From packs to pouches: the first evidence on the spread of nicotine pouches among 15–19‑year‑olds in Italy| Tabaccologia

Abstract

Background: Nicotine pouches represent a new oral nicotine delivery product, promoted as an alternative to traditional tobacco products, that raise public health concerns, especially due to their potential appeal among adolescents. This study presents the first national prevalence estimates of use among Italian students aged 15–19, based on data from the 2024 ESPAD®Italia study.

Methods: ESPAD®Italia is an annual survey representative of the upper secondary school student population. In 2024, a total of 20,201 students (mean age 17.1 years; 51.8% male) completed an anonymous self-administered questionnaire, which included new items on nicotine pouch use. Descriptive analyses and a multivariable logistic regression were conducted.

Results: 6.8% of students reported having used nicotine pouches at least once in their lifetime, 5.2% had used them in the past year, and 3.0% in the past month, with higher rates among boys. Among users, 2.0% had not used any other nicotine-containing product in the past month, and 0.4% had never tried any other nicotine product in their life. Nicotine pouch use was positively associated with daily smoking, e-cigarette use, cannabis use, binge drinking, and having parents who vape. Being female, older in age, or having parents who smoke traditional cigarettes were inversely associated with use.

Conclusions: Nicotine pouch use is already prevalent among Italian adolescents, including among those with no experience using other nicotine products. Ongoing monitoring and the development of targeted prevention strategies are urgently needed.