MyVoice poll finds youth have mixed perceptions of oral nicotine pouches

While the use of nicotine via smoking or electronic cigarettes has decreased among young people, more youth are being exposed to oral nicotine pouches (ONP), manufactured and distributed by companies like On!, Rogue, Velo and the most popular brand, Zyn. The company promotes its products on social media and through brand ambassadors, called ‘Zynfluencers.’

University of Michigan Family Medicine researchers sought to understand how young people feel about Zyn, a discreet product that contains nicotine and is taken orally.

Ailish Dougerty, a woman with dark hair, wearing a light blue cardigan and black shirt
Results of their findings were recently published in the paper, “United States Youth Perspectives on Zyn Oral Nicotine Pouches,” in the Journal of Adolescent Health. Authors include first author and recent U-M Medical School graduate Ailish Dougherty, M.D., pictured left; U-M students Abby Frank and Arianne Hunter, U-M Medical School student Mahesh Gupta; as well as Marika Waselewski, MPH, and Associate Professor Tammy Chang, MD, MPH, MS, both of the Department of Family Medicine.

Researchers with the MyVoice project, led by Chang and managed by Waselewski, sent out a nationwide text message survey to 704 youth aged 14 to 24 years. The survey asked five open-ended questions about Zyn: If they knew anyone who used it; how people their age first learned about it; reasons for using it; their feelings about Zyn use; and whether doctors should ask young people about Zyn use.

Out of the 704 youth contacted, 622 responded (88%). The average age of the respondents was 20 years old. Most were female (56%) and non-Hispanic White (48%). Only a few (3%) said they used Zyn themselves, but 37% said their friends used it.

Researchers identified three main themes:

Exposure and Peer Pressure: Youth are exposed to Zyns in many ways, especially through friends and online sources. Peer pressure was a major reason why some young people try Zyns. Many said they felt the need to “fit in” or “look cool” because others around them were using Zyns.

Mixed Feelings (Ambivalence): Young people had mixed feelings about Zyn use or felt disappointed that the nicotine-containing substance was still being consumed by their peers. “I do believe that my generation would have ended smoking,” one respondent said. “We have just replaced it with similar product. People seem to be blind about the effects of nicotine and I don’t understand why.”

While 60% percent of youth said they felt negatively about Zyn use, mentioning health dangers, addiction, or that it was “pointless” or “gross,” about 21% had positive opinions, often saying Zyns were a better alternative to smoking or vaping. Other youth had the perception that ONPs were a nicotine cessation method, helped alleviate stress, or were easier to use discreetly. “People my age are going through a lot and some don’t have the resources to have help so they look to other outlets,” one youth said.

A different youth had this to say about Zyn usage: “It’s inevitable. There’s an ongoing nicotine addiction epidemic with young people in the U.S. Life sucks and it is stressful, they will try to find a way to cope period.”

Awareness of Risks and Support for Doctor Involvement: Most youth were aware of the health risks of Zyns, like potential gum health issues, possible negative interactions with other medications, and the effects of nicotine on the body. A large majority (86%) thought doctors should ask young people about Zyn use, including one respondent who said, “I think they should because it is so new and unknown if it is as strongly linked to carcinogens and other negative health effects.”

Youth also believed doctors could help by giving accurate information about the product, as well as counseling and support to help users quit, a strategy the authors endorsed.

“Simply telling youth not to use Zyns is inadequate,” Dougherty et al said. “Educational campaigns should address the reasons youth are using ONP – specifically to feel connected and to cope with stress -- and to help youth find healthier ways of doing so.  They should also clarify misinformation about youths’ perceived positives of using Zyns.

“Healthcare professionals should screen for all forms of nicotine use, including Zyns, and offer support for quitting," they added.

Article cited: Dougherty, A., Frank, A., Hunter, A., Gupta, M., Waselewski, M., & Chang, T (2026). United States youth perspectives on Zyn oral nicotine pouches. Journal of Adolescent Health. https://doi.org/10.1016/j.jadohealth.2026.04.003