Abstract
BACKGROUND AND OBJECTIVES: Use of flavored oral nicotine products (ONPs), including nicotine pouches and other ONPs (eg, gums and lozenges) is increasing among adolescents who use e-cigarettes (ie, vape). It is unknown whether ONP use is associated with vaping behaviors. METHODS: We used data from 6 semiannual waves of a prospective cohort of Southern California adolescents (2021-2024). Among participants who used e-cigarettes in the past 6 months at waves 1-5 (n = 703; mean age = 16 years), we examined the time-varying and time-lagged association of ONP use (any ONP, nicotine pouch, other ONPs [eg, gum or lozenges]) at waves 1-5 with subsequent vaping persistence and frequency 6 months later at waves 2-6. RESULTS: Across a total of 1173 observations, there were 277(23.7%) observations of any past 6-month ONP use (17.4% nicotine pouch and 21.3% other ONPs). Past 6-month use (vs nonuse) of any ONP (risk ratio [RR] = 0.75; 95% CI, 0.62-0.91), nicotine pouches (RR = 0.43; 95% CI:, 0.32-0.58), and other ONPs (RR = 0.72; 95% CI, 0.59-0.89) was associated with lower likelihood of subsequent vaping persistence. Use of nicotine pouches was also inversely associated with past 30-day vaping frequency at follow-up (incidence rate ratio = 0.43; 95% CI, 0.26-0.72). In secondary analyses (examining ONP use in the past 30 days and restricted to youth reporting past 30-day e-cigarette use at exposure waves), only inverse associations of nicotine pouch use with vaping persistence remained. CONCLUSIONS: Youth nicotine pouch use was associated with a lower likelihood of continued vaping and lower vaping frequency 6 months later. ONP use might not increase vaping, and nicotine pouches may serve as a partial nicotine substitute for youth who vape.