‘I'd rather have worse gums than worse lungs’: Young people's views of nicotine pouches in the UK

Abstract

Background and aims Nicotine pouches entered the UK market in 2019. Although research has shown that young people's prevalence of use has been low, it has been reported to be increasing and a cause for concern. This paper reports the findings of the first qualitative study in the UK to explore the views of 14–16 year olds' knowledge, awareness of, access to and use of nicotine pouches, augmented by the views of school staff, as part of a wider study investigating the marketing and use of new nicotine products (NNPs) in Scotland (NIPS Study). Design Qualitative study using 16 focus groups conducted February–March 2025, and in-person and telephone interviews (nine individual and two paired) with school staff. Setting Four schools in Scotland based in areas of differing socio-economic status and two levels of urbanity. Participants Seventy-seven third-year (S3; 14–15 years) and fourth-year (S4; 15–16 years) pupils who vaped or were at-risk of vaping. School staff (n = 13) with a senior teaching or pastoral care/guidance role. Measurements Focus groups with pupils and interviews with staff explored perceptions and use of nicotine pouches and other NNPs. The qualitative data underwent thematic analysis. Findings Pupils were knowledgeable about nicotine pouches and thought that they were easy to access. Experimental use was commonplace and regular use was reported, particularly among boys. This was in stark contrast to the views of the staff, who were largely unaware of pouches and perceived that pupils were not using them. Young people liked that nicotine pouches could be used discreetly as well as experiencing a ‘nicotine rush’; however, pupils reported adverse effects from the use of pouches, from pain in the gums to more serious episodes of sickness and fainting. Conclusions Young people in Scotland appear to have high awareness and knowledge of nicotine pouches, and experimental use and adverse effects are common. More established use is reported among older boys than other students, who are able to use these products discreetly in schools. School staff appear to be aware of pupils vaping but largely unaware of pouch use.