Abstract
OBJECTIVES: Oral nicotine pouches are gaining global popularity as a novel alternative nicotine product. Our objective was to examine nicotine pouch use among a large sample of Québec adolescents, including sociodemographic and health-related risk factors, co-use with cigarettes and e-cigarettes, and risk perceptions. METHODS: We surveyed 13,914 Quebec secondary school students as part of the 2024 COMPASS study. Participants answered questions on past-month use of oral nicotine pouches, e-cigarettes, and cigarettes, as well as perceived addictiveness and health risks. Poisson regression was used to examine relative risks for current nicotine pouch use by sociodemographic and health factors, current smoking and vaping status, and risk perceptions. Risk perceptions were compared across nicotine products. RESULTS: Nicotine pouches were the most used alternative nicotine product following e-cigarettes, with prevalence of current use (2.6%) comparable to cigarette smoking (3.0%). Older adolescents, cisgender boys, gender diverse adolescents, academically at-risk youth, and current cigarette and e-cigarette users had higher relative risks for nicotine pouch use. Nearly one-quarter of adolescents were unsure of the health risks of nicotine pouches and 16% did not know whether they were addictive. Lower risk perceptions were associated with increased likelihood of current use. CONCLUSION: Nicotine pouches are an emerging nicotine product that appear to be gaining popularity among Canadian youth. Given their design features which allow for use in most situations and environments, nicotine pouches have considerable potential to follow the same popularity trajectory as e-cigarettes if not regulated appropriately.