Nicotine pouch use characteristics, self-perceived addiction and regret among Danish youth.
Arp Stine S, Pisinger Charlotta C, Lund Lisbeth L, Bast Lotus Sofie LS
Use of nicotine pouches is increasing among youth worldwide. A subsequent increase in the prevalence of youth becoming addicted is therefore expected. We sought to estimate current prevalences of self-perceived addiction and regret, as well as the association between nicotine pouch characteristics and self-perceived addiction. As regretting ever starting to use nicotine pouches may reflect motivation to quit, we additionally aimed to estimate the association between self-perceived addiction and regret. Cross-sectional national population-based survey (§SMOKE). The invited population (n = 37 500) was selected randomly through the Danish national Civil Register, and 9801 responded (26.3%). Analyses were weighted for non-response according by age and sex. Denmark (2025). Danish 15-29-year-olds with a current daily or occasional use of nicotine pouches (n = 1201). Primary outcomes were reporting being very addicted compared to not or somewhat addicted, and regret of nicotine pouch initiation was defined as not wanting to start using nicotine pouches, if having the chance to do it over again. Outcomes were self-reported. A total of 14.0% [95% confidence interval (CI): 13.3%; 14.7%] of Danish youth aged 15-29 years use nicotine pouches either daily or occasionally. Among these, approximately 82.2% reported self-perceived addiction (36.4% [95% CI: 33.6%; 39.3%] somewhat addicted and 44.8% [95% CI: 41.9%; 47.8%] very addicted), while 79.0% [95% CI: 76.1%; 81.6%] reported regretting nicotine pouch initiation. Adjusting for age, sex and education, daily use (adjusted odds ratio (aOR): 40.68 [18.41;89.88]), more than one year since initiation (2-4 years, aOR: 2.79 [1.88;4.16]; 5-9 years, aOR: 3.68 [2.36;5,72]; 10 years or more, aOR: 3.02 [1.45;6.31]), using menthol and mint flavors (aOR: 1.59 [1.18;2.15], nicotine strength of 5 or more mg (5-9 mg, aOR: 1.93 [1.32;2.83]; 10-14 mg: aOR 2.45 [1.70;3.54]; 15 mg or more, aOR: 1.80 [1.13;2.85]) and using for more than 15 minutes (15-30 minutes, aOR: 1.66 [1.24;2.23] and 30 minutes or more, aOR: 1.69 [1.10;2.58]) were associated with reporting being very addicted to nicotine pouches. Further, being very addicted was positively associated with regretting initiation (aOR: 1.97, 95%CI [1.17;3.31]). The prevalence of self-perceived addiction to nicotine pouches and regret with starting to use them appears to be high among Danish youth. Several nicotine pouch use characteristics appear to be positively associated with reporting being very addicted, which were further associated with regret.