NIH-Funded Researchers Blame Nicotine Pouch Survey Outlier Data on Teen Use

A recent paper published through the JAMA Network aimed to uncover how popular pouches are in the US. However, when the results didn’t match market data, the authors speculated that teen use is rampant.

The paper

Prevalence of Nicotine Pouch Use Among US Adults (HD Dai, 2024) was published in July 2024. Funded by the National Institutes of Health (NIH), it was co-led by the Keck School of Medicine of USC and the University of Nebraska Medical Center. The authors surveyed a nationally representative sample of 39,557 U.S. adults to see how many people are using nicotine pouches.

The results of the survey are surprisingly low. The paper states that:

• 2.9% of US adults have tried nicotine pouches.
• 0.4% of US adults currently use nicotine pouches.

Other nicotine pouch prevalence data from roughly the same period paints a very different picture. Patterns of oral nicotine pouch use among U.S. adolescents and young adults (Patel, 2023) suggest US pouch use is far higher at around 14%.

Of course, it’s important to note that this data is brought to us by Minal Patel, who at the time worked for the Truth Initiative, the sponsor of the study. Bizarrely, the authors of that 2023 paper declare no conflict of interest.

Despite its name, the Truth Initiative is not an honest broker. It would come as no surprise if the advocacy group engaged in some chicanery to exaggerate use so that they could get their parasitic fangs into more of other people’s money.

Indeed, Patel arrived at that current use figure with the following:

To assess for current use, those who responded “yes” were asked on how many of the past 30 days they used pouches; this was dichotomized to “no” if 0 days, and “yes” if 1–30 days.

Patel considers someone who tried a pouch in the last 30 days as equivalent to a daily user, which is where that inflated 14% figure comes from. The disparities between the two surveys make it challenging to get a high-resolution picture of actual use, but it’s what I’ve got to work with.

Surprising numbers, predictable reaction

In the new HD Dai paper, the data suggests that just 0.4% of US adults use pouches, which seems like an outlier. Even the authors were surprised, stating:

“The low prevalence of nicotine pouch use in adults surprised us, given the rapid increase in sales, but it’s also possible that the sales are being diverted to adolescents, who were not represented in this survey.”

This is a very strange statement that suggests 15-17-year-olds are responsible for an incredible amount of nicotine pouch sales.

So, let’s do a quick back-of-the-napkin calculation to see what’s actually happening here.

The paper states that pouch sales in the US increased by 641% between 2019 and 2022. That’s a big, scary, and dramatic number. But what does the market data say?

What’s causing these disparities?

As I wrote here previously, according to consumer intelligence firm NIQ, retail sales of oral nicotine pouches amount to around $6 billion. Other analysts, such as Raphael Moreau at Euromonitor, put the figure at closer to $8.5 billion in 2023, up from $7.2 billion the year previously.

So, let’s take that $7.2 billion in 2022 as our base figure. From there, we can calculate the figure from 2019, before the 641% increase. The number we get is around $970 million.

Then, we’ve got to think about the US population. Per the 2022 Census, the population of the US is around 335 million people, with the adult population standing at 258 million. If we take 0.4% of that number, we get just over 1 million current pouch users in the US.

So, the author’s contention is roughly as follows:

Per 2022, nicotine pouch revenues stood at $7.2 billion. If there are just over 1 million US adults that use pouches, these revenue figures imply that each of these users spends an average of $7,200 on pouches each year.

Nicotine pouches cost between $5 and $10 in the US, so the claim here is that the average US adult nicotine pouch user consumes something like 700 to 1,400 tins per year.

Obviously, that’s ridiculous. However, the author’s speculation that 15 to 17-year-old pouch use can explain these disparities is little more than a low-resolution fever dream.

Even the Truth Initiative-sponsored study suggests that 4.7% of 15 to 17-year-olds used pouches at any time over the last 30 days, as shown below.

Census data suggest there are 12 million 15 to 17-year-olds in the US. 4% of that number is around 560,000.

If we use monthly vs. daily vaping as a benchmark, that 560,000 will need to be slashed by at least 75%. So, we’ll get around 140,000 users.

Voodoo mathematics

Per this article, the average poucher spends around $1,600 on their habit per year. That leaves almost $5.4 billion unaccounted for, which Leventhal’s voodoo mathematics suggests could be shared among the 140,000 regular teen users.

That means that Leventhal thinks it’s possible that each daily 15-17-year-old pouch user spends around $38,000 on the habit per year. As Abraham Maslow famously said, “If the only tool you have is a hammer, you tend to see every problem as a nail.”

So, for me, the survey has not managed to capture a true picture of the prevalence of nicotine pouches in the US. Alternatively, revenue figures for pouches are wildly over-reported. Either way, filling this gap in knowledge with conjecture about teen use does not pass the smell test.