According to The Wall Street Journal, there are over 52 million daily active users of Reddit. Reddit is a popular social media outlet that is differentiated from other social media platforms by its capability for users to form niche groups called “subreddits.” Each subreddit has a common topic and users within the subreddit can express their opinions and personal experiences. The universality of social media makes it a suitable platform to collect information on public attitudes and perceptions of new emerging trends. Although there have been studies about the chemical characteristics of oral nicotine pouches, few studies have investigated public perceptions of these products, the importance of which is highlighted further by the substantial and increasing use of oral nicotine pouches. Potential health effects of oral nicotine pouches await further investigation. Given that Swedish snus has been shown to have significantly fewer health risks than cigarette smoking, these results indicate that nicotine pouch users may be at lower risk of adverse health effects than users of Swedish snus or cigarettes. Nevertheless, another study estimated the toxicant levels of oral nicotine pouches and concluded that users are likely to be exposed to lower levels of toxic compounds than with Swedish snus. The various flavors contained in the oral nicotine pouches are another rising concern as flavors are one of the major reasons that youth are attracted to and use electronic nicotine delivery system products with high nicotine content. Due to the high nicotine content, the authors expressed concern over appeal to, and use by, young people and that oral nicotine pouches may be a gateway to more harmful tobacco products. They found a similar pH across products and nicotine content comparable to, or greater than, smokeless tobacco pouch products, suggesting a similar addiction potential as those products. For example, a recent study examined the moisture content, pH, and nicotine content of 37 oral nicotine pouch brands. To date, several studies have investigated the chemical components of oral nicotine pouches. Among a great variety of brands in the United States, ZYN, a Swedish Match product, by far occupied the largest national market share (nearly two-thirds), and shipments of ZYN in the United States have increased from 114.1 million cans in 2020 to 173.9 million cans in 2021. The market for oral nicotine pouches is rapidly growing, indicated by the sales volume of the global market, which is estimated at US $2.33 billion in 2020 and expected to reach US $21.84 billion by the end of 2027. A cross-sectional survey study found that almost all oral nicotine pouch users were either former or current tobacco users (96.3%). The properties of being spit-free and tobacco-free may make oral nicotine pouches attractive alternatives to smokeless tobacco products. Instead of containing the tobacco leaf found in snus, they are composed of white nicotine-containing powder. In appearance, oral nicotine pouches are similar to snus, a smokeless tobacco product originated in Sweden. Oral nicotine pouches are popular products launched by tobacco manufacturers over the past 3 years. In addition, a greater number of Reddit posts described positive attitudes compared to negative attitudes toward oral nicotine pouches (354/653, 54.2% vs 101/653, 15.5% P<.001). The least popular topic was “legality and permissions” related to oral nicotine pouches (15/653, 2.3%). The next popular topic was “asking product-related questions” (product properties and product recommendations 115/653, 17.6%), followed by “quitting nicotine products” such as vaping or smoking through use of oral nicotine pouches or quitting the oral nicotine pouches themselves (83/653, 12.7%) and “discussing oral nicotine pouch–related health” symptoms or concerns related to oral nicotine pouches (74/653, 11.3%). Content analysis showed that the most popular topic was “sharing product information and user experience” (366/653, 56%), in which sharing oral nicotine pouch products and user experiences were dominant. The number of Reddit posts related to oral nicotine pouches increased during the study period.
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