Who starts nicotine pouches — and who stops: new US cohort data
A new preprint using nationally representative PATH data (2022–2024) finds nicotine pouch initiation is heavily concentrated among people who already use other tobacco products — smokeless users were over 40 times more likely to start than non-users — while most adults never touch the category.
Most US adults never try a nicotine pouch. But the ones who do overwhelmingly come from other nicotine categories — and most of them don't stick with it.
That's the picture from a new preprint posted on medRxiv on October 7, 2026, by researchers at the University of Michigan, Georgetown and Rutgers. It uses the nationally representative PATH Study — the same survey behind this week's prevalence figures — but follows the same adults over time, tracking who moved into and out of nicotine pouch use between 2022 and 2024.
Note on status: this is a preprint. It has not been peer-reviewed yet, so the numbers should be read as provisional until the paper clears review.
What the study did
The team followed 24,640 adults across PATH Waves 7 and 8. In 2022, 96.7% had never used a nicotine pouch, 2.5% had used one but weren't current users, and 0.8% were current users. The researchers then modeled who transitioned between those states over the following two years.
Who starts pouches
Initiation was strongly concentrated among people already using other tobacco or nicotine products. Compared with adults using none of them, the risk of starting nicotine pouches between 2022 and 2024 was:
- 42.4 times higher among smokeless tobacco users
- 18.4 times higher among people using multiple products
- 9.7 times higher among vapers (ENDS-only users)
- 3.3 times higher among cigarette-only smokers
Demographics matter too: men started more than women, adults 35 and older started less than 18–24-year-olds, and non-Hispanic Black participants quit pouches at higher rates than non-Hispanic White participants.
Who stops
Contrary to the image of a habit that hooks everyone it touches, discontinuation was common. Cigarette-only smokers, vapers and multi-product users all stopped using pouches at higher rates than people who used no other products. The authors read that as a sign that a lot of pouch use is experimentation rather than sustained use.
Why it matters
The study can't settle the central policy question — whether pouches replace other nicotine products or pile on top of them — and the authors are explicit that they don't claim to. But it sharpens the picture regulators are arguing over: in this data, pouches are not primarily a product pulling non-users into nicotine. They're being picked up almost entirely by people already in the category, and frequently dropped again.
That matters on both sides of the ongoing EU debate, where member states are asking Brussels to freeze the pouch market. If initiation among never-users stays near zero, the "gateway" argument rests on thin ground. If poly-use turns out to be the norm instead, the harm-reduction story gets more complicated too.
The next step the authors flag: work out whether pouches replace other products or lead to poly-tobacco use. Peer review of this paper will be worth watching.
Compare nicotine pouch brands and prices at PouchFinder.
SOURCES:
- Roberts, O.K. et al., "Rates of oral nicotine pouch experimentation, initiation, and cessation by other tobacco product use and sociodemographic characteristics among U.S. adults, 2022–2024." medRxiv, posted 7 Oct 2026. medrxiv.org (preprint, not peer-reviewed)