The use of nicotine pouches — small, easily concealed sachets of nicotine and additives that are placed between the gum and lip — nearly doubled among U.S. high school students between 2023 and 2024, according to a new USC study.
The research, involving surveys of more than 10,000 teens from around the country, appears in JAMA Network Open.
"This growing public health issue needs more attention. Like flavored e-cigarettes when they first emerged, use of this new oral nicotine product is becoming more widespread, particularly among adolescents," said Dae-Hee Han, PhD, a postdoctoral scholar in population and public health sciences at the Keck School of Medicine of USC and first author of the study.
The findings come at a time of growing national concern over nicotine pouches like Zyn, which have surged in popularity on social media through a wave of young "Zynfluencers," who often link pouch use to confidence, masculinity and mental sharpness. Organizations such as the American Heart Association and the Campaign for Tobacco-Free Kids have called for regulation of nicotine pouches, citing concerns about use among teens.
In January, the U.S. Food and Drug Administration (FDA) authorized Zyn to market flavored nicotine pouches to adults 21 and older as commercial tobacco products. The rationale for the FDA decision was that nicotine pouches may be a less harmful alternative to cigarettes for adults who want to quit smoking; but unlike nicotine gum and patches, they are not FDA-approved as official smoking cessation products . A 2024 Keck School of Medicine of USC study found that less than 1% of adults were using them, raising questions about who is buying them.
Tracking trends in use
Funded in part by the National Institutes of Health, Han and his colleagues analyzed surveys from 10,146 10th and 12th graders around the country who participate in Monitoring the Future , an annual survey launched in 1975 that asks students about their substance use. In 2024, 5.4% of teens said they had used nicotine pouches, compared to 3.0% in 2023. More teens also reported using nicotine pouches in the past 30 days and past 12 months, as well as using both pouches and e-cigarettes in 2024, compared to 2023.
Over the same time period, the share of teens vaping decreased. In 2023, 20% of teens surveyed had used e-cigarettes in the past 12 months, compared to 17.6% in 2024. But dual use of both e-cigarettes and nicotine pouches increased: 3.6% of teens had used both products in the past 12 months in 2024, compared to 2.1% in 2023. Compared to the previous year, more teens also reported in 2024 that they had used both products in their lifetime.
Some teens faced a higher risk of nicotine pouch use than others. Those who are male, non-Hispanic white or living in a rural area were more likely than their counterpart peers to use nicotine pouches. Researchers say this demographic mirrors that of traditional smokeless tobacco products, such as those who use chewing tobacco, highlighting the need for a tailored prevention strategy.
"We're finding that the risk profile differs quite a bit between nicotine pouches and e-cigarettes, which means we need prevention approaches that are targeted for each," Han said.
The long-term health effects of nicotine pouches are unknown, but they carry the risk of nicotine addiction, and some users report symptoms such as mouth sores and gum irritation after using them. Other research has suggested that exposure to nicotine during adolescence may harm brain development and cause problems with learning, memory and attention.
"Parents, teachers, and pediatricians should be aware that teen nicotine pouch use is increasing across the nation," said the study's senior author, Adam Leventhal, PhD , a University Professor of Population and Public Health Sciences at the Keck School of Medicine 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."
Regulation and prevention
The FDA's decision to authorize Zyn nicotine pouch marketing relied partly on data from the National Youth Tobacco Survey (NYTS), which surveyed a different group of teens and found that the increase in teens who used nicotine pouches in the past month between 2023 and 2024 was not statistically significant.
Like the USC-led survey, the NYTS also found significant increases in lifetime use of nicotine pouches between 2023 and 2024 among U.S. high school students. The FDA did not address this increase in lifetime use in its decision to authorize the marketing of Zyn pouches. Further examining changes in lifetime and past-year use is critical for understanding trends in experimental substance use, Han said.
Tracking nicotine pouch use in 2025 will be key for assessing the effects of that authorization, the researchers said. Future studies should also assess long-term trends in use, initiation of use, nicotine concentration and potential negative health outcomes linked to nicotine pouches.
Studying the effectiveness of regulatory policies and prevention efforts is also important, particularly among high-risk groups, such as teens in rural areas and those who are using both nicotine pouches and e-cigarettes.
"Nicotine pouches are relatively new, so we need time to collect data on prevalence, policy and prevention," Han said.
About this research
In addition to Han and Leventhal, the study's other authors are Alyssa F. Harlow, Dayoung Bae, Junhan Cho, Steven Y. Sussman, Louisiana M. Sanchez and Leah Meza from the Department of Population and Public Health Sciences, Keck School of Medicine of USC, University of Southern California; Richard A. Miech from the Institute for Social Research, University of Michigan, Ann Arbor, Michigan and Hongying D. Dai from the Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska.
This work was supported by the National Cancer Institute and the Food and Drug Administration and the National Institute on Drug Abuse.
