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Qualitative perspective on nicotine pouches from adults who smoke cigarettes in North Carolina
  1. Sonia A Clark1,2,
  2. Guido Baler1,
  3. Kristen L Jarman1,
  4. M Justin Byron1,2,3,
  5. Adam O Goldstein1,2,
  6. Leah M Ranney1,2
  1. 1Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  2. 2Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  3. 3Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  1. Correspondence to Sonia A Clark, Family Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA; Soniac{at}


Background Little is known about how nicotine pouch products are perceived by people who smoke, including if they are perceived as a cessation aid or a substitute for when they cannot smoke. We qualitatively investigated the reactions and perceptions about On!, a leading brand of nicotine pouches.

Methods We conducted online semistructured interviews with 30 adults who smoke cigarettes. Participants viewed an On! brochure and an image of an opened nicotine pouch and were asked about their initial impression, who the intended user is, and how they thought of the product’s safety compared with other tobacco and cessation products. Transcripts were independently coded and the data were analysed using thematic content analysis.

Results Among the participants, half identified as female and slightly more than half were white (n=16). The mean age was 43 years old. The following are the central themes that emerged: (1) participants perceived the concealability, flavours and packaging of On! as appealing to youth and young adults; (2) participants perceived nicotine pouches as a product that would supplement rather than replace tobacco use; and (3) the product raised health concerns, which decreased interest in trying nicotine pouches.

Conclusions Participants believed that the On! nicotine pouch promotional material may promote youth and young adult nicotine product initiation and dual product use for people who smoke. Most viewed On! as a product to use with cigarettes, rather than a way to quit cigarettes. Increased surveillance of nicotine pouches is warranted to monitor the trajectory of this emerging tobacco product and prevent youth initiation.

  • Advertising and Promotion
  • Non-cigarette tobacco products
  • Public opinion

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  • Contributors AOG, MJB and LR led the conceptual design of the project. The thematic content analysis of the qualitative data was conducted by SAC, GB, KJ and LR. All authors contributed to the interpretation of the results. SAC drafted the initial manuscript and all authors contributed to the review and editing of the final paper. All authors approved the work for journal publication and agree to be accountable for all aspects of the work herein.

  • Funding Research reported in this publication was supported by the NIH National Cancer Institute and FDA Center for Tobacco Products under award number R21CA234968. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Food and Drug Administration.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.