Awareness and use of oral nicotine pouches are increasing across multiple countries, according to new peer-reviewed research published in BMJ Public Health. While this growth reflects changing nicotine markets and consumer behaviour, the findings also reveal a persistent challenge: greater awareness has not been matched by clear public understanding of relative health risk. This gap has important implications for public health communication and regulatory design.
The BMJ study analysed population-level data on awareness, experimentation, and current use of nicotine pouches, focusing on who is using these products and how they are perceived. The results show that awareness of nicotine pouches is now relatively high among adults, even in jurisdictions where regulatory frameworks remain unsettled. Importantly, however, actual use remains concentrated among current or former smokers and users of other nicotine products, rather than among people with no prior nicotine experience.
This distinction is critical from a public-health perspective. When awareness grows primarily among adults who already smoke or use nicotine, it may support transitions away from combustible tobacco—provided that information about relative risk is accurate and accessible. The study, however, highlights that many respondents remain uncertain about the health effects of nicotine pouches. Large segments of the population perceive them as equally harmful as cigarettes, while others report not having enough information to make an informed judgement at all.
These findings reflect a broader and well-documented problem. Scientific evidence consistently shows that non-combustible nicotine products expose users to far fewer harmful toxicants than cigarettes, largely because they eliminate combustion, the main driver of smoking-related disease. This places nicotine pouches lower on the continuum of risk than smoking. Yet population surveys continue to show that these distinctions are poorly understood, even as product visibility increases.
The study also draws attention to age-related patterns of awareness. While reported use remains predominantly among adults, awareness among younger age groups is rising, underscoring the need for careful regulatory balance. Youth protection remains essential, but policies focused solely on restriction, without parallel investment in risk communication, risk reinforcing confusion rather than reducing harm. Treating all nicotine products as equivalent in policy and messaging may inadvertently obscure meaningful differences in risk for adults who smoke.
Another important insight from the research concerns information sources. Awareness of nicotine pouches is often driven by informal channels such as social media, peer networks, and online discussion, rather than structured public-health communication. In the absence of clear, authoritative guidance from regulators and health institutions, these informal sources can fill the gap, sometimes amplifying incomplete or misleading narratives. Silence from official sources does not prevent communication—it simply shifts it elsewhere.
From a regulatory standpoint, the findings reinforce the importance of proportionality. Strong age-verification requirements, enforcement against illegal sales, and restrictions on youth-appealing marketing are essential. At the same time, adults who smoke benefit from access to clear, factual information that accurately reflects relative risk. When regulatory frameworks restrict all forms of communication equally, they may unintentionally limit adults’ ability to distinguish between combustible tobacco and lower-risk alternatives.
The BMJ study does not suggest that nicotine pouches are risk-free, nor does it call for unrestricted promotion. Rather, it highlights the consequences of a persistent information gap. Awareness without understanding is unlikely to deliver meaningful public-health gains. As nicotine markets continue to evolve, regulators face an increasingly important choice: allow misperceptions to persist, or support communication strategies that reflect the scientific consensus while maintaining robust protections for young people.
A regulatory environment that recognises the continuum of risk, supports accurate communication, and prioritises youth protection offers a more credible and effective path toward reducing smoking-related disease.
