Oral Nicotine Pouches and Public Health: Emerging Evidence and Trends from an Updated Scoping Review AUTHORS: Nargiz Travis, MScPH, Jamie Hartmann-Boyce, PhD, Claire Ma, PhD, David T. Levy, PhD DESCRIPTION: Introduction
• Oral nicotine pouches (ONPs), mainly produced by major combustible tobacco manufacturers,
have become widely available in the US and other
process.
• Based in part on the ev industry-funded studies, O toxic than cigarettes and comparable
nicotine
countries.
• Their public health impact depends on the extent to which they replace or supplement the
use of other, more harmful tobacco products, or contribute to the initiation of
ONPs among tobacco-naïve populations.
• This scoping review provides an update of the previously published review by Travis et
al. (2025)1 on the
potential public health impact of ONPs.
Modeling Peer-Influenced Smoking Initiation Using Agent-Based Simulation with Calibration 
Oral nicotine pouches for cessation or
reduction of use of other tobacco or nicotine
products: a Cochrane systematic review 
Associations between daily vs. non-daily use of cigarettes and ENDS and transitions in product use in adults 2021–2022 
Transitions in ENDS and cigarette use among youth in the PATH study from 2015—2023: a multistate transition modeling analysis 
Trends in cigarette and e-cigarette use among
American Indian and Alaska Native Adults, 2014-2023 
Differences in cigarette and e-cigarette use among American Indian and Alaskan Natives based on group definition 
The influence of social networks on youth and young adult smoking: A systematic overview of reviews to inform an agent-based model 
How Does the Exclusion of Several Population Groups from the National Health Interview Survey Affect Estimates of US Cigarette Smoking Prevalence? 
Relative mortality by smoking in the American
Indian and Alaska Native population 
A global comparison of flavor restrictions
for cigarettes and e-cigarettes 
Latest evidence from the Cochrane living systematic
review of electronic cigarettes for smoking cessation 
Estimating the risk of COPD incidence accounting for time-varying and sociodemographic risk-factors. A Markov state transition analysis of longitudinal PATH data 
Trends in exclusive and dual use of
combustible and non-combustible tobacco
products in the United States, 2015 to 2023 
Trends of Lung Cancer Incidence by Histology and Sociodemographic Characteristics in
the US from 2000-2019 
An Exploration of Flavours in Studies of
E-Cigarettes for Smoking Cessation: Secondary
Analyses of a Systematic Review with Meta-
Analyses 
Transitions in cigarette and ENDS use in the PATH Study: a
multistate transition model analysis of adults in 2021–2022
compared to previous years 
Observational studies of exposure to tobacco and nicotine products:
Best practices for maximizing statistical precision and accuracy 
Assessing the prospective association between e-cigarette use and
COPD: Results from W4-W7 (2017-2022) of the PATH Study 
Qualitative methods impact tobacco
policy evaluation via assumptions,
temporality, comparison, data
quality, and relevance. 
Transitions Into and Out of Dual Use of Combustible and E-Cigarettes: Implications for Public Health 
Trends in Cigarette and Electronic Nicotine Delivery Systems Use in Adolescents
in the United States from 2017 to 2023 
The impacts of e-cigarette flavours: An overview of systematic reviews 
Trends of Cigar Use -Exclusive and Multiproduct-
Among US Adult Population. Results from the PATH
Study 
Trends in Adolescent Exclusive and Dual Cigarettes and Electronic Nicotine Delivery Systems (ENDS) Use: Monitoring the Future Survey 
The potential impact of oral nicotine pouches on public health:
A scoping review. 
The Lifetime Mortality Implications of Vaping and Smoking Initiated During Adolescence 
Continuous associations of the Wisconsin Inventory of Smoking Dependence Motives with
transitions between cigarette and e-cigarette use in the Exhale longitudinal cohort study 
The impacts of e
cigarette flavours: An overview of
systematic reviews 
The Public Health Impact of a Ban on Flavored Cigars:
A Decision-Theoretic Policy Framework 
An update of a systematic review and meta-analyses exploring flavors in studies of e-cigarettes for smoking cessation 
Transitions in cigarette and ENDS use in the PATH Study: a multistate transition model analysis of adults in 2021–2022 compared to previous years 
Recent Trends in Nicotine Product Use By Flavors 
Menthol cigarette use, flavored cigar use
and dual use of menthol cigarettes and flavored cigars
at the intersection of sociodemographic variables 
Are Cigarettes Still Claiming 480,000 American Lives Every Year? 
If Vaping E-Cigarettes Is A Gateway To Cigarette Smoking, What Are The Implications? 
Cigarette Smoking Relapse among Recent Former Smokers
who Switched to E-Cigarettes or Other Tobacco Products 
The potential impact of oral nicotine
pouches on public health: A scoping review. 
Trends in Cigarette and Heated Tobacco Products (HTPs) Use in Japan: A Scoping Review 
Cigarette Smoking Susceptibility Modifies The
Effect Of ENDS Use On Youth Cigarette
Smoking Initiation 
An Examination of the Differential Population Health Impact Between an Immediate vs Gradual Nicotine Reduction in Cigarettes: A Simulation Analysis 
Variation in Nicotine and Flavor Policies Across the U.S. 
Smoking Prevalence and Lung Cancer Screening Eligibility from 2020-2060 for the Overall and the Non-Hispanic Black US Populations 
Responses to real-world and hypothetical e-cigarette flavor bans among US adults who use flavored e-cigarettes. 
Cigarette smoking cessation among adult users of nontobacco-flavored ENDS: longitudinal analysis of PATH study 
Continuous associations of urinary tobacco exposure biomarker concentrations and transitions between cigarette and e-cigarette use in the Exhale cohort 
Changing patterns of cigarette and ENDS transitions in the PATH study 
Initial preferences for menthol cigarettes and subsequent changes in preferences and smoking cessation among adult smokers from the United States: Findings from the ITC 4 Country Surveys, 2002-2020 
Prevalence of Menthol Use among Adults who Smoke Cigarettes from the United States (US) by Census Division and Demographic Subgroup, 2002–2020 
Patterns of Birth Cohort
Specific Smoking Histories in Brazil 
Sociodemographic patterns of cigarette and ENDS transitions in the PATH Study: a multistate transition model analysis of adults and youth in 2015–2017 vs 2017–2019 
Longitudinal Associations Between Cigar Use, With and
Without Cigarettes, and Self-Reported Diagnosed
Incident COPD Among US Adults 40+ 
Machine Learning Application for Predicting Smoking Cessation Among US Adults 
Relative Mortality by Smoking Status for Different Sociodemographic Groups 
Impact of ENDS Non-Tobacco Flavors on Adult Cigarette Smoking
Cessation: A Longitudinal Analysis of PATH Study Data 
Are the relevant risk factors being adequately captured in empirical studies of
smoking initiation? A machine learning analysis based on the PATH study 
The impact time since product change on transitions in cigarette and e-cigarette
use in a cohort of cigarette and dual users 
A longitudinal analysis of flavored cigar use and
cigar smoking cessation in US adults 
Interaction of Tobacco 21 and Taxation Policies on Youth Cigarette Smoking Outcomes 
Modeling from the margins to the masses:
Perspectives on commercial tobacco and health equity 
Poland’s Menthol Cigarette Ban: Small
Effects with Large Policy Implications 
The EVALI Outbreak and US Tobacco Sales 
Electronic Nicotine Delivery Systems (ENDS) use
during a six-year period is not associated with
self-reported chronic obstructive pulmonary
disease (COPD) after proper adjustment of
cigarette smoking history: A longitudinal analysis
of PATH data 
Changing age patterns of cigarette and ENDS transitions in the PATH study:
a multistate transition model analysis of adults and youth through 2017 (Waves 1–4) vs after 2017 (Waves 4–5) 
Response to Restrictions on Electronic
Nicotine Delivery Systems: A
Systematic Review 
Nicotine/tobacco use among gender-fluid and gender-stable adolescents and adults in the U.S. 
Longitudinal Associations Between Multiple Tobacco Product Use
and Incident Asthma Among US Youth 
Monitoring the Increase in the U.S. Smoking Cessation Rate
and its Implication for Future Smoking Prevalence 
Short-term ENDS use is not associated with self-reported COPD after adjusting for cigarette
smoking history: A longitudinal analysis of PATH data 
Longitudinal Association of Exclusive and Dual Use of ENDS and Cigarettes with Asthma among
US Youth Population Assessment of Tobacco and Health Study Waves 1-5 (2013-2019) 
The impact of demographics, dependence, and biomarkers on transitions in tobacco product use in a cohort
of smokers and dual users 
Demographic Correlates of Tobacco Poly-Use in the Population Assessment of Tobacco
and Health Study: A Multistate Markov Transition Analysis 
Health
Effects of Electronic Cigarettes:
An Umbrella Review and Methodological Considerations 
Disparities in cigarettes and e-cigarettes at the Intersection of
Multiple Identities in the U.S Adult Population: Results from the TUS-CPS 2018-19 
Exclusive, dual, and poly tobacco use is associated with the incidence of acute
bronchitis among youth 
Trends in Smoking (2002 to 2020) and E-cigarette use (2015 to 2020) in Mexico, a
country that bans the sale and distribution of E-cigarettes 
An Estimation of the Harm of Menthol Cigarettes in the United States from 1980-2018 
Modeling public health impacts of vaping 
Latent Transition Analysis of Tobacco Use Frequencies for Multiple Products in US Adults 
Tobacco Transitions Tool: Development of a Web Aid to Facilitate Exploration of Tobacco Use Patterns and Transitions in PATH 
A machine learning approach to identify
product characteristics that contribute to
increased risk of frequent vaping and
vulnerable youth populations 
Demographic Correlates of
Polytobacco Transitions 
The impact of demographics, dependence, and biomarkers on transitions in tobacco product use in a cohort of smokers and dual users 
Sociodemographic Differences in Patterns of Nicotine and
Marijuana Vaping Among US Adults 
Retail availability of tobacco and cigarette
and e-cigarette use among youth and
adults: a scoping review. 
Expert Elicitation on the
Effects of a Federal
Menthol Ban 
Correlates of smoking cessation behaviors among dual users of cigarettes
and e-cigarettes. Results from the TUS-CPS 2018-2019 
Racial/ethnic disparities in cigarette and cigar prevalence and intensity
of use among exclusive, dual, and polyusers 
Trends in single-, dual-, and poly-tobacco use among US adults, 2014-2019:
Results from two nationally representative surveys 
Sociodemographic Patterns of Exclusive and Dual Use of Menthol/Non
Menthol Cigarettes and ENDS among
US Youth (Ages 15 17) Population Assessment of Tobacco and Health Study (2013 2017) 
Patterns of Tobacco Poly-Use in the Population Assessment of Tobacco and Health Study:
A Multistate Markov Transition Analysis 
Flavoring patterns of exclusive and dual-use of cigarettes and e-cigarettes
among US adults. Results from the TUS-CPS 2018-2019 
The impact of current tobacco
product use definitions on estimates
of transitions between cigarette and
e-cigarette use