More high schoolers reported using nicotine pouches last year than the year before, according to new data published in JAMA Open Network.
The survey of more than 10,000 adolescents found nearly 5.5% of 10th and 12th graders said they’d used a nicotine pouch in 2024. That’s up from three percent in 2023.
Will Humble, executive director of the Arizona Public Health Association and a former director of the Arizona Department of Health Services, joined The Show to talk about why this may be happening and what it means.
Full conversation
MARK BRODIE: Good morning, Will.
WILL HUMBLE: Morning. And I'm also a sustaining member of KJZZ and KBACH.
BRODIE: We appreciate that, not a prerequisite for you on The Show though. We should say that. So let's sort of define our terms here. What are these nicotine pouches exactly?
HUMBLE: They look like little pillows on your bed, but really, really small, shrink them down, really small. And they're little pouches that adults who want to quit smoking might put in their cheeks. So it's not like it's similar to what you might think of, remember this product called Skoal, like the little pouches, but, but it's not tobacco, it's just pure nicotine. So it's a little pouch that they put in their cheek.
BRODIE: Are they seen as ways to try to wean one off smoking?
HUMBLE: It's also a strategy for an adult smoker to get to relieve their craving for nicotine while phasing out active cigarette smoking, which is by far the most harmful thing of all these things between the vaping, the pouches and the cigarettes, like the cigarettes are by far the worst, health wise.
So it can, it can be that, but as we see with younger people, it's, they have a craving for nicotine that they're now increasingly using pouches to satisfy at school. I think in part, partly because the vaping has been such a problem in high schools and stuff that they start to get, I mean, the teachers and administrators are cracking down more and this is a lot easier to hide.
Also, it's not like the old pouches with tobacco, you know, you kind of have to spit. So these aren't like that.
BRODIE: It just sits in your mouth and nobody would know that it's there necessarily.
HUMBLE: Correct. Right, so it's a lot easier to hide than vaping, for example, at school.
BRODIE: So in terms of, I wanna ask one last question for people who are trying to maybe get off smoking, are these more or less effective than nicotine pouches or Nicorette gum or something like that?
HUMBLE: I don't want to answer that question because I don't, not sure which is the most effective. There's also prescription drugs that help too, so Chantix is the brand name, so like there's different strategies that people use. From a public health point of view, I'm most interested in the harm reduction aspects of this.
So, like, I'm not one of those persons that's freaking out about vaping in these pouches, cause I'm like, the act of cigarette smoking is really the big public health threat. That's what ruins your lungs and it causes cancer and all kinds of stuff. Nicotine's super addictive, but it doesn't have the kinds of really damaging effects that active cigarette smoking has.
BRODIE: So it sounds like what you're saying is, you know, it's maybe not, in a perfect world, we wouldn't have this percentage of high school students using these pouches, but you'd rather have them using these than smoking cigarettes or vaping.
HUMBLE: Or vaping, because like, you look at it it's a continuum, like cigarette smoking is by far the worst. Vaping isn't great, but way better than active cigarette smoking, and these pouches are better than vaping. In terms, because you're not bringing it into your lungs, it's dissolving into your mouth. So, and it's, remember, it's not tobacco products, it's just nicotine. I'm not trying to sell the things, I'm just trying to put some perspective on this because a lot of the people in my public health world are idealists, and they're like, no, no, everything's bad, you have to go to zero, and that's not the world that we live in.
BRODIE: Is it possible, I mean, do do you foresee a time maybe when The number of people of, especially teens and and high school students using these pouches might get to a point where you have to say, OK, we, we might need to look at this and try to do something about this.
HUMBLE: I don't know. I mean, I'm most interested in making now, one thing you didn't talk about yet is the smoking, the active smoking rate among teens in 25 years ago in the year 2000 was like in the high 20s, low 30s for cigarettes. That's down to in Arizona, that's down to like 2%. So that's a public health success story. So you're asking, is there a point where we would start freaking out about the pouches? I'm not, I can't see that.
Now, these folks are gonna be addicted to nicotine, and they eventually will probably want to kick that addiction. And for that, there are still the prescription drugs, which is really goes after the nicotine craving.
BRODIE: What gets high schoolers started on these pouches in the first place, especially if they're not, as you suggested, fewer teens are smoking cigarettes and fewer teens than in the most recent past are vaping. So like, why, why are people starting these in the first place?
HUMBLE: Well, nicotine is much like caffeine and it's a stimulant and so there’s something that kids want from these pouches. It's not, I mean, with the cigarettes, you could say, well, I want to portray myself as being cool back in the day, right? And a rebel kind of thing. Now with these pouches, you can't see it, so it's not like the perception thing.
There's a reason why they want the nicotine and, and it's probably a stim that they might not be getting enough sleep, for example. It provides an alertness. There's something they like about it, but it also causes difficulty with emotional regulation. There's good evidence that it can present mood disorders that can even be not permanent, but perhaps permanent necessarily. So, nicotine isn't a great thing, but there's a reason kids are gravitating to these things because they're getting something back from it, like it's a stimulant.
BRODIE: Well, so you mentioned it's not such a social thing because as we discussed, unless you knew someone was using it, you wouldn't necessarily know. But I wonder like, it's sort of in the popular culture that, you know, these are, are seen as kind of cool or maybe a way to boost your masculinity, things like that. Is that something that you're seeing in Arizona?
HUMBLE: Well, that is something that the, the companies that sell these pouches, I'm glad we got to this part of it, because this is the part that really ticks me off, is that the manufacturer of these pouches are paying these influencers, people on TikTok and Instagram and stuff that kids know about. I have no clue who these people are, but like they do and they're pushing, they're getting paid to post this crap on the, you know, on these platforms. And one of the things they're selling is the masculinity thing. So that is bad.
BRODIE: Not a good thing in your mind.
HUMBLE: But yeah, and, and it's not a good thing to be motivating kids but with that kind of perception and paying these influencers to just do this. I don't know. It shouldn't even be a job, I don't think.
BRODIE: Sure, fair enough. All right. Will Humble will never be a social media influencer. We do love having him on The Show though.
