Brittney Keller-Hamilton

INTRODUCTION Oral nicotine pouches (ONPs) are smokeless, non-combustible products that do not contain tobacco leaf. Because they eliminate exposure to combustion-related toxicants and do not produce inhaled aerosols, ONPs are generally considered to be lower-risk than combustible tobacco products [1-3]. However, ONPs still deliver nicotine that is responsible for addiction [2, 4]. The evidence on their long-term health effects remains limited and is continually evolving.

INTRODUCTION Oral nicotine pouches (ONPs) are smokeless, non-combustible products that do not contain tobacco leaf. Because they eliminate exposure to combustion-related toxicants and do not produce inhaled aerosols, ONPs are generally considered to be lower-risk than combustible tobacco products [1-3]. However, ONPs still deliver nicotine that is responsible for addiction [2, 4]. The evidence on their long-term health effects remains limited and is continually evolving.

Abstract Objective: Examine trends in the prevalence of oral nicotine pouch (ONP) use among U.S. college students. Participants: During the Spring 2025 semester (January-early May), we enrolled 578 undergraduate and 888 graduate students from a large Midwestern University. Methods: Students completed an online survey assessing ONP use and their reasons for use/nonuse. Their history of using other substances and sociodemographic characteristics were also assessed.