Factors Associated with Exposure to Nicotine Pouch Content on Social Media among U.S. Adolescents

INTRODUCTION: Exposure to tobacco content on social media is associated with adolescent susceptibility to tobacco product initiation. This study examines the prevalence of adolesecent exposure to nicotine pouch content on social media and characteristics of those exposed. METHODS: Data came from U.S. Population Assessment of Tobacco and Health Wave 7 participants aged 12-17 (January 2022-April 2023). Past-week exposure to nicotine pouch content on social media was estimated overall and by demographic, behavioral, and tobacco use characteristics using weighted percentages and covariate-adjusted logistic regression. RESULTS: Among 10 650 respondents,1.9% reported past-week exposure to nicotine pouch content on social media. Exposure prevalence varied by platform used most often (Snapchat [4.1%], TikTok [2.6%], Instagram [2.0%], YouTube [1.2%]) and was curvilinearly associated with time spent using social media (inverted U). Exposure was more common among adolescents who had ever used nicotine pouches vs. never (Adjusted Odds Ratio [AOR] = 3.1[95% CI: 1.4-7.0]) and those with high vs. no externalizing problems (AOR[95% CI] = 1.9[1.1-3.5]). Hispanic adolescents had lower exposure prevalence than non-Hispanic White respondents (AOR[95% CI] = 0.6[0.4-1.0]). CONCLUSIONS: Past-week exposure to nicotine pouch content on social media was not merely the result of time spent on social media, but was associated with race and ethnicity, social media platform, and externalizing behaviors. Longitudinal data and further questioning are needed to identify why some adolescent groups have greater exposure to nicotine pouch content and to understand long-term consequences.