Multiple tobacco and nicotine product use is increasingly common among young people

A study published in Preventive Medicine Reports found a significant increase in the use of multiple tobacco and nicotine products among young people (aged 15-24 years) between 2021 and 2024.

Dual use of cigarettes and e-cigarettes was the most common pattern of nicotine and tobacco product use among young people in the study (27.8%), followed by exclusive e-cigarette use (24.7%). Researchers also found that dual use of e-cigarettes and oral nicotine pouches increased significantly from 2023 to 2024.

These findings underscore how a rapidly expanding product landscape offers more avenues for nicotine use than ever before. Evidence of dual and poly use among youth and young adults prompts new concerns about the potential for increased nicotine dependence, exacerbated health harms, and difficulty quitting.

Dual use with oral nicotine pouches is on the rise

Findings from this study show a rise in oral nicotine pouch use in combination with other nicotine and tobacco products. Dual use of e-cigarettes and oral nicotine pouches increased by 14.75% between July 2023 and September 2024, and poly use of e-cigarettes, cigarettes, and oral nicotine pouches increased by 6.82% during that time. 

These trends suggest that oral nicotine pouches are not replacing other tobacco products but rather supplementing existing use patterns, potentially exposing young people to higher levels of nicotine. This comes at a time when e-cigarettes – the most commonly used nicotine product among young people – have grown bigger, stronger, and cheaper, offering more nicotine at prices accessible to young people.

Sales of oral nicotine pouches from brands like Zyn, Velo, and On! have increased dramatically, with total monthly nicotine pouch sales increasing by 207% between January 2023 and April 2025, from $145.5 million to $446.8 million. Oral nicotine pouches are discreet, odorless, and easier to use in situations where smoking and vaping may be prohibited, which may contribute to their use among people who use other nicotine products.

Young adults show greater odds of dual and poly use and oral nicotine pouch use

Patterns of use varied by demographic factors. Young adults ages 21-24 had greater odds of multiple product use compared with young people ages 15-20. In addition, young adults aged 21-24 demonstrated higher odds of using oral nicotine pouches in any pattern. 

Gender identity, race, and financial security also played a role in usage patterns. Women had lower odds of dual and poly use with combustible products compared to men, and Black youth showed greater odds of exclusive combustible tobacco use. Participants with higher perceived financial status had greater odds of poly use of e-cigarettes, cigarettes, and oral nicotine products. 

Free digital cessation resources are needed to help people quit multiple tobacco and nicotine products

The rising prevalence of dual and poly tobacco product use among young people, particularly the combination of e-cigarettes with oral nicotine pouches, demands ongoing monitoring. E-cigarettes expose users to more nicotine than ever before, and young people who used e-cigarettes in 2024 reported frequent use – a sign of potential nicotine addiction. In addition, both e-cigarettes and oral nicotine pouches are available in fruit, mint, and candy flavors, which appeal to young people. 

EX Program, a free digital quitting program developed by Truth Initiative with Mayo Clinic, can help people successfully quit using multiple tobacco and nicotine products. EX Program provides tailored support based on product type and offers the most established online community of quitters, where current and former tobacco users can share tips and advice about quitting multiple products. 

As the tobacco product landscape continues to evolve and dual use becomes more common, expanding awareness of free digital cessation resources will be key to supporting successful quit attempts and reducing nicotine addiction among youth and young adults.