Exposure to nicotine pouch marketing and nicotine pouch experimentation among US adults who use commercial tobacco

Objective: U.S. nicotine pouch (NP) sales have grown since 2016. Among U.S. adults who currently and formerly used commercial tobacco, we examined demographic associations with learning about NPs through varying marketing channels, and their associations with NP experimentation overall and stratified by race/ethnicity. Methods: A nationally representative sample of U.S. adults who currently and formerly used commercial tobacco (n = 1,700) were surveyed online in January-February 2021. Participants reported their demographics and whether they learned about NPs through nine marketing channels. We used weighted multivariable logistic regressions to examine demographic associations of each channel, and each channel's association with NP ever-use. Results: Overall, 45.2 % were aware of NPs, and 17.4 % ever used NPs. Highest reported NP awareness was through stores (16.6 %), internet/social media ads (9.2 %), friends/family's social media (8.2 %), direct mail/ email (7.6 %), and print media ads (6.9 %). Younger, female, Black and Hispanic (vs. White) adults had lower odds of NP awareness through various marketing channels than their counterparts. Black adults (vs. White) had higher odds of NP awareness through news stories on TV/radio/online. Awareness through each channel was associated with higher odds of ever-using NPs, especially brand sponsored events, brand website/social media accounts, and direct mail/email (p's < 0.05). Results were generally consistent when stratified by race/ethnicity, but notable differences were also observed (race/ethnicity interaction p < 0.05). Conclusions: NP marketing may promote NP experimentation among U.S. adults who use commercial tobacco. Future research should examine whether exposure to NP marketing leads to poly-tobacco use, which could increase the detrimental health effects of tobacco use.