Nicotine Pouches: Assessing Use Trends Among U.S. High School Students

A quiet but significant shift is unfolding in American high schools. Recent data reveal that nicotine pouch use among students nearly doubled between 2023 and 2024, climbing from approximately 3% to 5.4%. While the numbers may seem modest on the surface, the growth rate—and the product’s discreet, smokeless design—makes this trend particularly troubling for public health officials, educators, and clinicians working to curtail adolescent nicotine exposure.

These findings, published in JAMA Network Open, underscore an urgent need for both improved clinical screening practices and policy innovation. Unlike combustible tobacco products or even e-cigarettes, nicotine pouches are small, odorless, and easily concealed—often tucked under the lip with little to no visible trace. This ease of use makes them especially attractive to high school students and simultaneously difficult for school authorities and parents to detect. Their inconspicuous nature also places them outside the typical scope of school-based enforcement or traditional anti-tobacco education efforts.

Nicotine pouches contain a synthetic or tobacco-derived form of nicotine, typically delivered through a flavor-infused white sachet. They offer a smoke-free experience, which for some young users may lower the perceived risk, despite delivering a potent dose of the addictive stimulant. Insights from PMI Science detail how the product’s discreet format is a feature, not a bug—intentionally designed for use in spaces where traditional tobacco products would be off-limits.

This surge in use presents immediate challenges to healthcare professionals, particularly those in primary care and adolescent medicine. With such rapid growth among youth, clinicians are being urged to update their substance use screening protocols to include emerging nicotine delivery systems like pouches—products that often fly under the radar in routine health visits. Standardized questionnaires and casual conversations during well-child exams may no longer suffice. A sharper, more proactive approach is needed, especially given the increasing variety of nicotine products marketed to young people under the guise of being less harmful or easier to use.

Public health policymakers are similarly grappling with the implications. While regulatory efforts in recent years have focused heavily on flavored vaping products and underage sales enforcement, the rise of nicotine pouches suggests a pivot is necessary. Regulatory gaps in packaging, marketing, and age verification may be contributing to their increased use among teens. Moreover, educational campaigns need to evolve to address these newer forms of nicotine, which are often mistakenly assumed by adolescents to be safer or non-addictive simply because they don’t involve inhalation or smoke.

What makes this issue particularly urgent is the developmental vulnerability of the adolescent brain to nicotine exposure. Research consistently shows that nicotine use during these formative years can interfere with cognitive development, attention, and impulse control, while also increasing the risk of long-term dependence. A nearly twofold increase in usage within a year is not just a statistical anomaly—it’s a flashing red light that interventions must catch up with the speed at which products are being adopted.

The path forward, experts suggest, will require a multi-pronged strategy: revised clinical guidelines that encourage pediatricians to ask the right questions about nicotine pouches, school-based education campaigns that demystify the products' perceived safety, and regulatory scrutiny that addresses both marketing tactics and accessibility. Importantly, these efforts must also confront the social appeal of discreet nicotine use—a factor that has helped pouches slip into classrooms and social circles with alarming ease.

As adolescent nicotine use once again evolves ahead of public health infrastructure, the challenge is clear. Spotting a cigarette was easy. Spotting a pouch? Not so much. But with sharper awareness, stronger screening, and smarter policies, the health community can begin to catch up to this invisible threat—before it becomes an entrenched epidemic.