Patterns of Daily and Non-Daily Nicotine Pouch Use Among U.S. Adults: An Exploratory Analysis of Use Contexts, Harm Perceptions, and Health Characteristics, 2025

Highlights

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

• Nicotine pouches are an emerging nicotine product with rapidly increasing use in the United States, yet detailed patterns of use among adults remain poorly understood.
• Understanding differences between daily and non-daily adult nicotine pouch use is important for identifying subgroups with greater nicotine exposure, co-use of other substances, and potential health risks.

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

• This study provides a comprehensive characterization of nicotine pouch use behaviors, motivations, perceptions, co-use patterns, and health correlates among U.S. adults reporting past-year use.
• Findings demonstrate meaningful heterogeneity between daily and non-daily use, with daily use associated with greater nicotine intensity, higher nicotine strengths, broader situational use, distinct risk perceptions, and higher prevalence of mental or behavioral health conditions.

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

• Public health surveillance should monitor not only nicotine pouch use prevalence and incidence but also frequency and intensity of use, average or usual nicotine strength per pouch, co-use with other substances, and driving risk factors such as perceptions of harm and addictiveness.
• Longitudinal research is needed to evaluate trajectories of problematic nicotine pouch use, dependence potential, product transitions, and long-term health outcomes associated with more intensive or complex patterns of use.

Abstract

This study examined differences between daily and non-daily nicotine pouch (NP) use by adults across various contexts in the United States (U.S.). Data were drawn from a cross-sectional survey of adults (≥18 years) reporting past-year NP use (N = 1009). Differences between daily and non-daily use groups were assessed using chi-square tests. Among the sample, 17.5% reported daily NP use. Daily use was associated with greater intensity, higher nicotine strength, and distinct situational use, including at home, while commuting, and at work or school (all p < 0.01). Adults who used daily more often endorsed motivations related to stress reduction, craving management, convenience, and product appeal (p ≤ 0.03). Daily use was linked to perceiving NPs as less harmful relative to combustible and smokeless tobacco, and more addictive relative to combustible, vaporized, and smokeless products (p < 0.05). Current and former use of combustible tobacco products, but not other substances, was common and varied by daily/non-daily use. Finally, adults who used daily were more likely to report a diagnosed mental or behavioral health condition (p = 0.002). Daily NP use reflects more intensive and contextually flexible use with distinct motivations and perceptions, underscoring heterogeneity in use patterns and the need for continued surveillance and longitudinal research on potential health implications.

1. Introduction

The nicotine product landscape in the United States (U.S.) has changed substantially in recent years with the emergence of newer nicotine delivery systems, including nicotine pouches (NPs). As these products continue to gain popularity, particularly among youth and young adults, understanding patterns of NP use and their public health implications has become increasingly important [1,2,3,4,5,6,7]. NPs, a type of novel oral nicotine product, differ from traditional oral tobacco (e.g., snus, chewing tobacco) by using prefilled microfiber pouches that contain crystallized nicotine powder rather than tobacco leaves [1]. Although cigarettes, cigars, and e-cigarettes continue to be used, emerging products such as NPs have gained increasing popularity among youth and adults [4,5,7,8,9,10]. These patterns may be explained in part by the products’ perceived appeal, strategic marketing campaigns, and the availability of flavored varieties [1,7,11,12,13,14,15], highlighting the need to better understand the risk and protective factors associated with NP use.

Recent data indicate an increase in NP sales over the past few years (e.g., 4% in 2023 to 5.4% in 2024 among U.S. youth) [8], accompanied by broad availability through online vendors and traditional retail stores [11,16,17,18]. Additionally, evidence suggests that NP use is commonly paired with other types of tobacco use. For example, among those who currently used NPs, 64.2% reported current e-cigarette use [19]. Factors surrounding use may be contextually driven (e.g., used in places where a combustible product is unacceptable) [20]. However, the extent to which NPs are paired with other tobacco products among adults is less understood [4]. Furthermore, relatively little is known about patterns of daily versus non-daily NP use in the general adult population. Distinguishing between these use patterns is important because daily use may reflect greater nicotine exposure, more established use behavior, and a higher likelihood of nicotine dependence, whereas non-daily use may be more indicative of experimentation, situational use, or product sampling. Adults who use daily may be at increased risk for nicotine-related adverse effects and concurrent use of other nicotine products [21], underscoring the need to characterize use patterns across levels of NP consumption. Understanding differences in use behaviors and product co-use across adults with daily and non-daily NP use may therefore help clarify the role of NPs within the broader nicotine product landscape.

Despite the increasing popularity and widespread availability of NPs, little is known about how these products are used across various contexts. Characterizing patterns of NP use—including frequency, intensity, and co-use with other tobacco products—is important for informing cessation and treatment efforts, tailoring public health messaging, identifying populations at risk for sustained nicotine exposure, and guiding evidence-based regulatory decision-making. Although studies have explored various dimensions of adult NP use, including epidemiological patterns, harm perceptions, awareness, motivations, and health effects, much of the existing work is constrained by small sample sizes collected as part of larger tobacco use studies and little is known about specific NP use patterns, risk perceptions, and health associations among U.S. adults [1]. Consequently, there is a critical need for studies that use larger, more diverse samples and NP-focused survey items to more comprehensively characterize use behaviors and associated risk and protective factors.

Our study, the Behavioral and Exposure Assessment of Adults Using Nicotine Pouches (BEAN), addresses this gap by providing, to our knowledge, one of the first surveys dedicated exclusively to adults who reported recent NP use. Guided by priorities in tobacco regulatory science [22], this exploratory study characterizes patterns of NP use and identifies factors associated with use behaviors, including potential risk and protective factors. This manuscript aims to comprehensively describe the BEAN sample and examine differences across a range of behavioral, product-related, psychosocial, and health domains by daily versus non-daily NP use.

2. Materials and Methods

2.1. Study Design and Recruitment

BEAN is a supplementary pilot study as part of the Appalachian Tobacco Regulatory Science Team (AppalTRUST) [23,24]. The BEAN Study employs a cross-sectional research design administered via an online survey to characterize NP use patterns, harm perceptions, and marketing factors, as well as health characteristics among U.S. adults reporting past-year use. We aimed to recruit a national convenience sample of at least 1000 adults, yielding an absolute number of adults who use NPs comparable to those observed in large national population-based surveys [4,5,6], while allowing for more detailed characterization specific to NP use patterns and perceptions. Participants were recruited through CloudResearch Prime Panels (CloudResearch, Flushing, NY, USA), an online platform that aggregates multiple opt-in research panels [25], from 2 December to 5 December 2025. CloudResearch employs Sentry, a proprietary data quality and bot-detection system, to screen respondents prior to survey entry [26]. Only participants meeting predefined quality criteria were permitted to access the survey link. Upon meeting eligibility criteria and agreeing to be in the study, participants were directed to a Qualtrics survey hosted by the University of Kentucky. All study procedures were reviewed and approved by the University of Kentucky Institutional Review Board. Participants provided electronic informed consent prior to beginning the survey, and all procedures were conducted in accordance with ethical principles for human subjects research.

To be eligible for the BEAN Study, adults had to self-report (1) past-year NP use, (2) U.S. residence, and (3) their age as 18 years or older. Those who met the eligibility criteria through the screening process were directed to the online survey, which took approximately 15 min to complete. Ineligible participants were redirected out of the survey. Eligible participants answered questions across the following survey sections: (1) Nicotine Pouch Characteristics, (2) Situations of and Main Reasons for Use, (3) Perceptions of Addictiveness, Toxicity, and Physical and Mental Health Effects, (4) Other Tobacco/Nicotine and Substance Use, (5) Health Status and Diagnosed Comorbidities, and (6) Background and Demographics. After completing the survey, participants were routed via CloudResearch Prime Panels back to the panel through which they were recruited and received compensation consistent with that panel’s standard practices. Prior studies have used CloudResearch Prime Panels for primary data collection in tobacco control and regulatory science research [27,28,29], supporting its utility as a recruitment platform for survey research involving adults who use tobacco/nicotine.

2.2. Participants

A total of 1526 respondents were eligible to participate. Following data quality checks, participants were excluded from analysis if they (1) did not complete the survey (n = 78), (2) completed the survey in fewer than five minutes (n = 265), a conservative threshold used to identify implausibly rapid responses that may indicate low-quality data, (3) failed any of the three attention checks (n = 170), or (4) indicated they were “Not honest at all” or “Not very honest” when completing the questionnaire (n = 4). The final analytic sample included 1009 respondents, meeting our target of at least 1000 adults reporting past-year NP use and demonstrating acceptable data quality. Figure S1 illustrates the study sample selection process and data quality exclusions.

2.3. Measures

2.3.1. NP Use Characteristics

Participants reported their NP use history and behaviors, including (1) recency of use (within the past 24 h; 2–7 days ago; 8–30 days ago; more than 30 days ago), (2) frequency of use in the past 30 days (0 days; 1–2 days; 3–5 days; 6–9 days; 10–14 days; 15–19 days; 20–29 days; all 30 days), (3) intensity of use, or the number of pouches used per day on days used (1 NP; 2–3 NPs; 4–5 NPs; 6–9 NPs; 10–14 NPs; 15 or more NPs), (4) usual nicotine strength per NP on days used (1–2 mg; 3–4 mg; 5–6 mg; 7–8 mg; 9 mg or higher; do not know/not sure), (5) usual NP brand (Zyn; On!; VELO; Rogue; Fully Loaded; Juice Head; Lucy; other (fill in the blank); no usual brand), and (6) usual NP flavor (mint/menthol; fruit; coffee, chocolate, or spice; tobacco; unflavored/flavorless; other (fill in the blank); do not know or not sure). Daily use was defined as NP use on all 30 of the past 30 days, whereas non-daily use was defined as use on 1–29 of the past 30 days.

2.3.2. NP Use Situations

Participants provided information on whether they used NPs (1) at work or school, (2) at home, (3) while driving or commuting, (4) while exercising (e.g., at the gym, weightlifting, or playing sports), (5) in social settings (e.g., with friends), (6) during high-stress situations or when feeling stressed, (7) in places where smoking or vaping is not allowed (e.g., indoors at work, public transportation, restaurants, or bars), (8) when respondents did not want others to know they were using nicotine (e.g., during class/meetings, around family or non-users), (9) while watching TV/streaming, gaming, or using phone/computer, and (10) other (fill in the blank). Participants could select all options that applied.

2.3.3. Main Reasons for NP Use

Similarly, participants provided the main reasons for NP use, including (1) to reduce stress or aid in coping with negative emotions, (2) to help manage nicotine cravings or withdrawal, (3) for convenience (e.g., discreet use, no smoke/vapor, easy to use anywhere), (4) because they can use them where smoking or vaping is not allowed, (5) because NPs do not produce odor, (6) curiosity or experimentation, (7) for social reasons (e.g., with friends or peers), (8) to help control appetite or weight, (9) to avoid using other tobacco or nicotine products (e.g., cigarettes, vapes), (10) because NPs taste good or have appealing flavors, (11) for energy, focus, or performance, and (12) other (fill in the blank). Participants could select all options that applied.

2.3.4. Perceptions of Harm, Addictiveness, and Toxicity

This survey section included questions on general harm perceptions of NPs as well as relative harm perceptions. Participants were asked about the (1) general harms of NPs (not at all; slightly; moderately; very; do not know or not sure) and (2) whether NPs cause harmful chemical exposure (yes; no; do not know or not sure). Furthermore, participants were asked about the (3) harms of NPs vs. combustible tobacco, (4) harms of NPs vs. Electronic Nicotine Delivery Systems (ENDS), (5) harms of NPs vs. smokeless tobacco, (6) addictiveness of NPs vs. combustible tobacco, (7) addictiveness of NPs vs. ENDS, and (8) addictiveness of NPs vs. smokeless tobacco. Response options for each included much less harmful/addictive; somewhat less harmful/addictive; about the same; somewhat more harmful/addictive; much more harmful/addictive; and do not know or not sure.

2.3.5. Other Tobacco/Nicotine and Substance Use

We asked participants about their never, former (i.e., non-past-30-day), and current (i.e., past-30-day) use of 17 substances and defined six broader categories: (1) combustible tobacco (i.e., cigarettes, big cigars, little cigars/cigarillos, hookah/waterpipe), (2) ENDS or heated tobacco (e.g., IQOS), (3) oral products (i.e., smokeless tobacco, flavored nicotine gum), (4) cannabis (i.e., smoking, blunting, vaping, dabbing, using delta-8-tetrahydrocannabinol), (5) alcohol (i.e., one full drink of any alcoholic beverage), and (6) other psychoactive drugs (i.e., kratom, prescription pill misuse, other (fill in the blank)).

2.3.6. Health Status and Diagnosed Comorbidities

Variables included (1) self-reported general health status (excellent; very good; good; fair; poor), (2) general oral health status (excellent; very good; good; fair; poor; do not know or not sure), (3) symptoms of anxiety based on Generalized Anxiety Disorder-2 (GAD-2) items [30], and (4) symptoms of depression based on Patient Health Questionnaire-2 (PHQ-2) items [30]. Participants were also asked whether they had ever been diagnosed (yes/no) with 30 different conditions, categorized into: (5) any mental or behavioral health condition (i.e., attention deficit hyperactivity disorder, anxiety disorder, depression, learning disability or disorder, mood disorder other than depression, obsessive–compulsive disorder, post-traumatic stress disorder, schizophrenia, sleep disorder), (6) any cardiometabolic condition (i.e., cardiac disease, diabetes, dyslipidemia, hypertension, obesity, pre-diabetes/borderline diabetes), (7) any respiratory condition (i.e., asthma, lung or respiratory disease such as COPD or chronic bronchitis), (8) any neurological condition (i.e., epilepsy/seizure disorder, multiple sclerosis/muscle spasms/spasticity, stroke or other neurological disorder), (9) any chronic pain or gastrointestinal condition (i.e., arthritis or joint disease, chronic nausea/cyclical vomiting syndrome, chronic pain, ulcers or other gastrointestinal disorder), (10) any other chronic medical condition (i.e., Human Immunodeficiency Virus, kidney disease, liver disease), and (11) any history of cancer.

2.3.7. Background and Sociodemographics

Defined characteristics included: age in years, gender identity (male/masculine; female/feminine; other), race and ethnicity (Hispanic; non-Hispanic White; non-Hispanic Black; non-Hispanic other), sexual orientation (heterosexual; gay/lesbian; bisexual; other), educational attainment (high school or less; some college/Associate’s degree; Bachelor’s degree; advanced degree), annual household income ($0 to $49,999; $50,000 to $99,999; $100,000 to $199,999; $200,000 or more), employment status (employed for wages; not employed; not in labor force), marital status (married; partnered, not married; not partnered), place of residence (city; town; suburban area; rural area), Appalachian residence (yes/no), and geographic region (Northeast; Midwest; South; West) based on state of residence. Other gender identities included transgender, gender variant/nonbinary, or another gender not listed; other sexual orientations included asexual, pansexual, queer, questioning/unsure, or another identity not listed; and other non-Hispanic races included American Indian/Alaska Native, Asian, Native Hawaiian/Pacific Islander, and multiracial.

2.4. Statistical Analysis

First, we calculated descriptive characteristics of all study variables overall and by daily/non-daily NP use status. Percentages were calculated using available-case denominators (i.e., respondents with non-missing data for the specific variable being reported) unless otherwise indicated. Variables with substantial missing data (≥5%) include an explicit “Missing” category. For distribution comparisons by daily/non-daily status, chi-square tests of independence were conducted using complete-case data; observations with missing values on the variables under comparison were excluded. We conducted all analyses in StataNow/MP 19.5.

3. Results

3.1. Sociodemographic Characteristics

Table 1. Sociodemographic characteristics of U.S. adults reporting past-year use of nicotine pouch products overall and stratified by daily and non-daily use (n = 1009).

Sociodemographic Characteristics		Frequency of Nicotine Pouch Use
	Overall	Non-Daily (n = 833)	Daily (n = 176)	p a
Age in years, mean (SD)	37.6 (10.9)	37.0 (11.0)	40.3 (9.9)	<0.001
Gender identity, n (%)				<0.001
Male/masculine	628 (62.3)	497 (59.7)	131 (74.4)
Female/feminine	368 (36.5)	327 (39.3)	41 (23.3)
Other b	12 (1.2)	8 (1.0)	4 (2.3)
Race and ethnicity, n (%)				0.456
Hispanic	207 (20.5)	171 (20.5)	36 (20.5)
Non-Hispanic White	636 (63.0)	518 (62.2)	118 (67.1)
Non-Hispanic Black	125 (12.4)	108 (13.0)	17 (9.7)
Non-Hispanic Other c	41 (4.1)	36 (4.3)	5 (2.8)
Sexual orientation, n (%)				0.422
Heterosexual	890 (88.6)	736 (88.8)	154 (87.5)
Gay/lesbian	24 (2.4)	18 (2.2)	6 (3.4)
Bisexual	64 (6.4)	55 (6.6)	9 (5.1)
Other d	27 (2.7)	20 (2.4)	7 (4.0)
Educational attainment, n (%)				0.001
High school or less	221 (21.9)	164 (19.7)	57 (32.4)
Some college/associate’s degree	305 (30.2)	250 (30.0)	55 (31.3)
Bachelor’s degree	288 (28.5)	255 (30.6)	33 (18.8)
Advanced degree	195 (19.3)	164 (19.7)	31 (17.6)
Annual household income, n (%)				<0.001
$0 to 49,999	241 (24.0)	179 (21.6)	62 (35.2)
$50,000 to $99,999	275 (27.4)	224 (27.0)	51 (29.0)
$100,000 to $199,999	384 (38.2)	329 (39.7)	55 (31.3)
$200,000 or more	105 (10.5)	97 (11.7)	8 (4.6)
Employment status, n (%)				0.388
Employed for wages	876 (87.1)	726 (87.5)	150 (85.2)
Not employed	57 (5.7)	48 (5.8)	9 (5.1)
Not in labor force	73 (7.3)	56 (6.8)	17 (9.7)
Marital status, n (%)				0.346
Married	492 (48.8)	413 (49.6)	79 (44.9)
Partnered, not married	124 (12.3)	104 (12.5)	20 (11.4)
Not partnered	392 (38.9)	315 (37.9)	77 (43.8)
Place of residence, n (%)				0.001
City	534 (52.9)	457 (54.9)	77 (43.8)
Town	124 (12.3)	104 (12.5)	20 (11.4)
Suburban area	247 (24.5)	200 (24.0)	47 (26.7)
Rural area	104 (10.3)	72 (8.6)	32 (18.2)
Appalachian residence, n (%)				0.055
No	898 (89.1)	734 (88.2)	164 (93.2)
Yes	110 (10.9)	98 (11.8)	12 (6.8)
Geographic region, n (%)				0.019
Northeast	160 (15.9)	141 (16.9)	19 (10.8)
Midwest	169 (16.8)	130 (15.6)	39 (22.2)
South	362 (35.9)	293 (35.2)	69 (39.2)
West	250 (24.8)	215 (25.8)	35 (19.9)
Missing	68 (6.7)	54 (6.5)	14 (8.0)

Percentages were calculated using non-missing responses unless otherwise indicated. Variables with substantial missing data (≥5%) include an explicit “Missing” category. ^a Chi-square tests of independence were conducted using complete-case data; observations with missing values on the variables under comparison were excluded. Bolded p-values indicate statistical significance (p < 0.05). ^b Includes respondents who identified as transgender male or female or gender variant/non-binary. ^c Includes respondents who identified as American Indian/Alaska Native, Asian, Native Hawaiian/other Pacific Islander, or multiracial. ^d Includes respondents who identified as asexual, pansexual, queer, questioning/unsure, or another identity.

displays sociodemographic characteristics of U.S. adults reporting past-year use of NPs overall and by daily/non-daily use. The average age was 37.6 years (SD = 10.9), and most identified as male/masculine (62.3%). A larger proportion of the sample identified as non-Hispanic White (63.0%), followed by Hispanic (20.5%) and non-Hispanic Black (12.4%), and as heterosexual (88.6%), with 6.4% identifying as bisexual, 2.7% as another orientation, and 2.4% as gay/lesbian. For education, most adults had some college/associate’s degree (30.2%), followed by bachelor’s degree (28.5%), high school or less (21.9%), and advanced degree (19.3%). Nearly two in five adults had household incomes of $100,000 to $199,999 (38.2%), followed by $50,000 to $99,999 (27.4%) and $0 to $49,999 (24.0%). Most respondents were employed (87.1%), though 5.7% were unemployed and 7.3% were not in the labor force. Most of the sample were married (48.8%) or partnered (12.3%), while 38.9% were not partnered. Over half of the adults lived in the city (52.9%) vs. suburban areas (24.5%), towns (12.3%), and rural areas (10.3%). About one in 10 adults resided in Appalachia (10.9%). Most lived in the Southern U.S. Census Region (35.9%), followed by the West (24.8%), Midwest (16.8%), and Northeast (15.9%).

Among the full sample, 82.6% of participants reported non-daily NP use, whereas 17.4% reported daily NP use. Differences in the distribution of daily/non-daily NP use by sociodemographic characteristics were observed by age, gender, educational attainment, annual household income, place of residence, and geographic region (p < 0.05). Lastly, the sample distribution by U.S. state is reported in Table S1.

3.2. NP Characteristics by Daily/Non-Daily NP Use

Overall, 59.6% of the sample reported NP use within the past 24 h; frequency of use was distributed nearly evenly across categories, with 17.5% reporting daily use; and most adults used 2–3 NPs/day (34.4%), followed by 4–5 NPs/day (27.3%) for intensity of use (

Table 2. Nicotine pouch characteristics among U.S. adults reporting past-year use of nicotine pouch products stratified by daily and non-daily use (n = 1009).

Nicotine Pouch Characteristics		Frequency of Nicotine Pouch Use
	Overall	Non-Daily (n = 833)	Daily (n = 176)	p a
Recency of use, n (%)				--
Within the past 24 h	601 (59.6)	425 (51.0)	176 (100.0)
2–7 days ago	276 (27.4)	276 (33.1)	--
8–30 days ago	76 (7.5)	76 (9.1)	--
More than 30 days ago	56 (5.6)	56 (6.7)	--
Frequency of use, n (%)				--
Did not report past-30-day use b	59 (5.9)	59 (7.1)	--
1–5 days	182 (18.1)	182 (22.0)	--
6–9 days	102 (10.2)	102 (12.3)	--
10–14 days	140 (13.9)	140 (16.9)	--
15–19 days	168 (16.7)	168 (20.3)	--
20–29 days	178 (17.7)	178 (21.5)	--
Every day	176 (17.5)	--	176 (100.0)
Intensity of use				<0.001
1 pouch/day	101 (10.0)	89 (10.7)	12 (6.8)
2–3 pouches/day	346 (34.4)	315 (37.9)	31 (17.6)
4–5 pouches/day	275 (27.3)	234 (28.2)	41 (23.3)
6–9 pouches/day	161 (16.0)	117 (14.1)	44 (25.0)
10+ pouches/day	124 (12.3)	76 (9.2)	48 (27.3)
Usual nicotine strength				<0.001
1–2 mg	60 (6.0)	52 (6.2)	8 (4.6)
3–4 mg	278 (27.6)	249 (29.9)	29 (16.5)
5–6 mg	435 (43.1)	360 (43.2)	75 (42.6)
7–8 mg	138 (13.7)	112 (13.5)	26 (14.8)
9 mg or higher	74 (7.3)	45 (5.4)	29 (16.5)
Do not know or not sure	24 (2.4)	15 (1.8)	9 (5.1)
Usual nicotine pouch brand				0.14
Zyn	476 (47.2)	379 (45.5)	97 (55.1)
On!	150 (14.9)	129 (15.5)	21 (11.9)
VELO	160 (15.9)	136 (16.3)	24 (13.6)
Other c	214 (21.2)	180 (21.6)	34 (19.3)
No usual brand	9 (0.9)	9 (1.1)	0 (0.0)
Usual nicotine pouch flavor				0.10
Mint/menthol	421 (41.8)	335 (40.3)	86 (49.1)
Sweet (fruit or dessert/spice)	413 (41.0)	351 (42.2)	62 (35.4)
Tobacco, unflavored, or other	173 (17.2)	146 (17.6)	27 (15.4)

Percentages were calculated using non-missing responses unless otherwise indicated. Variables with substantial missing data (≥5%) include an explicit “Missing” category. ^a Chi-square tests of independence were conducted using complete-case data; observations with missing values on the variables under comparison were excluded. Bolded p-values indicate statistical significance (p < 0.05). ^b Three respondents who initially reported past-30-day use later indicated zero days of use in the past 30 days and were therefore grouped with respondents who did not report past-30-day use. ^c Includes Rogue, Fully Loaded, Juice Head, Lucy, or another brand.

). For usual nicotine strength, 43.1% reported 5–6 mg, followed by 3–4 mg (27.6%) and 7–8 mg (13.7%). The most common NP brand was Zyn (47.2%) followed by ‘another brand’ (21.2%), VELO (15.9%), and On! (14.9%). Usual NP flavor was primarily mint/menthol (41.8%) or sweet (fruit or dessert/spice; 41.0%).

Daily/non-daily NP use varied by intensity of use (p < 0.001) and usual nicotine strength (p < 0.001) but not usual NP brand (p = 0.14) or usual NP flavor (p = 0.10). For intensity of use, a higher proportion of adults who used NPs daily consumed 10+ NPs/day (27.3%) compared to non-daily users (9.2%). A similar pattern was observed for nicotine strength, with 16.5% of those using 9 mg or higher reporting daily use, compared to 5.4% among non-daily users.

3.3. Situations of and Main Reasons for NP Use by Daily/Non-Daily Use

The most common use situations were at home (70.8%), during high-stress situations or when feeling stressed (53.6%), while driving or commuting (49.5%), in social settings (e.g., with friends; 48.6%), and in places where smoking or vaping is not allowed (e.g., indoors at work, public transportation, restaurants, or bars; 44.8%;

Table 3. Situations of and main reasons for nicotine pouch use among U.S. adults reporting past-year use of nicotine pouch products stratified by daily and non-daily use (n = 1009).

Situations of and Main Reasons for Use		Frequency of Nicotine Pouch Use
	Overall	Non-Daily (n = 833)	Daily (n = 176)	p a
Situations of use (select all that apply) b
At work or school	437 (43.3)	327 (39.3)	110 (62.5)	<0.001
At home	714 (70.8)	565 (67.8)	149 (84.7)	<0.001
While driving or commuting	499 (49.5)	360 (43.2)	139 (79.0)	<0.001
While exercising (e.g., at the gym, weightlifting, or playing sports)	234 (23.2)	188 (22.6)	46 (26.1)	0.308
In social settings (e.g., with friends)	490 (48.6)	380 (45.6)	110 (62.5)	<0.001
During high-stress situations or when feeling stressed	541 (53.6)	429 (51.5)	112 (63.6)	0.003
In places where smoking or vaping is not allowed (e.g., indoors at work, public transportation, restaurants, or bars)	452 (44.8)	343 (41.2)	109 (61.9)	<0.001
When I don’t want others to know I am using nicotine (e.g., during class/meetings, around family or non-users)	259 (25.7)	193 (23.2)	66 (37.5)	<0.001
While watching TV/streaming, gaming, or using my phone/computer	374 (37.1)	270 (32.4)	104 (59.1)	<0.001
Other	6 (0.6)	5 (0.6)	1 (0.6)	0.96
Main reasons for use (select all that apply) b
To reduce stress or cope with negative emotions	575 (57.0)	455 (54.6)	120 (68.2)	0.001
To help manage nicotine cravings or withdrawal	528 (52.3)	426 (51.1)	102 (58.0)	0.100
For convenience (e.g., discreet use, no smoke/vapor, easy to use anywhere)	471 (46.7)	371 (44.5)	100 (56.8)	0.003
Because I can use them where smoking or vaping is not allowed	389 (38.6)	303 (36.4)	86 (48.9)	0.002
Because they do not produce odor	307 (30.4)	241 (28.9)	66 (37.5)	0.025
Curiosity of experimentation	174 (17.2)	146 (17.5)	28 (15.9)	0.606
For social reasons (e.g., with friends or peers)	241 (23.9)	206 (24.7)	35 (19.9)	0.171
To help control appetite or weight	206 (20.4)	173 (20.8)	33 (18.8)	0.546
To avoid using other tobacco or nicotine products (e.g., cigarettes, vapes)	281 (27.9)	222 (26.7)	59 (33.5)	0.065
Because they taste good or have appealing flavors	254 (25.2)	179 (21.5)	75 (42.6)	<0.001
For energy, focus, or performance	183 (18.1)	137 (16.5)	46 (26.1)	0.002
Other	4 (0.4)	3 (0.4)	1 (0.6)	0.690

Percentages were calculated using non-missing responses unless otherwise indicated. Variables with substantial missing data (≥5%) include an explicit “Missing” category. ^a Chi-square tests of independence were conducted using complete-case data; observations with missing values on the variables under comparison were excluded. Bolded p-values indicate statistical significance (p < 0.05). ^b “Don’t know/Not sure” responses were coded as missing because cell sizes were very small (range: n = 2–9).

). Most common main reasons for use included to reduce stress or cope with negative emotions (57.0%), to help manage nicotine cravings or withdrawal (52.3%), for convenience (e.g., discreet use, no smoke/vapor, easy to use anywhere; 46.7%), because NPs can be used where smoking or vaping is not allowed (38.6%), and because NPs do not produce odor (30.4%).

Daily/non-daily NP use varied by most situations of and main reasons for use. For example, compared to adults who used NPs non-daily, a higher proportion of adults who used NPs daily endorsed using at home (84.7% vs. 67.8%, p < 0.001), while driving or commuting (79.0% vs. 43.2%, p < 0.001), during high-stress situations or when feeling stressed (63.6% vs. 51.5%, p = 0.003), at work or school (62.5% vs. 39.3%, p < 0.001), and in social settings (e.g., with friends; 62.5% vs. 45.6%, p < 0.001). Participants who used daily were also more likely to report that they used NPs to reduce stress or cope with negative emotions (68.2% vs. 54.6%, p = 0.001), for convenience (e.g., discreet use, no smoke/vapor, easy to use anywhere; 56.8% vs. 44.5%, p = 0.003), because NPs can be used where smoking or vaping is not allowed (48.9% vs. 36.4%, p = 0.002), because NPs taste good or have appealing flavors (42.6% vs. 21.5%, p < 0.001), and because NPs do not produce odor (37.5% vs. 28.9%, p = 0.025).

3.4. Perceived Harm, Addictiveness, and Toxicity of NPs by Daily/Non-Daily Use

Most respondents reported that NPs were slightly (35.9%) or moderately (36.9%) harmful, opposed to very (14.7%) and not at all (12.5%) harmful. For relative harms, many perceived NPs to involve the same level of or greater harm than combustible tobacco (42.1%), ENDS (43.6%), and smokeless tobacco (47.9%;

Table 4. Perceived harm, addictiveness, and toxicity of nicotine pouches among U.S. adults reporting past-year use of nicotine pouch products stratified by daily and non-daily use (n = 1009).

Harm Perceptions		Frequency of Nicotine Pouch Use
	Overall	Non-Daily (n = 833)	Daily (n = 176)	p a
Harm of nicotine pouches b				0.019
Not at all harmful	125 (12.5)	100 (12.1)	25 (14.3)
Slightly harmful	359 (35.9)	282 (34.2)	77 (44.0)
Moderately harmful	369 (36.9)	312 (37.8)	57 (32.6)
Very harmful	147 (14.7)	131 (15.9)	16 (9.1)
Harm of nicotine pouches vs. combustible tobacco b				0.013
Less harmful	581 (57.9)	465 (56.1)	116 (66.3)
Same or more harmful	423 (42.1)	364 (43.9)	59 (33.7)
Harm of nicotine pouches vs. ENDS b				0.17
Less harmful	567 (56.4)	460 (55.4)	107 (61.1)
Same or more harmful	438 (43.6)	370 (44.6)	68 (38.9)
Harm of nicotine pouches vs. smokeless tobacco b				0.027
Less harmful	523 (52.1)	419 (50.5)	104 (59.8)
Same or more harmful	480 (47.9)	410 (49.5)	70 (40.2)
Addictiveness of nicotine pouches vs. combustible tobacco b				0.014
Less addictive	397 (39.5)	342 (41.2)	55 (31.3)
Same or more addictive	609 (60.5)	488 (58.8)	121 (68.8)
Addictiveness of nicotine pouches vs. ENDS b				0.016
Less addictive	416 (41.3)	358 (43.0)	58 (33.1)
Same or more addictive	591 (58.7)	474 (57.0)	117 (66.9)
Addictiveness of nicotine pouches vs. smokeless tobacco b				0.023
Less addictive	378 (37.7)	325 (39.3)	53 (30.1)
Same or more addictive	626 (62.4)	503 (60.8)	123 (69.9)
Harmful chemical exposure of nicotine pouches				0.46
Believes exposure to harmful chemicals	453 (44.9)	373 (44.8)	80 (45.5)
Does not believe exposure	432 (42.8)	362 (43.5)	70 (39.8)
Does not know or not sure	124 (12.3)	98 (11.8)	26 (14.8)

Percentages were calculated using non-missing responses unless otherwise indicated. Variables with substantial missing data (≥5%) include an explicit “Missing” category. ^a Chi-square tests of independence were conducted using complete-case data; observations with missing values on the variables under comparison were excluded. Bolded p-values indicate statistical significance (p < 0.05). ^b “Don’t know/Not sure” responses were coded as missing because cell sizes were very small (range: n = 2–9).

). For relative addictiveness, substantial proportions of adults perceived NPs to have the same or greater addictive potential than combustible tobacco (60.5%), ENDS (58.7%), and smokeless tobacco (62.4%). Finally, 44.9% of respondents believed NPs exposed them to harmful chemicals, whereas 42.8% did not believe harmful exposure occurred, and 12.3% did not know or were not sure.

All perceptions varied by daily/non-daily NP use except for harms of NPs vs. ENDS (p = 0.17) and harmful chemical exposure to NPs (p = 0.46). More adults who used NPs daily thought NPs were slightly (44.0% vs. 34.2%, p = 0.019) and not at all (14.3% vs. 12.1%) harmful than those who used non-daily. A lower proportion of adults who used NPs daily thought NPs were the same or more harmful than combustible (33.7% vs. 43.9%, p = 0.013) and smokeless (40.2% vs. 49.5%, p = 0.027) tobacco products, compared to adults who used NPs non-daily. However, adults who used NPs daily thought NPs were the same or more addictive compared to combustible (68.7% vs. 58.8%, p = 0.014), ENDS (66.9% vs. 57.0%, p = 0.016), and smokeless (69.9% vs. 60.7%, p = 0.023) products, relative to adults who used NPs non-daily.

3.5. Other Tobacco, Nicotine, and Substance Use by Daily/Non-Daily NP Use

Most participants reported past-30-day use of other tobacco products, including combustible tobacco (71.0%), ENDS or heated tobacco (52.2%), and other oral products (58.9%) (

Table 5. Other tobacco, nicotine, and substance use among U.S. adults reporting past-year use of nicotine pouch products stratified by daily and non-daily use (n = 1009).

Substance Use		Frequency of Nicotine Pouch Use
	Overall	Non-Daily (n = 833)	Daily (n = 176)	p a
Combustible tobacco products b				0.020
Never	68 (6.7)	59 (7.1)	9 (5.1)
Former (non-past-30-day) use	225 (22.3)	172 (20.7)	53 (30.1)
Current (past-30-day) use	716 (71.0)	602 (72.3)	114 (64.8)
ENDS or heated tobacco products c				0.96
Never	215 (21.3)	179 (21.5)	36 (20.5)
Former (non-past-30-day) use	267 (26.5)	220 (26.4)	47 (26.7)
Current (past-30-day) use	527 (52.2)	434 (52.1)	93 (52.8)
Oral noncombustible products d				0.11
Never	190 (18.8)	164 (19.7)	26 (14.8)
Former (non-past-30-day) use	225 (22.3)	191 (22.9)	34 (19.3)
Current (past-30-day) use	594 (58.9)	478 (57.4)	116 (65.9)
Any cannabis product e				0.06
Never	190 (18.8)	146 (17.5)	44 (25.0)
Former (non-past-30-day) use	233 (23.1)	192 (23.1)	41 (23.3)
Current (past-30-day) use	586 (58.1)	495 (59.4)	91 (51.7)
Any alcohol product f				0.06
Never	213 (21.1)	182 (21.9)	31 (17.6)
Former (non-past-30-day) use	265 (26.3)	227 (27.3)	38 (21.6)
Current (past-30-day) use	530 (52.6)	423 (50.8)	107 (60.8)
Any other psychoactive drug g				0.76
Never	445 (44.2)	363 (43.6)	82 (46.6)
Former (non-past-30-day) use	251 (24.9)	210 (25.2)	41 (23.3)
Current (past-30-day) use	312 (31.0)	259 (31.1)	53 (30.1)

Percentages were calculated using non-missing responses unless otherwise indicated. Variables with substantial missing data (≥5%) include an explicit “Missing” category. ^a Chi-square tests of independence were conducted using complete-case data; observations with missing values on the variables under comparison were excluded. Bolded p-values indicate statistical significance (p < 0.05). ^b Includes cigarettes, big cigars, little cigars/cigarillos, and hookah/waterpipe. ^c Includes electronic nicotine delivery systems (ENDS) and heated tobacco products (e.g., IQOS). ^d Includes oral noncombustible products such as smokeless tobacco and flavored nicotine gum. ^e Includes cannabis use modalities and products such as smoking, blunting, vaping, dabbing, and delta-8-THC. ^f Includes consuming one full drink of any alcohol beverage. ^g Includes kratom, prescription pill misuse, and other drugs.

). Furthermore, most also reported current use of cannabis (58.1%), alcohol (52.6%), or any other psychoactive drug (31.0%). Former use ranged from 22.3% to 26.5% across all substance use variables.

Daily/non-daily NP use varied by current combustible tobacco product (64.8% daily vs. 72.3% non-daily for current use; p = 0.020) but not ENDS or heated tobacco product (p = 0.96), oral noncombustible product (p = 0.11), or other psychoactive drug (p = 0.76) use. Differences were marginally statistically significant for any cannabis product (51.7% daily vs. 59.4% non-daily for current use; p = 0.06) and any alcohol product (60.8% daily vs. 50.8% non-daily for current use; p = 0.06) use.

3.6. Health Status and Diagnosed Comorbidities by Daily/Non-Daily NP Use

Over half of the sample reported excellent/very good health status (52.1%), followed by 32.7% who reported good and 15.2% who reported fair/poor (

Table 6. Health status and diagnosed comorbidities among U.S. adults reporting past-year use of nicotine pouch products stratified by daily and non-daily use (n = 1009).

Health Status and Comorbidities		Frequency of Nicotine Pouch Use
	Overall	Non-Daily (n = 833)	Daily (n = 176)	p a
General health status				0.52
Excellent/very good	525 (52.1)	439 (52.8)	86 (48.9)
Good	330 (32.7)	271 (32.6)	59 (33.5)
Fair/poor	153 (15.2)	122 (14.7)	31 (17.6)
Oral health status				0.07
Excellent/very good	448 (44.7)	371 (44.9)	77 (43.8)
Good	310 (30.9)	265 (32.0)	45 (25.6)
Fair/poor	245 (24.4)	191 (23.1)	54 (30.7)
GAD-2				0.09
Negative screen (score < 3)	685 (67.9)	575 (69.0)	110 (62.5)
Positive screen (score ≥ 3)	324 (32.1)	258 (31.0)	66 (37.5)
PHQ-2				0.11
Negative screen (score < 3)	703 (69.7)	589 (70.8)	114 (64.8)
Positive screen (score ≥ 3)	305 (30.3)	243 (29.2)	62 (35.2)
Any mental or behavioral health condition b				0.002
No	443 (44.0)	384 (46.3)	59 (33.5)
Yes	563 (56.0)	446 (53.7)	117 (66.5)
Any cardiometabolic condition c				0.06
No	594 (59.2)	501 (60.5)	93 (52.8)
Yes	410 (40.8)	327 (39.5)	83 (47.2)
Any respiratory condition d				0.55
No	771 (76.7)	639 (77.1)	132 (75.0)
Yes	234 (23.3)	190 (22.9)	44 (25.0)
Any neurological condition e				0.94
No	868 (86.5)	716 (86.6)	152 (86.4)
Yes	135 (13.5)	111 (13.4)	24 (13.6)
Any chronic pain or gastrointestinal condition f				0.19
No	681 (67.8)	569 (68.7)	112 (63.6)
Yes	323 (32.2)	259 (31.3)	64 (36.4)
Any other chronic medical condition g				0.79
No	889 (88.6)	734 (88.8)	155 (88.1)
Yes	114 (11.4)	93 (11.3)	21 (11.9)
History of cancer				0.49
No	947 (94.3)	780 (94.1)	167 (95.4)
Yes	57 (5.7)	49 (5.9)	8 (4.6)

Percentages were calculated using non-missing responses unless otherwise indicated. Variables with substantial missing data (≥5%) include an explicit “Missing” category. ^a Chi-square tests of independence were conducted using complete-case data; observations with missing values on the variables under comparison were excluded. Bolded p-values indicate statistical significance (p < 0.05). ^b Includes attention deficit hyperactivity disorder, anxiety disorder, depression, learning disability or disorder, mood disorder other than depression, obsessive–compulsive disorder, post-traumatic stress disorder, schizophrenia, and sleep disorder. ^c Includes cardiac disease, diabetes, dyslipidemia, hypertension, obesity, and pre-diabetes/borderline diabetes. ^d Includes asthma, lung or respiratory disease such as COPD or chronic bronchitis. ^e Includes epilepsy/seizure disorder, multiple sclerosis/muscle spasms/spasticity, stroke or other neurological disorder. ^f Includes arthritis or joint disease, chronic nausea/cyclical vomiting syndrome, chronic pain, ulcers or other gastrointestinal disorder. ^g Includes Human Immunodeficiency Virus, kidney disease, and liver disease.

). Oral health status differed slightly, with 44.7% reporting excellent/very good, compared to 30.9% who reported good and 24.4% who reported fair/poor. For the GAD-2 and PHQ-2, 32.1% of participants exhibited clinically meaningful anxiety symptoms, and 30.3% exhibited depressive symptoms. For categories of diagnosed conditions, 56.0% had a mental or behavioral health condition, 40.8% a cardiometabolic condition, 23.3% a respiratory condition, 13.5% a neurological condition, 32.2% a chronic pain or gastrointestinal condition, and 11.4% another chronic medical condition. Furthermore, 5.7% reported a history of cancer.

No health characteristics other than any diagnosed mental or behavioral health condition varied by daily/non-daily NP use. A higher proportion of adults who used NPs daily had any diagnosed mental or behavioral health condition (66.5%) compared to adults who used non-daily (53.7%; p = 0.002). We observed variation in proportions between daily (47.2%) and non-daily (39.5%) use for any diagnosed cardiometabolic condition (p = 0.06), as well as in oral health status (30.7% fair/poor among daily users vs. 23.1% among non-daily users; p = 0.07); however, neither difference reached statistical significance.

4. Discussion

In this study of U.S. adults reporting past-year NP use, we provide a comprehensive characterization of use patterns and product characteristics, situations of and motivations for use, harm perceptions, co-use patterns, and health correlates, with a particular focus on differences between daily and non-daily use. Overall, NP use was more common in our relatively younger and predominantly male sample, with high levels of co-tobacco/nicotine and other substance use. Although our sample shared some characteristics with nationally representative estimates of adults reporting past-12-month NP use (e.g., a predominance of male participants and similar prevalence of current e-cigarette use) [10], other sociodemographic and use differences were evident. These differences should be interpreted in the context of the distinct sampling strategies, as the present study recruited a convenience sample of adults who use NPs to facilitate more detailed characterization of product use and related factors. Compared to non-daily use, daily NP use was linked to greater use intensity, nicotine strength, distinct situations of and motivations for use, perceptions of harm and addictiveness, other current combustible tobacco use, and mental or behavioral health conditions, suggesting meaningful heterogeneity in patterns of NP use frequency. Viewed collectively, these findings contribute to current tobacco regulatory science priorities [22] by characterizing daily and non-daily NP use across multiple domains relevant to understanding patterns of use and the potential public health impact of emerging nicotine products. The exploratory nature of this work provides a foundation for future confirmatory studies.

A key contribution of this study is the examination of daily versus non-daily NP use across multiple behavioral domains. Adults who used NPs daily reported higher use intensity (e.g., 10+ pouches/day) and use of higher nicotine strengths per pouch, patterns that are consistent with greater nicotine exposure and may reflect increased nicotine dependence or tolerance [31,32]. To our knowledge, few studies have characterized differences in NP use intensity and nicotine strength preferences by daily use status. Our findings suggest that daily NP use is characterized not only by more frequent use but also by selection of products with higher nicotine concentrations, potentially resulting in substantially greater cumulative nicotine exposure throughout the day. Adults who used NPs daily also endorsed a wider range of use contexts, such as at home, during commuting, at work or school, and in social settings. These results highlight the versatility of NPs and their potential to be used in unique settings and continuously throughout the day. These contexts also parallel those of ENDS in relation to situational, discreet use [33,34,35]. All in all, our findings align with emerging evidence suggesting that NPs, as discreet and smoke-free products, may facilitate more frequent and contextually unrestricted nicotine exposure, potentially extending exposure beyond that of other products [31,36].

We found that motivations for NP use also differed by daily/non-daily use. Although stress reduction, craving management, and convenience were commonly reported, adults who used NPs daily and more frequently endorsed these reasons, as well as product appeal and situational advantages. This pattern suggests that daily use may be driven by both dependence-related factors and product characteristics that reinforce habitual use. Findings are also consistent with previous studies on conventional nicotine products, suggesting that both pharmacologic (nicotine delivery) and non-pharmacologic (e.g., flavor, convenience, discretion) features contribute to use and possibly sustained use [37,38]. Differences in reported situations and reasons for NP use by daily and non-daily status should partly be interpreted in the context of differences in overall use frequency. Adults who use NPs daily have more opportunities to use the product across a range of situations and for different reasons than those who use less frequently. Nevertheless, the descriptive patterns within each frequency group provide important context regarding when and why NPs are used.

There were distinct differences in perceptions of relative harm and addictiveness based on daily and non-daily use. Adults who used daily had higher proportions of perceiving NPs as less harmful relative to combustible and smokeless tobacco products, yet viewed them as equally or more addictive. This discordance may reflect evolving risk perceptions as adults continue to use products. While the findings highlight that many adults acknowledge some sort of risk associated with NPs, addictiveness may be viewed as less concerning. These findings are consistent with the broader nicotine product literature suggesting that perceived harm and addictiveness are distinct constructs and may differentially influence initiation, product use, and sustained use [39,40].

Co-use of other tobacco/nicotine products and substances—including combustible tobacco, oral noncombustible products, alcohol, and cannabis—was highly prevalent in this sample. Differences by daily NP use suggest potential clustering of risk behaviors. Notably, combustible tobacco use was slightly lower among adults who used NPs daily compared to those who used non-daily, which may reflect substitution or transition patterns, though we are not able to confidently infer such patterns given the study’s cross-sectional design. Nevertheless, these findings underscore the importance of considering NP use within broader contexts of dual or poly use of nicotine and other substances, as noted in previous observational research [21,41].

Regarding self-reported health status, most variables did not significantly differ by daily/non-daily use status. However, adults who used NPs daily had higher proportions of diagnosed mental or behavioral health conditions, and we observed suggestive, though not statistically significant, differences in cardiometabolic conditions and oral health status. Although these findings did not reach statistical significance, their direction and magnitude may suggest potential differences in health status by NP use frequency. These patterns may reflect differences in nicotine exposure, co-use of other substances, or clustering of health-related behaviors among adults who use NPs daily. However, these inferences should be interpreted with caution, as studies specifically designed for causal inference or longitudinal follow-up are better suited to elucidate such associations. Future research on potential unique health effects of NPs is needed to better understand the risks associated with more frequent and intensive use across the life course. Furthermore, future studies should move beyond individual-level correlates of NP use to examine how broader social and environmental determinants influence initiation, progression to daily use, patterns of co-use, and related health outcomes [42].

Limitations

First, given the cross-sectional design and the exploratory nature of this study, we prioritized stratified descriptive analyses to characterize variation between adult daily and non-daily NP use rather than estimating adjusted associations. This approach avoids overinterpretation of temporally ambiguous relationships while providing foundational data needed to inform hypothesis-driven analytic studies. Longitudinal and causal modeling approaches are needed to better assess independent risk and protective factors and downstream health effects of NP use. Second, data were self-reported and subject to response biases. Third, respondents were recruited as part of a convenience sample; thus, study findings may not be representative of the U.S. population who used NPs in the past year. Fourth, although we examined a broad range of health indicators, none were clinically validated. Fifth, we did not perform adjustments for multiple comparisons given the exploratory nature of this study. Therefore, some statistically significant findings may reflect chance and should not be interpreted as confirmatory, but rather as hypothesis-generating until replicated in future research. Lastly, because we did not directly assess whether NP use was intended to stop or reduce use of other tobacco products, we were unable to distinguish NP use motivated by tobacco harm reduction or cessation from use for other reasons.

Despite these limitations, this study has the potential to inform future research that advances public health and regulatory science. The high prevalence of daily NP use, co-use with other substances, and differential perceptions of harm and addictiveness highlight the need for continued surveillance of use patterns and a better understanding of risk and protective factors for use. The potential for frequent use raises questions about nicotine dependence and long-term health effects—due to NP use alone and in conjunction with other substances, particularly as NPs continue to evolve in nicotine strength and formulation. Future research must prioritize longitudinal designs to assess trajectories of NP use, transitions between products, including NP’s role in product substitutability, and associated health outcomes. Such evidence will be critical for informing product standards, marketing regulations, and public health messaging surrounding NPs.

5. Conclusions

In this study of over 1000 U.S. adults reporting past-year NP use, daily use was associated with greater use intensity, distinct situations of and motivations for use, differential perceptions of harm and addictiveness, and current combustible tobacco use, compared to non-daily use. Although most health indicators did not differ significantly by use frequency, adults who used NPs daily differentially reported mental or behavioral health conditions. These findings highlight meaningful heterogeneity in NP use patterns and underscore the need for continued surveillance and longitudinal research to better understand the risk factors and health implications of frequent NP use within the evolving nicotine product landscape.