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Abstract

Introduction: Nicotine pouches (NPs) are emerging nicotine products that appeal to youth due to their discreet use, tobacco-free formulation, and flavor availability. However, given their recent introduction to the market, little is known about how neighborhood environments may influence US youth NP use.

Methods: We imputed cross-sectional data from the 2023 National Youth Tobacco Survey (n = 22,069, ages 9 + years) and developed a neighborhood risk score (range: 1–4) by averaging 10 items related to neighborhood disorder, safety, and disadvantage. To estimate associations between the risk score and current (past 30-day) NP use, we fit logistic regression models adjusted for sociodemographic, school, environmental, and behavioral characteristics.

Results: The prevalence of current NP use was 1.6% (95% CI=1.0–2.1). The mean neighborhood risk score was 1.6 (95% CI=1.6–1.7) and was higher among youth who currently used NPs (mean=2.1, 95% CI=1.8–2.3) vs. those who did not (mean=1.6, 95% CI=1.6–1.7). Adjusted results showed that for each unit increase in neighborhood disadvantage, the odds of current NP use increased by 77% (95% CI=1.08–2.91). Further, specific neighborhood items included in the risk score, such as violence and vandalism, were associated with NP use.

Discussion: This study found that youth living in high-risk neighborhoods had higher odds to use NPs, highlighting the influence of environmental factors on novel tobacco/nicotine use. The findings support the need for community-level prevention strategies to address youth use of emerging tobacco/nicotine products.

Document Type

Article

Publication Date

2026

Notes/Citation Information

0376-8716/© 2026 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Digital Object Identifier (DOI)

https://doi.org/10.1016/j.drugalcdep.2026.113118

Funding Information

Research reported in this publication was supported by grant U54DA058256 from the National Institute of Health (NIH) and the Food and Drug Administration (FDA) Center for Tobacco Products (CTP) and by grant R01CA251478–05S1 from the National Cancer Institute of the NIH. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the FDA.

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