Nicotine pouch use among soldiers significantly higher than civilians

American soldiers are 10 times more likely to use nicotine pouches that can cause serious health issues than average American adults, according to a survey of military personnel at Fort Liberty, the largest American military base.

Conducted by researchers at UVA Cancer Center, the Fort Liberty Department of Public Health and the UNC Lineberger Comprehensive Cancer Center, the study analyzed anonymous responses from 1,957 soldiers surveyed in 2022 and 2023. Among survey participants, 23.8% reported using nicotine pouches in the previous 30 days, compared with a 2022 study that found just 2.9 percent of all American adults had reported ever using nicotine pouches.

Military personnel historically use tobacco and nicotine products at much higher rates than their civilian counterparts. Our results show that these same disparities are continuing with new and emerging products, like nicotine pouches."

Melissa Little, PhD, Director, Center for Nicotine and Tobacco Research, University of Virginia School of Medicine

Growing popularity

Nicotine pouch use grew in popularity during the survey period, as 24.7% of soldiers queried in 2023 reported using nicotine pouches compared with 20.2% in 2022. The highly addictive pouches have been linked to cardiovascular risks, lung and stomach problems, gum ulcers, oral health issues and other concerns, including nicotine's ability to promote the growth of cancer. 

Users were more likely to be younger, male, White, unmarried and users of other tobacco or nicotine products such as cigarettes, smokeless tobacco and vapes. Soldiers ages 30 and older were less likely to use nicotine pouches than soldiers ages 17 to 24. Survey participants with at least a bachelor's degree were more likely to use nicotine pouches than soldiers with a high school degree or GED.

With approximately 200,000 American soldiers leaving the military each year, the researchers said that continued research into nicotine pouch use is needed to develop ways to reduce nicotine and tobacco consumption as soldiers return to civilian life.

"We are currently working on addressing these high rates of nicotine pouches by developing tailored interventions for military personnel," Little said. "Given everything that military personnel sacrifice to serve our country, providing them with the tools to lead the healthiest lives possible is the best way we can give back."

Findings published

The researchers have published their results in the scientific journal JAMA Network Open. The research team consisted of Little, Kathryn M. Polaskey, Asal Pilehvari, Rebecca A. Krukowski, Kurt M. Ribisl and Teresa D. Pearce. Ribisl disclosed that he has served as a paid expert consultant representing plaintiffs in litigation against e-cigarette and tobacco companies. 

The study was supported by grant R01DA043468 from the National Institutes of Health's National Institute on Drug Abuse and grants P30CA225520 and P30CA044579 from the National Cancer Institute.