Prevalence of Nicotine Pouch Use Among Youth and Adults in Great Britain-Analysis of Cross-Sectional, Nationally Representative Surveys.

Background: The public health impact of new nicotine products will depend on their use by different population groups. We assessed the prevalence of nicotine pouch use among youth and adults in Great Britain (GB).

Aims and methods: Cross-sectional annual Action on Smoking and Health Smokefree GB Adult Surveys 2020-2024 (n: 12 247 to 13 266, 18+) and Action on Smoking and Health Smokefree GB Youth Survey 2024 (n = 2872 11-18-year-olds). Weighted proportions and 95% confidence intervals for pouch ever and current use among adults over time, and in 2024 among youth and adults overall, by socio-demographics, mental health, tobacco smoking, vaping, past-12-month gambling, cannabis, and alcohol use; for youth also family members' smoking and vaping. Multivariable logistic regression assessed the association with ever pouch use.

Results: The prevalence of adult ever and current use doubled from 2020 to 2024, reaching 5.4% (95% confidence interval = 5.0 to 5.8) and 1.0% (0.8-1.1). Among youth, 3.3% (2.7-4.0) reported ever use, including 1.2% (0.8-1.6) reporting current use. Ever use was associated with the use of other addictive products. Among adults, ever use was also more common among younger groups (18-24, 25-34, 35-44 vs. 55+), males, and those in rented accommodation or receiving mental health treatment. Among youth, ever use was also more common among those in London than elsewhere in England.

Conclusions: Pouch use in GB is rare with about 1 in 100 youth and adults reporting current use. However, use appears to be increasing and is higher in some groups, including younger adults, males and people with experience of vaping, smoking, and use of other addictive products.

Implications: While currently low, close monitoring of pouch use is indicated. It is currently concentrated among those with experience of nicotine use. However, given the higher levels of use among young adults and teenagers, consideration of regulation may be required to minimize uptake among groups that would otherwise not have used nicotine-containing products.