphia (n=1,402) and documented the availability of ONPs. Binomial generalized linear mixed models estimated adjusted odds of ONP availability by city, store type, and district sociodemographic characteristics.

Results: ONPs were available in 28.7% of retailers and were most prevalent in chain convenience stores (60.5%), followed by smoke/vape shops (53.3%, p<.0001). After adjusting for city and store type, the odds of a retailer carrying ONPs were higher in districts with a greater proportion of non-Hispanic White residents (aOR: 2.33 [1.10, 4.94]), a higher median household income (aOR: 2.04 [1.23, 3.38]), and a lower proportion of youth residents (aOR: 0.25 [0.15, 0.43]).

Conclusions: ONP availability was greater in retailers located in predominantly white and higher income neighborhoods and those with fewer youth. As researchers continue to evaluate the risks of ONPs as well as their potential as a tobacco harm reduction strategy, attention to variations in retail access and population patterns of use will be critical to determine impacts on health equity.

Implications: Sales of oral nicotine pouches (ONPs) have increased precipitously in the US, but little is known about patterns of retail access in neighborhoods, which may influence consumer use behaviors. This study found that over 1 in 4 tobacco retailers carried ONPs, but availability was greater in largely white and high-income neighborhoods and those with fewer youth. As researchers continue to evaluate ONP risks and potential benefits, this study provides insight into the role that retail access may play in shaping population patterns of use and subsequent impacts on health equity.