Use of nicotine pouches surges, especially among young adults

A surge in nicotine pouch use, especially among young adults, is alarming public health experts, even as some view the product as a less dangerous alternative to cigarette smoking.

The debate over pouches stems in part from the lack of strong scientific data on whether nicotine pouches help cigarette smokers quit or smoke less, and because the full long-term health risks of the pouches are unknown. Experts agree that nicotine is highly addictive and can harm adolescents’ and young adults’ brain development and lead to cardiovascular disease.

Although available since 2014, the pouches have spiked in popularity in the past few years. Nationwide use increased from 4.8% of adults ages 19 to 30 in 2023 to 12.7% in 2025, and use among 12th graders rose from 2.9% to 6.9%, according to federally funded University of Michigan Monitoring the Future surveys, which looked at consumption over the previous 12 months. Use among older adults also more than doubled.

"I am very worried," said Dr. Rachel Boykan, a clinical professor of pediatrics at the Renaissance School of Medicine at Stony Brook University. "I’m worried about nicotine and the developing brain. I'm worried about addiction. I'm worried about all the potential for long-term consequences that we have yet to discover."

New York data is less recent than the nationwide numbers, but it showed a doubling of nicotine pouch use among high school students between 2022 and 2024, to 3%. New York enacted a 75% tax on nicotine pouches that went into effect on Sept. 1, which Long Island store owners said has caused a sharp drop in sales.

The pouches dissolve in the user’s mouth, and the nicotine is absorbed into the gums and the mouth’s lining. About half of adult pouch users said in a survey that they had mouth lesions, and a third had mouth soreness, according to a July article in the medical journal JAMA.

One of the appeals of the pouches, and a reason for concern that use may continue to rise, is that they can discreetly be used in places where smoking and vaping are banned, said Michael Seilback, the Commack-based assistant vice president for nationwide advocacy for the American Lung Association.

Seilback said assertions from companies like Altria, maker of Zyn, the most popular nicotine pouch brand, and Marlboro, the top-selling cigarette maker, that pouches are a healthier alternative to cigarettes ignore the dangers of nicotine.

"Their sole purpose is to sell products, and the only way they’re going to do that is to continue coming out with new products that are going to addict people," he said.

Effects of tax

New York State's 75% tax was supported by the American Lung Association, the American Academy of Pediatrics and other major health groups. Gov. Kathy Hochul proposed the tax to "safeguard public health" and deter young people from buying nicotine pouches, Nicolette Simmonds, a spokeswoman for the governor, said in a statement.

The industry disputes whether this is a good idea. Brian Erkkila, head of scientific engagement for Philip Morris International, the Altria company that makes Zyn, said that "when you tax a product like this at such a high level, you remove that incentive for people who are smoking cigarettes to move to that better alternative, the nicotine pouch."

The tax is imposed on all pouch distributors, including ones shipping the product from out of state, said Department of Taxation and Finance spokesman Darren Dopp.

Erkkila said it's too early to tell whether the tax will reduce sales of Zyn in the long term.

Owners and employees of Long Island smoke shops and convenience stores said their sales of nicotine pouches plummeted after the tax went into effect.

"Right now, nobody’s buying," said Gurvinder Singh, owner of Highr in East Northport.

He raised prices for nicotine pouches from about $8 to $13, not passing on the entire cost of the tax to customers.

Some Long Islander store owners said customers are now buying the pouches online, where prices often are lower.

On nicokick.com, for example, Zyn was much cheaper than in stores: $8.23 per 15-pouch can for Long Island ZIP codes, including excise and sales taxes, and $6.60 per can with the purchase of 50.

Uncertain health effects

Although the pouches' long-term health effects are unknown, they likely are less dangerous than cigarettes because there is no combustion, said Michelle Bover Manderski, an assistant professor of epidemiology at Rutgers University and a researcher in its Institute for Nicotine and Tobacco Studies.

The Food and Drug Administration warns that pouches "can deliver harmful chemicals," but in June it authorized Altria to market 20 Zyn products as carrying a lower risk than cigarettes of several diseases, including mouth and lung cancer. Several major public health groups strongly criticized the move.

Boykan, at Stony Brook University, said nicotine impairs users’ ability to learn and focus and has been linked to anxiety and depression because of its effect on brain development, which continues until about age 25.

Smokers wanting to quit should use FDA-approved smoking cessation treatments rather than nicotine pouches, she said.

Kevin Zamora, 32, of Shirley, said he stopped smoking eight months ago because of FDA-approved nicotine lozenges. He said he would never use nicotine pouches.

The lozenges, he said, "are designed to wean you off these products. My goal is to be nicotine-free."

Industry's argument

But Erkkila, with Philip Morris, said some FDA-approved products have been on the market for decades and many New Yorkers — about 1.4 million, according to state Health Department data — still smoke.

"Innovations like nicotine pouches could really play a role in getting those numbers down," he said.

Jennifer Cantrell, an associate professor of social and behavioral sciences at the NYU School of Global Health who researches nicotine and tobacco use, sees a potential role for pouches in "harm reduction." She said they seem more likely to lead people to smoke less than quit entirely — and even that data is limited.

With pouches' potential to reduce smoking, Cantrell opposes proposals such as banning flavored pouches.

"You can’t make these products completely unappealing, or people won’t use them," she said.

A bill now before the State Senate that would allow pouches only with tobacco flavor is bottled up in committee. Consumers currently can choose from flavors such as citrus, mint and spicy mango, and supporters of a ban said the flavors attract kids.

A Rutgers study released last year based on 2022 and 2023 data found that daily nicotine pouch use was most common among adults who had stopped using another tobacco product, especially cigarettes.

The study does not show that nicotine pouches successfully helped people quit or reduce consumption of cigarettes, but research to examine that is ongoing, said Manderski, one of the study’s co-authors.

About 13% of people new to nicotine use started by either using nicotine pouches alone or pouches with another nicotine product, according to a study published in August.

Cantrell said "we have to watch really closely" if that number rises, "especially with the massive increase in marketing."

"You see young-looking social media influencers and others who are using these products and who are very glamorous, attractive and appealing and are going to appeal to youth across the board, especially high school students, and into young adulthood," she said.