A Review of the Health Impact of Nicotine Pouches
DOI:
https://doi.org/10.12775/QS.2024.37.57617Keywords
Nicotine pouches, smoking, , type 2 diabetes, smokeless tobacco, snus, peripheral artery disease, oral mucosal changesAbstract
Introduction and Purpose of Research
Nicotine pouches, popular especially among young people, are smokeless alternatives to traditional tobacco. Placed in the mouth, they release nicotine absorbed through the mucosa, reducing withdrawal symptoms and avoiding harmful tobacco smoke. Often used for smoking cessation, they are considered lower-risk than smoking and may help reduce smoking rates. The aim of this review is to summarize the current knowledge on the impact of nicotine pouches on overall human health.
Review Methods
The review is based on 39 articles found in PubMed databases published between 2006–2024.
Conclusion
While nicotine pouches and snus are marketed as lower-risk alternatives to smoking, their health implications are still significant. These products, popular among young adults and athletes, may help with smoking cessation but carry risks, particularly with long-term use. Research suggests nicotine pouches and snus may have no performance-enhancing effects in sports and could impair physical performance, including endurance and strength. Moreover, their use is linked to various health concerns such as cardiovascular issues, type 2 diabetes, oral mucosal changes, and decreased sperm count. Snus has been associated with a modest increase in cardiovascular disease risk, although the risks are lower than smoking. Additionally, smokeless tobacco use is linked to an increased risk of oral squamous cell carcinoma, especially in women. The use of snus during pregnancy has also been linked to higher risks of post-neonatal mortality and other adverse outcomes. Despite these findings, there is a need for more extensive, well-controlled studies to fully understand the long-term health effects of smokeless tobacco products and their role in public health.
References
1. Acharya R, Clapp W, Upadhyay K. Association of Oral Tobacco-Free Nicotine Delivery Product with Acute Renal Tubular Necrosis. Medicina (B Aires). 2024; 60(11): 1846, doi: 10.3390/medicina60111846.
2. Alaranta A, Alaranta H, Patja K, et al. Snuff Use and Smoking in Finnish Olympic Athletes. Int J Sports Med. 2006; 27(7): 581–586, doi: 10.1055/s-2005-865826.
3. Back S, Masser AE, Rutqvist LE, et al. Harmful and potentially harmful constituents (HPHCs) in two novel nicotine pouch products in comparison with regular smokeless tobacco products and pharmaceutical nicotine replacement therapy products (NRTs). BMC Chem. 2023; 17(1): 9, doi: 10.1186/s13065-023-00918-1.
4. Björkman F, Edin F, Mattsson CM, et al. Regular moist snuff dipping does not affect endurance exercise performance. PLoS One. 2017; 12(7): e0181228, doi: 10.1371/journal.pone.0181228.
5. Conrad AK, Hutton SB, Munnelly M, et al. Screening for smokeless tobacco use and presence of oral lesions in major league baseball athletes. J Calif Dent Assoc. 2015; 43(1): 14–20.
6. El-Naggar AK, Chan JKC, Grandis JR, et al. (eds). WHO Classification of Head and Neck Tumours. 4th ed. IARC, Lyon.
7. Fagerström K. Can alternative nicotine products put the final nail in the smoking coffin? Harm Reduct J. 2022; 19(1): 131, doi: 10.1186/s12954-022-00722-5.
8. Jaimes EA, Tian R-X, Joshi MS, et al. Nicotine Augments Glomerular Injury in a Rat Model of Acute Nephritis. Am J Nephrol. 2009; 29(4): 319–326, doi: 10.1159/000163593.
9. Jankowski M, Rees VW. Awareness and use of nicotine pouches in a nationwide sample of adults in Poland. Tob Induc Dis. 2024; 22(September): 1–12, doi: 10.18332/tid/192522.
10. Kasper AM, Close GL. Practitioner observations of oral nicotine use in elite sport: You snus you lose. Eur J Sport Sci. 2021; 21(12): 1693–1698, doi: 10.1080/17461391.2020.1859621.
11. Kent JT, Mok G, Austin E. Nicotine Toxicity From Repeat Use of Nicotine Pouches. Nicotine and Tobacco Research. 2024, doi: 10.1093/ntr/ntae111.
12. Kimblad A, Ollvik G, Lindh CH, et al. Decreased sperm counts in Swedish users of oral tobacco. Andrology. 2022; 10(6): 1181–1188, doi: 10.1111/andr.13198.
13. Koyama Y, Miyazato T, Tsuha M, et al. Does the high level of lactate dehydrogenase predict renal function and outcome after renal transplantation from non–heart-beating cadaver donors? Transplant Proc. 2000; 32(7): 1604–1605, doi: 10.1016/S0041-1345(00)01454-8.
14. Kramer RD, Park-Lee E, Marynak KL, et al. Nicotine Pouch Awareness and Use Among Youth, National Youth Tobacco Survey, 2021. Nicotine and Tobacco Research. 2023; 25(9): 1610–1613, doi: 10.1093/ntr/ntad080.
15. Lietzmann J, Moulac M. Novel tobacco and nicotine products and their effects on health-HWG workshop proceedings. Committee on Environment,. 2023. Committee on Environment, Public Health and Food Safety, Policy Department for Economic, Scientific and Quality of Life Policies, European Parliament.
16. Majmundar A, Okitondo C, Xue A, et al. Nicotine Pouch Sales Trends in the US by Volume and Nicotine Concentration Levels From 2019 to 2022. JAMA Netw Open. 2022; 5(11): e2242235, doi: 10.1001/jamanetworkopen.2022.42235.
17. Mantey DS, Clendennen SL, Pasch KE, et al. Marketing exposure and smokeless tobacco use initiation among young adults: A longitudinal analysis. Addictive Behaviors. 2019; 99: 106014, doi: 10.1016/j.addbeh.2019.06.003.
18. Miluna S, Melderis R, Briuka L, et al. The Correlation of Swedish Snus, Nicotine Pouches and Other Tobacco Products with Oral Mucosal Health and Salivary Biomarkers. Dent J (Basel). 2022; 10(8): 154, doi: 10.3390/dj10080154.
19. Miluna-Meldere S, Vanka SA, Skadins I, et al. Oral mucosal changes caused by nicotine pouches: case series. Diagn Pathol. 2024; 19(1): 127, doi: 10.1186/s13000-024-01549-3.
20. Mu G, Wang J, Liu Z, et al. Association between smokeless tobacco use and oral cavity cancer risk in women compared with men: a systematic review and meta-analysis. BMC Cancer. 2021; 21(1): 960, doi: 10.1186/s12885-021-08691-x.
21. Müller S. Frictional Keratosis, Contact Keratosis and Smokeless Tobacco Keratosis: Features of Reactive White Lesions of the Oral Mucosa. Head Neck Pathol. 2019; 13(1): 16–24, doi: 10.1007/s12105-018-0986-3.
22. Mündel T. Nicotine: Sporting Friend or Foe? A Review of Athlete Use, Performance Consequences and Other Considerations. Sports Medicine. 2017; 47(12): 2497–2506, doi: 10.1007/s40279-017-0764-5.
23. National Cancer Institute C for DC and PUSD of H and HS. Smokeless Tobacco and Public Health: A Global Perspective. NIH Publication No.14-7983 , 2014.
24. Németh O, Sipos L, Mátrai P, et al. Snus Use in Adolescents: A Threat to Oral Health. J Clin Med. 2024; 13(14): 4235, doi: 10.3390/jcm13144235.
25. Read D, Carter S, Hopley P, et al. Snus use in football: the threat of a new addiction? Biol Sport. 2024; 41(1): 201–205, doi: 10.5114/biolsport.2024.130050.
26. Rensch J, Edmiston J, Wang J, et al. A Randomized, Controlled Study to Assess Changes in Biomarkers of Exposures Among Adults Who Smoke That Switch to Oral Nicotine Pouch Products Relative to Continuing Smoking or Stopping All Tobacco Use. The Journal of Clinical Pharmacology. 2023; 63(10): 1108–1118, doi: 10.1002/jcph.2293.
27. Rezonzew G, Chumley P, Feng W, et al. Nicotine exposure and the progression of chronic kidney disease: role of the α7-nicotinic acetylcholine receptor. American Journal of Physiology-Renal Physiology. 2012; 303(2): F304–F312, doi: 10.1152/ajprenal.00661.2011.
28. Robichaud MO, Seidenberg AB, Byron MJ. Tobacco companies introduce ‘tobacco-free’ nicotine pouches. Tob Control. 2019; tobaccocontrol-2019-055321, doi: 10.1136/tobaccocontrol-2019-055321.
29. Robichaud MO, Seidenberg AB, Byron MJ. Tobacco companies introduce ‘tobacco-free’ nicotine pouches. Tob Control. 2019; tobaccocontrol-2019-055321, doi: 10.1136/tobaccocontrol-2019-055321.
30. Roses J, Woods JE, Zincke H. The value of lactic dehydrogenase as a predictor of early allograft survival. The American Journal of Surgery. 1977; 133(6): 726–728, doi: 10.1016/0002-9610(77)90165-9.
31. Siddiqi K, Husain S, Vidyasagaran A, et al. Global burden of disease due to smokeless tobacco consumption in adults: an updated analysis of data from 127 countries. BMC Med. 2020; 18(1): 222, doi: 10.1186/s12916-020-01677-9.
32. Skogsdal Y, Karlsson J, Tydén T, et al. The association of smoking, use of snuff, and preconception alcohol consumption with spontaneous abortion: A population‐based cohort study. Acta Obstet Gynecol Scand. 2023; 102(1): 15–24, doi: 10.1111/aogs.14470.
33. Sohlberg T, Wennberg P. Snus cessation patterns - a long-term follow-up of snus users in Sweden. Harm Reduct J. 2020; 17(1): 62, doi: 10.1186/s12954-020-00405-z.
34. Song P, Rudan D, Zhu Y, et al. Global, regional, and national prevalence and risk factors for peripheral artery disease in 2015: an updated systematic review and analysis. Lancet Glob Health. 2019; 7(8): e1020–e1030, doi: 10.1016/S2214-109X(19)30255-4.
35. Titova OE, Baron JA, Fall T, et al. Swedish Snuff (Snus), Cigarette Smoking, and Risk of Type 2 Diabetes. Am J Prev Med. 2023; 65(1): 60–66, doi: 10.1016/j.amepre.2023.01.016.
36. Titova OE, Baron JA, Fall T, et al. Swedish Snuff (Snus), Cigarette Smoking, and Risk of Type 2 Diabetes. Am J Prev Med. 2023; 65(1): 60–66, doi: 10.1016/j.amepre.2023.01.016.
37. Ye D, Rahman I. Emerging Oral Nicotine Products and Periodontal Diseases. Int J Dent. 2023; 2023: 1–7, doi: 10.1155/2023/9437475.
38. Yuan S, Titova OE, Damrauer SM, et al. Swedish snuff (snus) dipping, cigarette smoking, and risk of peripheral artery disease: a prospective cohort study. Sci Rep. 2022; 12(1): 12139, doi: 10.1038/s41598-022-16467-x.
39. Zheng C-M, Lee Y-H, Chiu I-J, et al. Nicotine Causes Nephrotoxicity through the Induction of NLRP6 Inflammasome and Alpha7 Nicotinic Acetylcholine Receptor. Toxics. 2020; 8(4): 92, doi: 10.3390/toxics8040092.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Radosław Chmiel, Daria Michałka, Natalie Papachristoforou, Zuzanna Gałuszka, Monika Makar, Tomasz Bartuś, Natalia Tekiela, Emilia Bąk, Justyna Głowacka, Aleksandra Kocjan

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 270
Number of citations: 0