Title: Exploration of Oral Nicotine Pouches: Association Between Use, Marketing Exposure, and Smoking and Vaping Cessation

Abstract: Research on oral nicotine pouches (ONPs) is relatively minimal compared to other nicotine and tobacco products due to the products’ novelty. This dissertation characterizes the use of ONPs within a large, nationally representative adult sample, and examines the sociodemographic (e.g., sex, age group, race/ethnicity) and behavioral factors (e.g., current use of conventional tobacco cigarettes or CTCs) associated with ONP use (Study One), examines the association between exposure to ONP marketing (i.e., receiving discounts/coupons, seeing social media content) and ONP use (Study Two), and to assesses the potential for smoking/vaping cessation using ONPs (Study Three).

                All three studies analyzed Wave 7 data from the Population Assessment of Tobacco and Health (PATH) Study, which is the first wave to include ONP-related questions with data collection occurring from January 2022 to April 2023,. Specifically, the adult survey (i.e., those aged 18 and older) was used for all three studies. Analyses included chi-square tests and multivariate logistic regressions to examine the associations.

                Study One found males, those younger than 65 years old, Non-Hispanic Whites, those with a higher education, those with a higher household income, those having important people close to them that use ONPs, current use of CTCs, current use of electronic nicotine delivery systems or ENDS, and current use of other smokeless tobacco products or SLTs had higher odds of being aware of and using ONPs. Study Two found that those exposed to ONP marketing (i.e., receiving discounts/coupons and seeing social media content) exhibited higher odds of ever and current use of ONPs. Additionally, certain sociodemographic groups reported higher rates of being exposed to ONP marketing which align with findings from Study One. Study Three found that those who intend to quit CTCs in the past 12 months and those who considered switching from CTCs to ONPs exhibited significantly higher odds of ever using ONPs, while only those considering switching from CTCs to ONPs exhibited higher odds of currently using ONPs. Additionally, those who have attempted to quit ENDS in the past 12 months, those who intend to quit ENDS in the past 12 months, and those who considered switching from ENDS to ONPs exhibited significantly higher odds of ever using ONPs and currently using ONPs. 

                Overall, while use of ONPs may not be widely reported currently, this dissertation highlights how critical it is to survey and regulate novel nicotine and tobacco products. Specifically, identifying population groups at risk for ONP uptake, assessing exposure to ONP marketing practices between ONP use, and examining the potential smoking and vaping cessation capabilities for ONPS may better inform public health policy and ongoing nicotine and tobacco harm reduction efforts.

Chair: Dr. Jidong Huang