Nicotine pouches: Youth survey shows opportunity for prevention

While the use of nicotine via smoking or electronic cigarettes has decreased among young people, more youth are being exposed to it via oral nicotine pouches, or ONPs.

The products, which came on the market in the last decade, are designed to be placed in the mouth so they can send nicotine into the bloodstream without any smoke or visible device.

They’re sold in many different flavors, which has raised concerns about their appeal to young people.

Oral nicotine pouches are manufactured and distributed under multiple brand names such as Zyn, On!, Rogue and Velo.

Their manufacturers promote their products on social media and through brand ambassadors, sometimes called ‘Zynfluencers.’

But how do young people feel about Zyn, the most popular and well-known brand?

University of Michigan Family Medicine researchers sought to understand this by surveying 704 youth aged 14 to 24 through the ongoing MyVoice text message-based project.

Only a few (3%) said they used Zyn themselves, but 37% said their friends used it.

The researchers recently published their study results in the Journal of Adolescent Health.

Recent U-M Medical School graduate Ailish Dougherty, M.D., served as first author.

The survey asked youth five open-ended questions about Zyn: If they knew anyone who used it; how people their age first learned about it; reasons for using it; their feelings about Zyn use; and whether doctors should ask young people about Zyn use.

The study was conducted before the United States Food and Drug Administration announced it would allow Zyn to market multiple flavored products as having lower health risks than cigarettes, while also requiring it to monitor youth use.

It was also done before the FDA changed its enforcement rules for certain oral nicotine products. This approval sparked a lawsuit from advocates for youth health.

The U-M study identified three main themes:

Exposure and Peer Pressure

Youth are exposed to Zyns in many ways, especially through friends and online sources.

Peer pressure was a major reason why some young people try Zyns.

Many said they felt the need to “fit in” or “look cool” because others around them were using Zyns.

Mixed Feelings (Ambivalence)

Young people had mixed feelings about Zyn use or felt disappointed that the nicotine-containing substance was still being consumed by their peers.

“I do believe that my generation would have ended smoking,” one respondent said.

“We have just replaced it with similar product. People seem to be blind about the effects of nicotine and I don’t understand why.” 

While 60% percent of youth said they felt negatively about Zyn use, mentioning health dangers, addiction, or that it was “pointless” or “gross,” about 21% had positive opinions, often saying Zyns were a better alternative to smoking or vaping.

Other youth had the perception that ONPs were a nicotine cessation method, helped alleviate stress, or were easier to use discreetly.

“People my age are going through a lot and some don’t have the resources to have help so they look to other outlets,” one youth said. 

A different youth had this to say about Zyn usage: “It’s inevitable. There’s an ongoing nicotine addiction epidemic with young people in the U.S. Life sucks and it is stressful, they will try to find a way to cope period.”

Awareness of Risks and Support for Doctor Involvement

Most youth were aware of the health risks of Zyns, like potential gum health issues, possible negative interactions with other medications, and the effects of nicotine on the body.

A large majority (86%) thought doctors should ask young people about Zyn use, including one respondent who said, “I think they should because it is so new and unknown if it is as strongly linked to carcinogens and other negative health effects.”

Youth also believed doctors could help by giving accurate information about the product, as well as counseling and support to help users quit, a strategy the authors endorsed.

“Simply telling youth not to use Zyns is inadequate,” Dougherty and colleagues wrote. “Educational campaigns should address the reasons youth are using ONP – specifically to feel connected and to cope with stress -- and to help youth find healthier ways of doing so.  They should also clarify misinformation about youths’ perceived positives of using Zyns. 

“Health care professionals should screen for all forms of nicotine use, including Zyns, and offer support for quitting," they added.

Authors include U-M students Abby Frank and Arianne Hunter, U-M Medical School student Mahesh Gupta, as well as Marika Waselewski, M.P.H., and Associate Professor Tammy Chang, M.D., M.P.H., M.S., both of the Department of Family Medicine.

The MyVoice project is led by Chang and managed by Waselewski. For this study, the team sent out a nationwide text message survey to 704 youth aged 14 to 24 years. Out of the 704 youth contacted, 622 responded (88%). The average age of the respondents was 20 years old. Most were female (56%) and non-Hispanic White (48%).

Article cited: Dougherty, A., Frank, A., Hunter, A., Gupta, M., Waselewski, M., & Chang, T (2026). "United States youth perspectives on Zyn oral nicotine pouches," Journal of Adolescent Health. DOI: 10.1016/j.jadohealth.2026.04.003