Non-Combustible Nicotine Use Among Amateur and University Athletes: Prevalence, Patterns and Reasons—A Scoping Review

Highlights

Public health relevance—How does this work relate to a public health issue?

• This study examines non-combustible nicotine use among amateur and university athletes, a population underrepresented in nicotine and public health research.
• The study identifies how sporting environments, team culture, and athletic identity may influence vaping and smokeless nicotine use.

Public health significance—Why is this work of significance to public health?

• Findings suggest nicotine use in sports is shaped by social and cultural sporting contexts, not solely by individual health behaviours or risk factors.
• Athletes commonly perceive e-cigarettes and smokeless nicotine products as compatible with performance and lower risk than combustible tobacco, despite limited supporting evidence.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?

• Sport-specific nicotine prevention and education strategies should address performance beliefs, perceived harm reduction, and peer influences within sporting environments.
• Public health interventions may be strengthened by engaging coaches, team leaders, and sporting organisations to challenge the normalisation of nicotine use and reshape team norms.

Abstract

Background: Nicotine exposure is increasingly occurring through non-combustible products such as electronic cigarettes and nicotine pouches. Although sport participation is often considered protective against substance use, nicotine use appears to be increasingly normalised within performance-oriented sporting environments. Methods: This scoping review synthesised evidence on non-combustible nicotine use among amateur and university athletes. Following Joanna Briggs Institute (JBI) methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, the searches were conducted in Ovid MEDLINE, Web of Science, Embase, Scopus, SPORTDiscus, and CINAHL for peer-reviewed studies published from 2019 onwards that examined non-combustible nicotine use in these populations. Results: Eleven studies, predominantly cross-sectional and conducted in high-income Western countries, met the inclusion criteria. Nicotine use was more common among male athletes, younger athletes, and those participating in team and contact sports, particularly for e-cigarette use. Across studies, nicotine use was frequently characterised as socially normative and compatible with sport, influenced by peer networks, social identity, perceived harm reduction, and beliefs regarding performance enhancement, coping, and recovery. The evidence base was limited by inconsistent measurement approaches and a predominance of studies examining demographic correlates rather than behavioural drivers. Conclusions: Non-combustible nicotine use appears embedded within sport-specific social norms and performance-related beliefs, highlighting the need for theoretically informed research and sport-specific prevention strategies.

1. Introduction

Extensive evidence linking combustible tobacco use to adverse health outcomes has underpinned tobacco control efforts worldwide [1]. In high-income settings, policies such as increased taxation, smoke-free environments, and restrictions on advertising have been associated with marked declines in smoking prevalence [2,3]. Globally, WHO reports a reduction in tobacco use prevalence from approximately 34% in 2000 to 20% in 2022 across 150 countries, attributed in part to the implementation of comprehensive measures such as the WHO Framework Convention on Tobacco Control and MPOWER [4].

Despite these successes, nicotine use is undergoing a significant transformation. While smokeless tobacco products such as snuff and snus (i.e., tobacco used without combustion and consumed orally or nasally) have been established for decades, the emergence of alternative nicotine delivery systems has altered patterns of nicotine use [5]. In particular, the growing popularity of electronic cigarettes (e-cigarettes) and, more recently, nicotine pouches (i.e., tobacco-free pouches) has further contributed to nicotine uptake, especially among adolescents and young adults [3,6,7]. Globally, an estimated 86 million adults use e-cigarettes [3]. Consistent with concerns regarding younger populations, an international systematic review estimated that 15.3% of individuals aged 9–25 years had reported lifetime e-cigarette use [8]. In the United States, e-cigarette use increased from 8.8% in 2020 to 10.2% in 2022 among adults aged 18–29 years [9]. Similarly, in the United Kingdom, vaping prevalence reached 10% in the general population and 15.8% among individuals aged 16–24 years in 2023 [10]. In Australia, the prevalence of e-cigarette use tripled between 2019 and 2023, increasing from 2.5% to 7% among people aged 14 and over [11]. Among young adults aged 18–24 years, e-cigarette use increased fourfold during the same period, from 5.3% to 21% [11]. Although recent estimates suggest that e-cigarette use among Australian adolescents aged 14–17 years decreased from approximately 18% to 15% from 2023 to 2025, prevalence remains substantial [12]. Emerging products such as nicotine pouches have raised further concern, as their uptake may follow patterns similar to those observed for e-cigarettes [13]. While combustible tobacco use has often been characterised as highly visible and socially stigmatised, emerging nicotine products are increasingly associated with perceptions of reduced harm, discretion, and social acceptability [14,15,16]. These perceptions may be reinforced by policy environments in some countries, such as the United Kingdom, where certain nicotine products are recommended as smoking cessation aids. This may help explain their growing uptake [17]. Collectively, these factors may increase the likelihood of nicotine product uptake among populations not traditionally associated with tobacco use [18], including athlete populations [19].

Emerging nicotine products are capable of delivering substantial doses of nicotine, sometimes exceeding those delivered by combustible tobacco [20]. Nicotine acts on the central nervous system by stimulating nicotinic acetylcholine receptors, which are associated with short-term subjective effects, including increased alertness, enhanced concentration, and perceived reductions in stress or discomfort [21]. In sporting contexts, these sensations can be construed as compatible with training and competition, supporting perceptions of functional benefit despite the lack of consistent evidence that nicotine enhances physical performance [22,23,24,25].

Within elite sport, the stimulatory impacts of nicotine have attracted scientific and regulatory attention [26]. Prevalence studies suggest that a notable proportion of elite athletes use nicotine, leading to its inclusion in the World Anti-Doping Agency (WADA) Monitoring Program [26]. As a result, much of the existing evidence on nicotine use among athletes has been shaped by concerns arising within elite sport, where athletes operate in highly regulated environments. In contrast, amateur and university athletes compete in less regulated sporting contexts, suggesting that evidence and policy frameworks derived from elite sport may not be directly applicable to these populations.

Amateur and university athletes represent a distinct, non-elite sporting population that has received comparatively little attention in nicotine-related research. However, their participation in organised sport may expose them to social, cultural, and performance-related influences that shape nicotine use. They are often located within overlapping life stages and participate in socially dense sporting environments that shape shared norms, identities, and meanings around substance use [27,28]. Furthermore, amateur and university athletes are also often in an age bracket (14–25 years) that may be particularly susceptible to social media influences [29]. The promotion of emerging nicotine products through social media platforms has increased in recent years [30]. Within these sporting environments, the visibility of nicotine product use by high-profile athletes may contribute to the normalisation of these products within sporting cultures [29,31], reinforcing unsubstantiated claims of non-combustible nicotine use as compatible with athletic performance. Despite growing concern regarding nicotine use in sport, evidence relating specifically to amateur and university athletes remains fragmented, with studies dispersed across different sporting contexts, nicotine products, and measures of nicotine use. Therefore, these limitations restrict understanding of prevalence, patterns of use, and reasons underpinning nicotine use in these populations [28,32].

Accordingly, this scoping review aims to map and synthesise the peer-reviewed literature on non-combustible nicotine use among amateur and university athletes. Specifically, the review examines prevalence, patterns of use, reported reasons for use, and methodological and conceptual gaps in the literature to inform future research and sport-specific prevention strategies. The review was guided by the following question: “What is known about the prevalence, patterns, and reported reasons for non-combustible nicotine use among amateur or university athletes in the peer-reviewed literature?”

2. Materials and Methods

2.1. Study Design

A scoping review was undertaken to map and synthesise the literature on the prevalence, patterns, and reported reasons for non-combustible nicotine use among amateur and university athletes. Given the fragmented and heterogeneous nature of research in this area, a scoping review is well-suited to capturing the breadth, characteristics, and conceptualisation of existing evidence [33]. This approach enables examination of how nicotine use has been studied, measured, and interpreted across diverse contexts.

This scoping review was conducted according to the Joanna Briggs Institute (JBI) methodology for scoping reviews [34] and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines (Table S1) [35].

2.2. Eligibility Criteria

This review included peer-reviewed research studies, including descriptive, experimental, qualitative, and quantitative studies. Studies published in English were eligible for inclusion.

For the purpose of this review, amateur and university athletes were defined as individuals participating in organised sport who are not engaged in professional or elite competition. Studies were excluded if they did not clearly identify the population as amateur or university athletes, did not assess nicotine use in an athletic population, or were exclusively focused on combustible tobacco products (e.g., cigarettes or waterpipes) to maintain focus on emerging non-combustible nicotine products (e.g., e-cigarettes, snus, snuff, nicotine pouches).

Literature reviews, theses, conference abstracts, editorials, commentaries, policy papers, and other non-peer-reviewed sources were excluded. To minimise potential conflicts of interest, publications sponsored or funded by the tobacco or nicotine industry were not included in this review.

2.3. Search Strategy

A systematic search was conducted across six databases: Ovid MEDLINE, Embase, CINAHL, Scopus, SPORTDiscus, and Web of Science. A research librarian was consulted to refine the search strategy. The search was conducted in March 2026 and included articles published from January 2019 onwards to capture literature relating to emerging nicotine products associated with recent increases in nicotine use, as well as the rapid growth of non-combustible nicotine use among adolescents and young adults in recent years [36].

The search strategy was developed using the Population–Concept–Context (PCC) framework. Given that the sporting setting formed part of the definition of the population of interest, the Population and Context elements were combined into a single search domain. An initial search strategy was developed in Ovid Medline (

Table 1. Search strategy developed using the Population–Concept–Context (PCC) framework.

PCC Elements	Search Terms
Population and Context: Amateur and university athletes participating in organised sporting environments	(Universities AND (Sports OR Athletes)) OR ((amateur OR non-elite OR sub-elite OR community OR club OR recreation*) adj (sport* OR athlete*)) OR Youth Sports OR Team Sports OR football OR soccer OR rugby OR cricket OR basketball OR volleyball OR netball OR hockey OR lacrosse OR baseball OR softball OR “runner*” OR running OR “swimmer*” OR swimming OR “cyclist*” OR cycling OR “rower*” OR rowing OR “gymnast*” OR tennis OR badminton OR handball OR ((sport* adj3 (participant* OR player OR team*)) and (non-professional or amateur)) OR Athletes OR Sports AND
Concept: Nicotine use and nicotine-containing products	Nicotine OR Nicotine Chewing Gum OR Electronic Nicotine Delivery Systems OR “electronic cigar*” OR “e-cig*” OR “vape*” OR Vaping OR “nicotine use*” OR “nicotine product*” OR “nicotine pouch*” OR “snus” OR “snuff” OR “nicotine use*” OR “nicotine product*” OR “nicotine pouch*” OR “oral nicotine product*” OR “modern oral nicotine*” OR Zyn OR Velo OR “Smokeless nicotine” OR Tobacco, Smokeless

) and adapted for use across other databases, with support from a custom-configured M365 AI Agent (Microsoft 365 Copilot), verified by the research team and a research librarian. The complete search strategies for all databases are provided in Supplementary Table S2.

2.4. Study Selection

All eligible studies were uploaded to Covidence, and duplicates were removed before title and abstract screening was conducted independently by two screeners (NH and CL). Full-text screening was also conducted independently by two reviewers. Discrepancies were resolved through discussion or consultation with a third reviewer (CB). The study selection process is shown in the PRISMA flow chart (Figure 1). Consistent with JBI recommendations, no formal quality appraisal was undertaken, as the aim of this scoping review was to map the available evidence rather than assess risk of bias [34].

2.5. Data Extraction, Charting, and Synthesis

Data were extracted using a customised template developed for this scoping review (Table 2). Extracted variables included study characteristics (year, country, design), participant characteristics (age group, athlete type, sporting context), nicotine products assessed, and outcomes related to prevalence, patterns, and reasons for use. Data extraction was initially undertaken manually. The extracted data were then imported into Google NotebookLM (Google LLC, Mountain View, CA, USA; https://notebooklm.google.com/, accessed on 25 August 2026) [37] to assist with data organisation and structuring (e.g., grouping study characteristics and identifying consistent variable labels). All outputs were reviewed against the original source articles, and final extracted data were independently reviewed and verified by the primary reviewer (NH).

Data analysis involved both descriptive and qualitative approaches. Descriptive analysis was used to summarise study characteristics. A narrative synthesis was conducted to summarise and organise findings across studies, focusing on prevalence, patterns, and reported reasons for non-combustible nicotine use, consistent with JBI guidance for scoping reviews [38]. Within the narrative synthesis, extracted data relating to patterns of use and reported reasons for use were reviewed and coded by the primary reviewer (NH). Similar concepts were identified through colour-coding and grouped into broader categories, while contrasting findings were retained and examined alongside recurring patterns. The resulting categories and interpretation of findings were reviewed and verified by a second reviewer (CB) and refined through comparison with the original study findings.

Table 2. Data extraction table of included studies.

	Study (Year), Country & Design	Population of Interest (n)	Type of Sports	Product & Prevalence *	Patterns/Rationale	Discussion/Key Findings
1	Milicic et al. (2019), Canada, Cross-sectional [39]	10,386 (Recreational) 11,629 (competitive) 13,637 (team sports)	Recreational, competitive, team sports	E-cigarettes 1 Male: 12.3% Female: 7%	E-cigarettes were perceived by users as a novel technological product with minimal perceived harm, particularly among male users. Participation in sport and physical activity declined with age, consistent with prior evidence indicating lower e-cigarette use among older adolescents.	E-cigarette users were more likely to engage in physical activity than non-users. A statistically significant association was observed between sport participation and e-cigarette use status. E-cigarette use was more prevalent than combustible cigarette smoking during the 2014–2015 school year.
2	Chaffee et al. (2019), USA, Prospective cohort [14]	594 male athletes	Interscholastic baseball	Smokeless tobacco (ST): Ever user 3: 36% Experienced user 3: 31% E-cigarettes: Ever user 3: 36%	Initiation of ST use was associated with peer and family use, low perceived harm, masculinity-related norms, rural traditions, and exposure to professional athlete role models. High susceptibility to ST use was observed; prior e-cigarette use did not predict ST initiation.	ST use among baseball players was nearly three times higher than among non-athlete peers and approximately twice the prevalence for high-school males. Expectations regarding ST predicted progression at one-year follow-up, with 89% remaining current users. High incidence rates were observed: 13% of never-users initiated ST use, and 17% of experimenters progressed to experienced use.
3	Williams et al. (2020), Canada, Cross-sectional [40]	6430 (recreational) 6569 (varsity) 14,270 (both)	Recreational, varsity	E-cigarettes 1 Recreational: 16.7% Varsity: 27.3% Both: 24.6%	Health-conscious youth avoid combustible cigarettes but perceived e-cigarettes as a safer alternative. Sport-specific team cultures and identities influenced behaviour alignment among athletes.	Participation in varsity or multiple sport contexts was associated with increased odds of e-cigarette use (OR 1.37–1.57). Recreational sport participation appeared generally protective.
4	Gossin et al. (2020), Switzerland, Cross-sectional [41]	3434	Team, individual	Snus 1 Occasional use: 9.6% Weekly use: 5.4% Snuff 1 Occasional use: 17.2% Weekly use: 2.3% E-cigarette 1 Occasional use: 3.3% Daily use: 1.1%	Cultural rituals (e.g., snus use in ice hockey) and peer influence were prominent. Athletes perceived potential performance-enhancing effects of nicotine. Lower vaping prevalence may reflect reduced exposure to vaping advertising.	Athletes are more likely to snus (p < 0.05) and snuff (p > 0.05) but less likely to vape compared with non-athletes. Individual-sport athletes are less likely to use snus or snuff but more likely to vape than team athletes. Athletes generally reported lower overall nicotine consumption.
5	O’Sullivan et al. (2021), Retrospective observational [42]	546	Rugby, soccer, Gaelic games, athletics, other sports	E-cigarette Current user 2: 2% Ever user: 23%	Use was highest among smokers, younger participants, and males; peer use was influential. Rugby players exhibited a higher prevalence compared to other sports. Amateur athletes were described as less health-conscious than elite athletes.	Prevalence of e-cigarette use was higher among amateur athletes than reported in elite athletes. Team and contact sports were associated with increased risk. Sport participation may exert a protective effect against certain unhealthy behaviours.
6	Soule et al. (2021), USA, Cross-sectional [43]	4256 (varsity) 5165 (club) 9038 (recreational)	Varsity, Club, Recreational	E-cigarette 1 Recreational: 6.2% Varsity: 4.9% Club: 5.3%	Convenience and perception of e-cigarettes as a technological innovation that is compatible with “elite athlete lifestyle.” Performance perceptions were not linked to concerns about health risks in the same way as combustible cigarettes. High density of e-cigarette retailers in college towns.	Athletes demonstrated equal or higher prevalence of e-cigarette use compared with non-athletes. Varsity status was protective for smoking but not for e-cigarette use.
7	Bullock et al. (2021), USA, Descriptive epidemiology [28]	97 (current players) 117 (former players)	Collegiate (81%) and Professional baseball (18%)	E-cigarette 2 Current player: 14% Former player: 3% ST (Chewing tobacco, snuff) 2 Current player: 26% Former player: 34%	ST use was career-associated, often initiated during active participation and continuing post-retirement.	Athletes frequently continued ST use after retirement. E-cigarette use was significantly higher among current players than former players.
8	Martin et al. (2021), USA, Cross-sectional [44]	230 collegiate female athletes	Individual, field/court, bat/ball, collision	E-cigarette 2 19.5%	E-cigarettes were used as a coping strategy for sport-related stress, pressure, and pain. Products were perceived as safer alternatives or smoking cessation tools due to fewer public-space restrictions and limited longitudinal evidence on performance effects. Increased marketing directed at younger consumers.	E-cigarette use was significantly more prevalent than combustible cigarette smoking among female athletes.
9	Chague et al. (2021), France, Cross-sectional [32]	559	Rugby	E-cigarette 2: 4.7% Dual use 2 (e-cigarettes and traditional tobacco): 3.4% Snuff 2: 0%	Approximately 75% of e-cigarette users reported vaping within two hours of training or competition. E-cigarettes were used to avoid smoking and minimise perceived performance impacts. E-cigarettes were perceived as less harmful to athletes’ health.	Awareness of e-cigarette risks was lower than awareness of cigarette risks. Female players’ vaping behaviours were influenced by normative social factors. Vaping prevalence among athletes exceeded that of the general French adult or student populations. E-cigarettes may function as a gateway to combustible smoking.
10	Rapoport et al. (2023), USA, Cross-sectional [45]	16,790	School or community sport teams	E-cigarette 1 18.3%	Peer group influence; perceptions of low harm and addictiveness.	Sport participation was associated with higher odds of EVP use but lower odds of cigarette smoking. Sport participation remained protective for combustible cigarette use.
11	Yazidjoglou et al. (2025), Australia, Qualitative [29]	96	Netball, basketball, footy, track, etc.	E-cigarette Ever user 4: 60% Former user: 21% Never user: 19%	Athletes described “responsible” vaping practices (e.g., not owning devices, situational use only). Non-users avoided initiation due to concerns about lung damage and breathlessness affecting performance. Current users often initiated cessation after perceiving declines in fitness. Some continued users believed high fitness mitigated potential harms.	Users reported shortness of breath impairing performance during activity. No participants reported using e-cigarettes for performance enhancement. Former users described noticeable improvements in fitness after cessation.

* Prevalence estimates are reported according to the definitions used in the original studies and were not harmonised across studies. ¹ Current use was defined as any use within the past 30 days. ² Current use was defined as at the time of survey completion. ³ Ever user was defined as an individual with ≤20 lifetime uses; experienced user was defined as an individual with >20 lifetime uses. ⁴ Ever user was defined as a current or occasional user.

Table 2. Data extraction table of included studies.

	Study (Year), Country & Design	Population of Interest (n)	Type of Sports	Product & Prevalence *	Patterns/Rationale	Discussion/Key Findings
1	Milicic et al. (2019), Canada, Cross-sectional [39]	10,386 (Recreational) 11,629 (competitive) 13,637 (team sports)	Recreational, competitive, team sports	E-cigarettes 1 Male: 12.3% Female: 7%	E-cigarettes were perceived by users as a novel technological product with minimal perceived harm, particularly among male users. Participation in sport and physical activity declined with age, consistent with prior evidence indicating lower e-cigarette use among older adolescents.	E-cigarette users were more likely to engage in physical activity than non-users. A statistically significant association was observed between sport participation and e-cigarette use status. E-cigarette use was more prevalent than combustible cigarette smoking during the 2014–2015 school year.
2	Chaffee et al. (2019), USA, Prospective cohort [14]	594 male athletes	Interscholastic baseball	Smokeless tobacco (ST): Ever user 3: 36% Experienced user 3: 31% E-cigarettes: Ever user 3: 36%	Initiation of ST use was associated with peer and family use, low perceived harm, masculinity-related norms, rural traditions, and exposure to professional athlete role models. High susceptibility to ST use was observed; prior e-cigarette use did not predict ST initiation.	ST use among baseball players was nearly three times higher than among non-athlete peers and approximately twice the prevalence for high-school males. Expectations regarding ST predicted progression at one-year follow-up, with 89% remaining current users. High incidence rates were observed: 13% of never-users initiated ST use, and 17% of experimenters progressed to experienced use.
3	Williams et al. (2020), Canada, Cross-sectional [40]	6430 (recreational) 6569 (varsity) 14,270 (both)	Recreational, varsity	E-cigarettes 1 Recreational: 16.7% Varsity: 27.3% Both: 24.6%	Health-conscious youth avoid combustible cigarettes but perceived e-cigarettes as a safer alternative. Sport-specific team cultures and identities influenced behaviour alignment among athletes.	Participation in varsity or multiple sport contexts was associated with increased odds of e-cigarette use (OR 1.37–1.57). Recreational sport participation appeared generally protective.
4	Gossin et al. (2020), Switzerland, Cross-sectional [41]	3434	Team, individual	Snus 1 Occasional use: 9.6% Weekly use: 5.4% Snuff 1 Occasional use: 17.2% Weekly use: 2.3% E-cigarette 1 Occasional use: 3.3% Daily use: 1.1%	Cultural rituals (e.g., snus use in ice hockey) and peer influence were prominent. Athletes perceived potential performance-enhancing effects of nicotine. Lower vaping prevalence may reflect reduced exposure to vaping advertising.	Athletes are more likely to snus (p < 0.05) and snuff (p > 0.05) but less likely to vape compared with non-athletes. Individual-sport athletes are less likely to use snus or snuff but more likely to vape than team athletes. Athletes generally reported lower overall nicotine consumption.
5	O’Sullivan et al. (2021), Retrospective observational [42]	546	Rugby, soccer, Gaelic games, athletics, other sports	E-cigarette Current user 2: 2% Ever user: 23%	Use was highest among smokers, younger participants, and males; peer use was influential. Rugby players exhibited a higher prevalence compared to other sports. Amateur athletes were described as less health-conscious than elite athletes.	Prevalence of e-cigarette use was higher among amateur athletes than reported in elite athletes. Team and contact sports were associated with increased risk. Sport participation may exert a protective effect against certain unhealthy behaviours.
6	Soule et al. (2021), USA, Cross-sectional [43]	4256 (varsity) 5165 (club) 9038 (recreational)	Varsity, Club, Recreational	E-cigarette 1 Recreational: 6.2% Varsity: 4.9% Club: 5.3%	Convenience and perception of e-cigarettes as a technological innovation that is compatible with “elite athlete lifestyle.” Performance perceptions were not linked to concerns about health risks in the same way as combustible cigarettes. High density of e-cigarette retailers in college towns.	Athletes demonstrated equal or higher prevalence of e-cigarette use compared with non-athletes. Varsity status was protective for smoking but not for e-cigarette use.
7	Bullock et al. (2021), USA, Descriptive epidemiology [28]	97 (current players) 117 (former players)	Collegiate (81%) and Professional baseball (18%)	E-cigarette 2 Current player: 14% Former player: 3% ST (Chewing tobacco, snuff) 2 Current player: 26% Former player: 34%	ST use was career-associated, often initiated during active participation and continuing post-retirement.	Athletes frequently continued ST use after retirement. E-cigarette use was significantly higher among current players than former players.
8	Martin et al. (2021), USA, Cross-sectional [44]	230 collegiate female athletes	Individual, field/court, bat/ball, collision	E-cigarette 2 19.5%	E-cigarettes were used as a coping strategy for sport-related stress, pressure, and pain. Products were perceived as safer alternatives or smoking cessation tools due to fewer public-space restrictions and limited longitudinal evidence on performance effects. Increased marketing directed at younger consumers.	E-cigarette use was significantly more prevalent than combustible cigarette smoking among female athletes.
9	Chague et al. (2021), France, Cross-sectional [32]	559	Rugby	E-cigarette 2: 4.7% Dual use 2 (e-cigarettes and traditional tobacco): 3.4% Snuff 2: 0%	Approximately 75% of e-cigarette users reported vaping within two hours of training or competition. E-cigarettes were used to avoid smoking and minimise perceived performance impacts. E-cigarettes were perceived as less harmful to athletes’ health.	Awareness of e-cigarette risks was lower than awareness of cigarette risks. Female players’ vaping behaviours were influenced by normative social factors. Vaping prevalence among athletes exceeded that of the general French adult or student populations. E-cigarettes may function as a gateway to combustible smoking.
10	Rapoport et al. (2023), USA, Cross-sectional [45]	16,790	School or community sport teams	E-cigarette 1 18.3%	Peer group influence; perceptions of low harm and addictiveness.	Sport participation was associated with higher odds of EVP use but lower odds of cigarette smoking. Sport participation remained protective for combustible cigarette use.
11	Yazidjoglou et al. (2025), Australia, Qualitative [29]	96	Netball, basketball, footy, track, etc.	E-cigarette Ever user 4: 60% Former user: 21% Never user: 19%	Athletes described “responsible” vaping practices (e.g., not owning devices, situational use only). Non-users avoided initiation due to concerns about lung damage and breathlessness affecting performance. Current users often initiated cessation after perceiving declines in fitness. Some continued users believed high fitness mitigated potential harms.	Users reported shortness of breath impairing performance during activity. No participants reported using e-cigarettes for performance enhancement. Former users described noticeable improvements in fitness after cessation.

* Prevalence estimates are reported according to the definitions used in the original studies and were not harmonised across studies. ¹ Current use was defined as any use within the past 30 days. ² Current use was defined as at the time of survey completion. ³ Ever user was defined as an individual with ≤20 lifetime uses; experienced user was defined as an individual with >20 lifetime uses. ⁴ Ever user was defined as a current or occasional user.

3. Results

A total of 11 empirical studies met the inclusion criteria. Geographically, the studies were concentrated within high-income Western nations, predominantly the United States (US) [14,28,43,44,45] but also Canada [39,40], France [32], Switzerland [41], Ireland [42], and Australia [29].

Methodologically, most studies were observational cross-sectional (n = 9) [28,32,39,40,41,42,43,44,45], with one longitudinal cohort [14] and one qualitative study [29].

Participants were predominantly adolescents and young adults, with samples including secondary school students and adolescents aged approximately 14–18 years [14,29,39,40,41,45], young adults aged 18–21 years [43,44], broader adult cohorts aged 18–35 years [28,42], and, in one study, participants aged from 18 to over 55 years [32].

The studies included a wide range of nicotine products, most commonly e-cigarettes [14,28,29,32,39,40,41,42,43,44,45], smokeless tobacco (ST), including snuff [14,28,32,41], snus [14,41], and chewing tobacco [14,28].

Sporting contexts varied and included recreational [39,40,42,43], club [43], and varsity [39,40,43] participation. Use within team-based [14,28,32,39,41,42,44,45] and individual sports [29,41,44] was also described in the included studies.

3.1. Epidemiology of Nicotine Use Among Amateur Athletes

Demographics

Past 30-day e-cigarette use varied substantially across countries. The highest prevalence was reported in North American samples, including 27.3% among Canadian varsity athletes and 18.3% among US high school sports team participants [40,45]. Using an alternative definition of current use (use at the time of survey completion), one study reported a prevalence of 19.5% among female US collegiate athletes [44]. European studies reported lower prevalence of current use, including 4.7% among French amateur rugby players, 4.4% among Swiss young male athletes, and 2% among Irish sports professionals [32,41,42].

The use of ST appeared to be specific to both cultural background and sport. Among US baseball players, ST use was common, with 26% of current players and 36% of rural high school players reporting ever use [14,28]. In Switzerland, athletes were more likely to occasionally use snus (9.6%) and snuff (17.2%) compared to non-athletes (6.6% and 16%, respectively) [41]. No snuff use was reported in the French rugby population [32].

Across studies, nicotine use was generally more prevalent among male athletes [29,39,42], although one study of French amateur rugby players reported higher past 30-day e-cigarette use among female participants compared with males (7% vs. 4.4%) [32]. E-cigarette use was most commonly reported among young adult athletes aged 18–24 years [28,32,41,42,43]. In contrast, ST use was more prevalent among older cohorts, with one study reporting higher current use among older baseball athletes compared to younger athletes (34% vs. 26%) [28].

3.2. Patterns and Rationales of Nicotine Use

3.2.1. Social Identity and Sport Contexts

Several studies reported differences in nicotine use according to sport type and mode of participation [14,29,41,42,45]. Higher prevalence of nicotine use was observed among athletes involved in team and contact sports compared with those participating in individual sports [14,29,41,42,45]. Authors frequently highlighted the social nature of team sports and the potential influence of shared environments and peer norms. Chaffee et al. [14] identified having friends who use nicotine products as a significant predictor of initiation and progression of use. Sport-specific patterns were also described. For instance, snus use was commonly reported among athletes participating in sports such as ice hockey, while snuff and chewing tobacco use were frequently observed in baseball and rugby populations [14,28,32,41].

3.2.2. Level of Amateur Competition Influences Nicotine Use

E-cigarette use varied across levels of sport participation. In a large Canadian survey, past 30-day e-cigarette use was reported by 27.3% of varsity athletes and 16.7% of recreational participants [40]. In a US study, past 30-day e-cigarette use was reported by 4.8% of varsity athletes and 6.2% of recreational athletes [43]. Differences were also observed between team and individual sports. Swiss data indicated significantly higher past 30-day snus use (19.6% vs. 13%) and snuff use (23.7% vs. 17.9%) among team-sport participants compared with individual-sport participants [41]. Similar patterns of nicotine use were reported in several other studies [29,42,45].

3.2.3. Health Perceptions and Risk Management

Across studies, athletes demonstrated a lower prevalence of combustible cigarette smoking compared with non-athletes, while rates of e-cigarette use were similar or higher [39,40,43,45]. Several authors suggested that athletes may perceive electronic nicotine products as a lower-risk alternative to smoking [14,32,39,40,44,45]. One study reported that e-cigarettes and ST were also viewed by athletes as having fewer immediate health consequences and as less likely to impair athletic performance [29]. Some studies reported that e-cigarette users were more likely to meet physical guidelines compared with non-users [29,40,45]. Milicic et al. [39] described this pattern as consistent with beliefs regarding the compatibility of e-cigarette use with an active or performance-oriented lifestyle, particularly among male athletes.

3.2.4. Functional Use: Performance, Coping, and Cessation

Several studies reported that athletes used nicotine for functional reasons related to performance, coping, or smoking cessation [32,41,43,44]. Athletes reported mixed beliefs regarding nicotine’s effects on performance, with some perceiving improvements in alertness or pain tolerance [41,43], while one study reported no benefit or negative effects on fitness and sporting goals [29]. Nicotine use was also reported as a coping strategy, particularly among athletes experiencing injury, chronic pain, or psychological stress [44]. In addition, several studies reported the use of e-cigarettes as a smoking cessation aid to reduce the perceived impact of combustible tobacco on fitness [32,43,44]. Conversely, some former users reported improvements in physical capacity after discontinuing nicotine use [29].

3.2.5. Behavioural Patterns and Operational Considerations

Patterns of nicotine use were also shaped by the practical demands of sporting participation. Athletes commonly reported consuming nicotine within a short window before and after training sessions or competitions [32]. Authors noted that the convenience and discretion of e-cigarettes may facilitate use in sporting environments where smoking is impractical or socially discouraged [14,32,43]. Some athletes also described adopting “responsible” use patterns, such as limiting frequency, abstaining during intensive training periods, or avoiding device ownership [29].

4. Discussion

This scoping review mapped and synthesised evidence on the prevalence, patterns, and reported reasons for non-combustible nicotine product use among amateur and university athletes. Collectively, the literature suggests that e-cigarette use was more prevalent among younger athletes, particularly males and those participating in team-based sports, while ST use appears more common among older athletes and within specific sporting cultures. However, prevalence and patterns of use were not uniform and varied according to product type, age group, and mode of sporting participation. Across studies, reported reasons for non-combustible nicotine use were shaped by social and sporting contexts, including peer influence and team norms, as well as athletes’ perceptions of e-cigarettes and ST as lower-risk alternatives to combustible cigarettes. Practical considerations related to sporting participation, such as convenience and discretion, also featured prominently in accounts of use.

A key theme emerging from this review is an apparent paradox of nicotine use within a population typically characterised by high levels of physical activity and engagement in health-promoting behaviours. Several included studies suggested that athletes may perceive nicotine-related risks differently within performance-oriented contexts. E-cigarettes and ST were frequently framed by athletes as lower-harm nicotine alternatives that were perceived as compatible with training demands and unlikely to compromise performance [14,32,39,40,43,45]. Rather than viewing nicotine use as contradictory to athletic identity, several studies described athletes perceiving non-combustible nicotine products as acceptable or neutral within a performance-focused lifestyle.

Age-related differences in nicotine use were observed in one study [28]. These differences may reflect factors including generational familiarity with specific nicotine products and changing patterns of product availability [46]. Moreover, shifts in marketing strategies towards digital platforms and social media have been suggested to increase the visibility of e-cigarette use among younger populations [44]. However, this interpretation has been contrasted with evidence suggesting that athletes may be less exposed to vaping promotion due to the lower levels of engagement in certain social and entertainment settings, highlighting variability in exposure and uptake across contexts [41].

Differences in nicotine use were also observed according to sport type and mode of participation. Higher prevalence of e-cigarette use among team-sport athletes was commonly interpreted in relation to social dynamics, including peer influence, group norms, and shared sporting identities [14,29,42,45]. However, findings are not entirely consistent, with some indicating that athletes in individual sports are more likely to use e-cigarettes [32,41], while team-sport participants show higher use of ST products [41]. Additionally, gender differences were similarly evident, with higher nicotine use generally reported among male athletes, particularly ST [29,39,42]. These patterns suggest that nicotine use may be influenced not only by individual risk perceptions but also by the social context and traditions associated with particular sports and their surrounding sporting cultures [14,41,43]. In particular, ST use has been associated with masculine sporting identities, a perception that was described as being reinforced through the marketing and cultural positioning of these products within certain sporting settings [14]. The higher prevalence of snus use reported among ice hockey athletes in several studies may reflect the influence of sport-specific norms and values [32,41]. It is possible that characteristics commonly associated with ice hockey, including its physical and highly competitive nature, may contribute to the social acceptability of ST products within that sporting context.

Several studies suggested that athletes use nicotine products for functional purposes related to performance enhancement, coping, or smoking cessation. While some athletes perceived benefits such as increased alertness or pain tolerance, experimental evidence does not support meaningful improvements in objective physical performance outcomes [22,43]. This finding is notable, given nicotine’s continued inclusion in WADA’s Monitoring Program. Rather than indicating definitive evidence of an ergogenic effect, its inclusion appears to reflect concerns regarding its widespread use among athletes, potential health risks, and the possibility of performance-enhancing effects that have not yet been conclusively established. Moreover, the disconnect between perceived and demonstrated performance benefits suggests that nicotine use among athletes may be influenced more by beliefs and sport-specific narratives than by evidence-based performance benefits.

Nicotine use was also described as a coping strategy in the context of injury, pain, or psychological stress [43], as well as a self-regulatory tool among athletes seeking to reduce or cease combustible cigarette use [32,40,43,44,45]. Together, these findings suggest that nicotine products may serve multiple functions within athletic populations, extending beyond performance enhancement to include stress management, injury-related coping, and harm-reduction practices. Authors further noted that uncertainty surrounding the long-term health effects of e-cigarettes may contribute to their continued use, allowing athletes to interpret these products as acceptable or temporary solutions within a performance-oriented lifestyle [28,39,40,42]. This highlights how perceptions of reduced harm, rather than established evidence of safety, may facilitate nicotine use among athletes and potentially normalise the use of alternative nicotine products within sporting environments.

Finally, patterns of nicotine use among athletes may be influenced by the practical demands of sporting environments. Two studies noted that the convenience and discreet nature of e-cigarettes and ST may facilitate use in contexts where smoking is impractical or socially discouraged [14,43]. Athletes described timing nicotine consumption around training or competition, specifically adopting self-regulated or “responsible” patterns of use [29]. These findings indicate that some athletes report integrating nicotine use into training and competition routines [32,42], highlighting how athletes may actively negotiate nicotine use in relation to performance goals and physical well-being, rather than engaging in indiscriminate risk-taking.

Strengths and Limitations

This scoping review is the first to provide a comprehensive mapping of the contemporary literature on emerging nicotine product use among amateur and university athletes. By synthesising evidence across diverse sporting contexts, nicotine product types, and study designs, this review clarifies how nicotine use has been conceptualised, measured, and interpreted in populations that are underrepresented in existing sport and nicotine research.

Several limitations of the existing literature should be acknowledged. Firstly, the geographical distribution of studies is heavily concentrated in Western countries, particularly North America and Europe. This limits the generalisability of findings to non-Western contexts, where cultural norms, regulatory environments, and sport systems may shape nicotine use differently. In addition, the inclusion of English-language publications only may have contributed to the underrepresentation of research conducted in non-English-speaking settings.

Secondly, the review adopted a broad definition of amateur and university athletes to capture the breadth of literature relating to non-elite sporting populations. While this approach was consistent with the aims of a scoping review, it encompassed athletes from diverse sporting contexts, competition levels, and demographic backgrounds. Therefore, the heterogeneity observed across the included studies may partly reflect differences in the populations studied. Additionally, the review was restricted to peer-reviewed research studies and excluded grey literature sources. While this approach was intended to prioritise evidence that had undergone peer review, it may have resulted in the exclusion of relevant surveillance data, sport-specific reports, and other sources that could have broadened understanding of nicotine use among athlete populations.

Thirdly, the literature is dominated by cross-sectional study designs. While these studies are useful for describing prevalence and associated factors, they provide only a snapshot of perspectives and do not allow examination of changes in nicotine use over time or establishment of causal relationships. As a result, important questions regarding initiation, progression, and cessation of nicotine use among university athletes remain underexplored. Longitudinal research in this context would be useful to better understand nicotine use trajectories over time and to inform contextually relevant prevention and intervention strategies.

Lastly, the search was restricted to studies published from January 2019 onwards to capture evidence relating to non-combustible nicotine products within a rapidly evolving nicotine landscape. While this approach enhanced the relevance of the findings to current patterns of nicotine use and sporting contexts, it may have excluded earlier studies examining nicotine use among athletes, particularly studies relating to products such as snus, snuff, or chewing tobacco. Consequently, the review should be interpreted as a synthesis of contemporary evidence.

5. Conclusions

This scoping review mapped the existing literature on nicotine use among amateur and university athletes, highlighting how non-combustible nicotine products have become embedded within sporting contexts despite broader declines in cigarette smoking. While sport participation remains associated with lower rates of combustible tobacco use, this protective effect does not consistently extend to products such as e-cigarettes and smokeless tobacco.

Across studies, nicotine use was shaped by social, cultural, and performance-related interpretations, with athletes frequently framing these products as less harmful, functionally useful, and compatible with athletic identity. However, the predominance of cross-sectional designs, reliance on self-reported data, and limited representation of female athletes and non-Western contexts constrain the current understanding.

Future research employing longitudinal and mixed-methods approaches is needed to clarify how nicotine use evolves over time and how athletes make sense of its role in relation to health, performance, and identity.

6. Future Directions

This scoping review suggests that non-combustible nicotine use is emerging as a relevant athlete-health issue within amateur and university sport. While sport participation has traditionally been considered protective against substance use, the findings indicate that e-cigarettes and smokeless nicotine products may be increasingly normalised through team cultures, peer influences, and beliefs regarding harm reduction and performance compatibility. These findings extend previous sports medicine research that has predominantly focused on elite athletes and the potential ergogenic effects of nicotine, highlighting the importance of understanding the social and cultural contexts that shape use in athletic populations.

Health promotion initiatives within colleges, universities, and sporting organisations may benefit from sport-specific education addressing perceived harm reduction, performance beliefs, and peer influences. Given the role of team culture in shaping nicotine use, interventions that engage coaches, team leaders, and the broader sporting environment may be more effective than approaches focused solely on individual behaviour change [47]. Similar sport-based health promotion programs, such as Australia’s Good Sports program, have successfully addressed alcohol-related norms and behaviours by targeting organisational culture and policy [48]. This review suggests that adapting such approaches to address alternative nicotine products may represent a promising strategy for reducing use and shifting social norms within sporting contexts.