SAFE GC Coalition: The Truth About Multiple Tobacco and Nicotine Product Use

According to The Truth Initiative, a study published in Preventive Medicine Reports found a significant increase in the use of multiple tobacco and nicotine products among young people (aged 15-24 years) between 2021 and 2024, including dual use of e-cigarettes and oral nicotine pouches. These findings suggest that oral nicotine pouches are not replacing other tobacco products but rather supplementing existing use patterns and demonstrate how a rapidly expanding product landscape offers more avenues for nicotine use and the evidence of dual and poly use among youth and young adults prompts new concerns about the potential for increased nicotine dependence, exacerbated health harms, and difficulty quitting.

Dual use of cigarettes and e-cigarettes was the most common pattern of nicotine and tobacco product use among young people in the study (27.8%), followed by exclusive e-cigarette use (24.7%). Researchers also found that dual use of e-cigarettes and oral nicotine pouches increased significantly (14.75%) from July 2023 to September 2024 and poly use of e-cigarettes, cigarettes, and oral nicotine pouches increased by 6.82% during that time.

These trends suggest that oral nicotine pouches are not replacing other tobacco products but rather supplementing existing use patterns, potentially exposing young people to higher levels of nicotine. This comes at a time when e-cigarettes – the most commonly used nicotine product among young people – have grown bigger, stronger, and cheaper, offering more nicotine at prices accessible to young people.

Sales of oral nicotine pouches from brands like Zyn, Velo, and On! have increased dramatically, with total monthly nicotine pouch sales increasing by 207% between January 2023 and April 2025, from $145.5 million to $446.8 million. Oral nicotine pouches are discreet, odorless, and easier to use in situations where smoking and vaping may be prohibited, which may contribute to their use among people who use other nicotine products.

Young adults show greater odds of dual and poly use and oral nicotine pouch use and patterns of use varied by demographic factors. Young adults ages 21-24 had greater odds of multiple product use compared with young people ages 15-20. In addition, young adults aged 21-24 demonstrated higher odds of using oral nicotine pouches in any pattern.

Gender identity, race, and financial security also played a role in usage patterns. Women had lower odds of dual and poly use with combustible products compared to men, and Black youth showed greater odds of exclusive combustible tobacco use. Participants with higher perceived financial status had greater odds of poly use of e-cigarettes, cigarettes, and oral nicotine products.

The rising prevalence of dual and poly tobacco product use among young people, particularly the combination of e-cigarettes with oral nicotine pouches, demands ongoing monitoring. E-cigarettes expose users to more nicotine than ever before, and young people who used e-cigarettes in 2024 reported frequent use – a sign of potential nicotine addiction. In addition, both e-cigarettes and oral nicotine pouches are available in fruit, mint, and candy flavors, which appeal to young people.

Free digital cessation resources are needed to help people quit multiple tobacco and nicotine products. As the tobacco product landscape continues to evolve and dual use becomes more common, expanding awareness of free digital cessation resources will be key to supporting successful quit attempts and reducing nicotine addiction among youth and young adults.

EX Program, a free digital quitting program developed by Truth Initiative with Mayo Clinic, can help people successfully quit using multiple tobacco and nicotine products. EX Program provides tailored support based on product type and offers the most established online community of quitters, where current and former tobacco users can share tips and advice about quitting multiple products. For more information, please visit www.exprogram.com

SAFE, Inc. is the only alcohol and substance abuse prevention, intervention, and education agency in the City of Glen Cove. Its Coalition is concerned with all combustible and electronic products with tobacco. The Agency employs environmental strategies to educate and update the community regarding the negative consequences of smoking and vaping. To learn more about the SAFE Glen Cove Coalition please follow www.facebook.com/safeglencove or to learn more about electronic products visit the Youth and Tobacco Use and Vaping Facts and Myths Pages of SAFE’s website to learn more about how vaping is detrimental to your health at www.safeglencove.org.

The Truth Initiative is the nation’s largest nonprofit public health organization dedicated to preventing youth and young adult nicotine addiction and empowering quitting. Research is conducted through the Truth Initiative Schroeder Institute that produces independent research to provide evidence for policy change and leadership in cessation research. For more information, please visit www.truthinitiative.org.