ArticleNicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco2026
Use of Images to Assess Awareness and Use of Emerging Nicotine Pouch Products.
Article in Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- The impact of question order on surveillance of nicotine pouch and smokeless tobacco use among adults in the United States.Preventive medicine reports · 2026Article
- Assessment of awareness, usage, and attitudes toward nicotine pouches in Saudi Arabia: a cross-sectional study.Frontiers in public health · 2026Article
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Authors and funding
3 authors.
Funding
Abstract
introductionAccurate measurement is critical for understanding the population health impact of nicotine pouches, yet precise, standardized measures of nicotine pouch use are lacking, possibly driving disparate prevalence estimates across studies. We implemented a split sample survey experiment to assess the impact of including a product image when asking about nicotine pouches.
methodsWe randomized an online sample of US adults ages 18-45 (N = 2130) recruited through the February 2023 wave of the Rutgers Omnibus Study to view either a text-only or text-plus-image description of oral nicotine pouches before being asked about awareness of the products. Participants who endorsed awareness were then asked about their use and the brands they had tried. We calculated the prevalence of awareness, ever, and current use of nicotine pouches and used chi-square tests to assess differences in responses to each question by survey condition.
resultsParticipants in the image condition were more likely than those in the text condition to report awareness (40.6% vs 31.5%, p < .001) and ever use (7.2% vs 5.2%, p = .044). Among those reporting nicotine pouch use, 5.9% in the text-only condition, compared to 0% in the image condition, listed a smokeless tobacco brand as one they tried, suggesting they were misclassified by the text-only question.
conclusionInclusion of product imagery can improve nicotine pouch measurement accuracy in surveys, while text-only measures may misestimate the prevalence of awareness and use. Differences in nicotine pouch prevalence estimates may be explained in part by differences in survey measures, highlighting a need to harmonize measures across studies. IMPLICATIONS: In this first study to evaluate nicotine pouch measurement methods, findings suggest that existing surveillance and research efforts may be undermined by misclassification. Text-only measures of nicotine pouch awareness and use may produce biased prevalence estimates, and inclusion of product imagery can improve nicotine pouch measurement accuracy in surveys.
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