As nicotine pouches gain market presence in the United States, regulators must understand not only who is using these products, but where and under what conditions they are being purchased. A recent peer-reviewed study published in Preventive Medicine provides new empirical evidence by examining urban–rural differences in nicotine pouch sales, pricing, and flavour preferences across U.S. retail markets.
Source: https://www.sciencedirect.com/science/article/pii/S0955395926000307
Using national retail scanner data, the study analyses sales volumes, per-capita purchasing patterns, average prices, and flavour distribution across U.S. counties classified as urban or rural. While the findings do not directly measure health outcomes, they offer important insight into real-world market behaviour, information that is highly relevant to risk-proportionate regulation, youth protection, and harm-reduction policy in the United States.
What the U.S. data show
The analysis finds that per-capita sales of nicotine pouches are generally higher in rural U.S. counties than in urban ones. This pattern persists even after adjusting for population size, indicating that demand is not evenly distributed across geographic contexts.
This finding is significant. Rural America has historically experienced higher cigarette smoking prevalence and more limited access to cessation resources. Elevated nicotine pouch sales in these areas may therefore reflect substitution among adults who smoke, although sales data alone cannot confirm this behavioural transition.
Flavour preferences also vary by geography. Mint and menthol flavours account for the majority of sales in both rural and urban markets, while fruit and other sweet flavours represent a smaller, though still meaningful, share. The dominance of mint-type flavours aligns with existing research indicating that adult users tend to favour these profiles. However, flavour diversity remains a regulatory concern because of potential youth appeal.
Pricing patterns further highlight geographic differences. The study reports variation in average price per unit, with rural consumers appearing somewhat more price-sensitive. This finding has direct implications for excise tax design, as uniform taxation may produce uneven behavioural effects across different U.S. regions.
Why the U.S. rural–urban divide matters for regulation
The data challenge the assumption that nicotine pouch use, and therefore regulatory impact, is uniform across the country. Geographic disparities suggest that one-size-fits-all policies may generate uneven public-health outcomes.
Measures such as blanket flavour bans, uniform excise rates, or broad retail restrictions could disproportionately affect rural communities, where smoking prevalence remains higher, and cessation infrastructure may be less accessible. If nicotine pouches are functioning as substitutes for cigarettes among rural adults, overly restrictive policies could unintentionally slow declines in combustible tobacco use.
From a harm-reduction perspective, the central question is whether rural pouch sales represent movement away from cigarettes or expansion of overall nicotine use. While the study cannot conclusively determine this, the strong alignment between higher rural pouch sales and historically higher rural smoking rates suggests substitution is a plausible and important dynamic.
Flavours, youth protection, and proportional U.S. policy
Flavour regulation remains one of the most contested elements of nicotine pouch oversight in the United States. The study’s finding that mint and menthol dominate sales complicates arguments for sweeping prohibitions across all flavour categories.
Youth protection is essential. However, if adult demand is concentrated in specific flavour profiles, targeted regulatory approaches may better balance youth prevention with adult harm-reduction pathways. Similarly, geographic variation in price sensitivity suggests that excise policy should consider regional behavioural responses rather than assume uniform impact nationwide.
Risk-proportionate regulation requires differentiation not only between combustible and non-combustible products, but also across population contexts.
Limitations and research gaps
As with all retail sales analyses, limitations must be acknowledged. Sales data do not identify the purchaser, reveal whether use is exclusive or dual, or track long-term switching behaviour. Nor can they measure health outcomes directly.
These gaps underscore the need for complementary research, including longitudinal studies examining transitions between cigarettes and oral nicotine products, particularly within rural populations. Understanding behavioural trajectories is essential for evaluating net public-health impact.
Implications for evidence-based U.S. nicotine policy
For GINN’s audience, the key takeaway is that U.S. nicotine regulation should be informed by observed behaviour rather than assumption. The urban–rural divide in nicotine pouch sales suggests that regulatory design must account for geographic variation, existing smoking prevalence, and differential access to alternatives.
Protecting youth and non-users remains paramount. However, policies that inadvertently entrench cigarette use among adults, particularly in high-burden rural communities, risk undermining broader public-health goals.
Data-driven, risk-proportionate regulation that distinguishes combustible from non-combustible products and recognises regional variation is more likely to support sustained declines in smoking-related disease across the United States.
The rural–urban divide highlighted in this study is not merely a market observation. It is a signal that nicotine policy must be geographically as well as scientifically informed.
