Use of nicotine pouches in childhood and adolescence

Background Unlike Swedish snus, nicotine pouches do not contain tobacco. Nicotine pouches are placed under the upper lip so that nicotine and other ingredients can be absorbed through the oral mucosa. Since 2021, they have been subject to the Foodstuffs Act in Germany and are not marketable due to their high nicotine content. The prevalence of nicotine pouch use in children and adolescents is being investigated. Method As part of the "Prevention Radar" observational study, a random sample of 12,655 pupils in grades 5 to 10 from 14 federal states were recruited to answer a questionnaire in the 2022/2023 school year. The average age was 13.2 years (SD=1.72). The gender ratio was balanced (49% girls). The primary endpoint of the cross-sectional study was the lifetime prevalence of nicotine pouch use. Results The lifetime prevalence of nicotine pouch use in the total sample was 5.4% [95% CI 4.9-5.8]. Use was more common among boys (6.3% [95% CI 5.6-6.9]) than girls (3.5% [95% CI 3.0-4.0]) and increased with age. At the age of 16/17 years, 15.2% [95% CI 12.3-18.7] of boys and 10.3% [95% CI 7.8-13.6] of girls had used nicotine pouches. Consumption covaried positively with sensation seeking, negatively with subjective social status and occurred less frequently in grammar schools. Almost all children and adolescents with consumption experience had also smoked other nicotine products (e-cigarettes, tobacco cigarettes and water pipes). Discussion Although not marketable, one in seven male pupils and one in ten female pupils aged 16/17 had used nicotine pouches at least once.