Background Oral nicotine pouches (ONPs) have rapidly gained popularity in recent years. While ONPs likely expose users to fewer toxicants than cigarettes, they contain nicotine and may initiate, sustain or increase nicotine addiction and dependence. Monitoring the ONP marketplace is essential to inform timely regulatory action. Methods We used Nielsen ScanTrack data to analyse ONP sales and prices from 2021 to 2024. Joinpoint regression assessed sales and price trends, and ordinary least squares regression evaluated the association between ONP sales and product characteristics. Results Monthly ONP unit sales increased significantly, from 327 million in July 2021 to 1046 million in May 2024—more than tripling over this period (p<0.001, average monthly per cent change (AMPC)=3.45). Inflation-adjusted prices also rose, from 19 cents/pouch in June 2021 to 22 cents/pouch in May 2024 (p<0.001, AMPC=0.50). The sales of ZYN, On!, Rogue and VELO account for 99.8% of total sales. ONPs with explicit flavour descriptors outsold those with implicit flavour descriptors by more than eight times. The ‘chill’ flavour had also gained notable popularity. ONPs with 6 mg and 3 mg nicotine concentrations made up 68% of total sales. Additionally, ONPs with explicit flavour descriptors and higher nicotine concentrations were associated with increased sales. Conclusions Policy-makers may need to consider the role of major manufacturers, product flavours, and nicotine content in shaping the market. Continued surveillance is warranted to assess trends in use, particularly among youth and non-tobacco users.

Introduction: Tobacco 21 (T21), which sets the minimum legal sales age for tobacco to age 21, is now a national law in the United States. Although T21 is expected to help curb youth tobacco use, its impact may be dampened due to poor retailer compliance. Even within environments where enforcement is strong (ie, compliance checks are conducted with tough sanctions for violations), compliance might vary due to other factors. Aims and Methods: Three studies were conducted in Columbus, OH, where T21 became strongly enforced in 2018. These studies examined how retailer compliance related to features of the neighborhood in which a retailer was located (Study 1), features of the retailer (Study 2), and features of the retail cashier (Study 3). Results: Study 1 found that, after controlling for race- and age-based factors, retailers located in high (vs. low)-poverty neighborhoods had a lower likelihood of conducting identification (ID) checks. Study 2 found that ID checks were related to whether retailers displayed signage about T21, as required by the city law. Study 3 found that, among cashiers, T21 awareness (which was high) and perceptions about T21 (which were moderate) were not generally related to their retailer’s compliance; having (vs. not having) scanners for ID checks was related to a higher likelihood of compliance. Conclusions: These studies emphasize the many, multilevel factors influencing T21 outcomes. Findings also indicate the potential for T21 to widen disparities in tobacco use, indicating the need for strategies to equitably improve T21 compliance. Implications: T21, which sets the minimum legal sales age for all tobacco products to age 21, is now a national law in the United States. Despite optimistic projections about what T21 could achieve, the ultimate impact may be dampened when it is applied in real-world settings. Our project revealed the many, multilevel factors influencing T21 compliance. Findings also indicate the potential for T21 to widen disparities in tobacco use if gaps in compliance persist. Strategies for equitably improving T21 compliance are discussed. This article is of relevance to areas interested in implementing or improving their local T21 enforcement.

Background and aims: Oral nicotine pouches (ONPs) probably offer reduced harm compared with cigarettes, but independent data concerning their misuse liability are lacking. We compared nicotine delivery and craving relief from ONPs with different nicotine concentrations to cigarettes.Design: This was a single‐blind, three‐visit (≥ 48‐hour washout), randomized‐cross‐over study. Participants were encouraged to complete all study visits in less than 1 month.Setting: The study took place in Rural/Appalachian Ohio.Participants: Participants comprised 30 adults who smoke cigarettes. Participants (mean_age = 34.5) were 60% men and 90% White.Intervention: Participants who were ≥ 12‐hour tobacco‐abstinent used: (1) a 3‐mg nicotine concentration ONP, (2) a 6‐mg nicotine concentration ONP and (3) usual brand cigarette in separate visits. ONPs (wintergreen Zyn) were used for 30 minutes; cigarettes were puffed every 30 sec for 5 minutes.Measurements: Plasma nicotine and self‐reported craving were assessed at t = 0, 5, 15, 30, 60 and 90 minutes. The primary outcome was plasma nicotine concentration at t = 30 minutes. A secondary outcome was craving relief at t = 5 minutes.Findings: At t = 30, mean [95% confidence interval (CI)] plasma nicotine was 9.5 ng/ml (95% CI = 7.1, 11.9 ng/ml) for the 3 mg nicotine ONP, 17.5 ng/ml (95% CI = 13.7, 21.3) for the 6 mg nicotine ONP and 11.4 ng/ml (95% CI = 9.2, 13.6 ng/ml) for the cigarette. Mean plasma nicotine at t = 30 minutes differed between the 3‐ and 6‐mg nicotine ONPs (P = 0.001) and between the 6‐mg nicotine ONP and cigarette (P = 0.002). Mean (95% CI) craving at t = 5 minutes was lower for the cigarette (mean = 1.00, 95% CI = 0.61, 1.39) than either the 3 mg (mean = 2.25, 95% CI = 1.68, 2.82; P < 0.0001) or 6 mg nicotine (mean = 2.19, 95% CI = 1.60, 2.79; P < 0.0001) ONP.Conclusions: Among adult smokers, using 6‐mg nicotine concentration oral nicotine pouches (ONPs) was associated with greater plasma nicotine delivery at 30 minutes than 3‐mg ONPs or cigarettes, but neither ONP relieved craving symptoms at 5 minutes as strongly as a cigarette. Accelerating the speed of nicotine delivery in ONPs might increase their misuse liability relative to cigarettes.