Use of Nicotine Pouches Among Daily Smokers

NCT ID: NCT06043362

Last Updated: 2025-10-01

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 375 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2024-09-17
• Study Completion Date: 2028-08-31

Brief Summary

The purpose of this clinical trial is to understand the health effects of a new oral nicotine pouch, and also to understand if this product can help reduce traditional cigarette smoking. The main aims are:

1. Understand the impact of nicotine pouch use on toxicant exposure biomarkers, and indicators of potential harms to health.

2. Examine the influence of nicotine pouch use on conventional tobacco product use (cigarettes).

Participants will be randomized to one of six nicotine pouch groups (3 nicotine strengths, each with 2 potential flavors) to use over 16 weeks and asked to reduce their cigarette smoking over that time by at least 75% by substituting with the use of the nicotine pouches. Researchers will compare the outcomes of the different nicotine pouch strengths and flavors to each other. Participants will be asked to complete study questionnaires and provide urine, exhaled carbon monoxide, and mouth cell samples, and other health measurements.

Detailed Description

Nicotine Pouches represent a rapidly growing category in the U.S. tobacco market, but little is known about their health effects (including addiction) or effects on cigarette smoking. The investigators propose to use a randomized controlled trial methodology to inform FDA on the effects of nicotine pouch use in smokers interested in reducing their smoking but not quitting smoking. The specific aim of this proposal is to recruit a cohort of 330 current daily smokers with an interest in reducing smoking, and to measure a comprehensive battery of behavioral and health indicators at baseline, and over 16 weeks after being randomized to use Nicotine Pouches containing either 0mg, 3mg or 6mg nicotine in "Smooth" or Wintergreen flavors in a randomized double-blind, placebo-controlled trial. The trial will be conducted at two sites: Penn State Hershey and M.D. Anderson in Texas in order to recruit a diverse sample of smokers. This trial therefore addresses the scientific domain of Product Composition and Design (specifically nicotine content and flavor additives). The central hypothesis is that key markers of toxicity and health effects (e.g. urine NNAL, exhaled carbon monoxide [CO], measures of cigarette addiction [e.g. Penn State Cigarette Dependence Index], oxidative stress and oral B(a)P DNA adducts) will be significantly reduced in smokers who are provided high nicotine (6mg) Nicotine Pouches, relative to 0mg pouches. The investigators will also assess the effects of Nicotine Pouch content on Nicotine Pouch addiction, and the effects of pouch nicotine dose on cigarette and other tobacco product consumption. Lastly, investigators will also compare the effects in those randomized to "Smooth" versus Wintergreen flavors. After the 16-week randomized phase, participants will be encouraged to quit smoking and connected to telephone cessation services and then followed-up 4 weeks later (week 20) in order to ascertain whether the nicotine content of the pouches influenced intention and ability to quit smoking. At the completion of this rigorous double-blind randomized trial investigators will have a better understanding of the effects of Nicotine Pouches (and their nicotine content and flavor characteristics) on cigarette consumption and the resulting changes to markers of health risks, oral health and nicotine addiction.

Conditions

Tobacco Dependence

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: PREVENTION
• Blinding Strategy: DOUBLE

Study Groups

0 mg + Smooth flavor

Participants are provided with zero strength (0 mg) nicotine pouches with smooth flavor.

Group Type: EXPERIMENTAL

0 mg nicotine pouch

Intervention Type: OTHER

Oral nicotine pouches that contain 0 mg of nicotine

Smooth nicotine pouch

Intervention Type: OTHER

Non-flavored nicotine pouches that are characterized as smooth.

3 mg + Smooth flavor

Participants are provided with medium strength (3 mg) nicotine pouches with smooth flavor.

Group Type: EXPERIMENTAL

3 mg nicotine pouch

Intervention Type: OTHER

Oral nicotine pouches that contain 3 mg of nicotine

Smooth nicotine pouch

Intervention Type: OTHER

Non-flavored nicotine pouches that are characterized as smooth.

6 mg + Smooth flavor

Participants are provided with high strength (6 mg) nicotine pouches with smooth flavor.

Group Type: EXPERIMENTAL

6 mg nicotine pouch

Intervention Type: OTHER

Oral nicotine pouches that contain 6 mg of nicotine

Smooth nicotine pouch

Intervention Type: OTHER

Non-flavored nicotine pouches that are characterized as smooth.

0 mg + Wintergreen flavor

Participants are provided with zero strength (0 mg) nicotine pouches with wintergreen flavor.

Group Type: EXPERIMENTAL

0 mg nicotine pouch

Intervention Type: OTHER

Oral nicotine pouches that contain 0 mg of nicotine

Wintergreen nicotine pouch

Intervention Type: OTHER

Menthol flavored nicotine pouches that are characterized as wintergreen.

3 mg + Wintergreen flavor

Participants are provided with medium strength (3 mg) nicotine pouches with wintergreen flavor.

Group Type: EXPERIMENTAL

3 mg nicotine pouch

Intervention Type: OTHER

Oral nicotine pouches that contain 3 mg of nicotine

Wintergreen nicotine pouch

Intervention Type: OTHER

Menthol flavored nicotine pouches that are characterized as wintergreen.

6 mg + Wintergreen flavor

Participants are provided with high strength (6 mg) nicotine pouches with wintergreen flavor.

Group Type: EXPERIMENTAL

6 mg nicotine pouch

Intervention Type: OTHER

Oral nicotine pouches that contain 6 mg of nicotine

Wintergreen nicotine pouch

Intervention Type: OTHER

Menthol flavored nicotine pouches that are characterized as wintergreen.

Interventions

0 mg nicotine pouch

Oral nicotine pouches that contain 0 mg of nicotine

Intervention Type: OTHER

3 mg nicotine pouch

Oral nicotine pouches that contain 3 mg of nicotine

Intervention Type: OTHER

6 mg nicotine pouch

Oral nicotine pouches that contain 6 mg of nicotine

Intervention Type: OTHER

Smooth nicotine pouch

Non-flavored nicotine pouches that are characterized as smooth.

Intervention Type: OTHER

Wintergreen nicotine pouch

Menthol flavored nicotine pouches that are characterized as wintergreen.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Commonly smoke ≥ 5 cigarettes per day (at least 2 days/week) for at least the prior 12 months
• Exhaled CO measurement of ≥ 6 parts per million at baseline
• Must be interested in reducing cigarette consumption by at least 50% and willing to try nicotine pouches
• Able to understand, read and write in English
• Access to e-mail and a smartphone/computer that has reliable internet connection
• Able to understand and give informed consent

Exclusion Criteria

• Plans to quit smoking within the next 30 days
• Currently pregnant, breastfeeding, or planning to become pregnant in the next 6 months
• Recent (past 3 months) unstable illness that may increase risks of participation or ability to participate fully (e.g. hospitalization for a mental health condition or substance use disorder in prior 6 months, stroke or myocardial infarction in the past year)
• Serious current respiratory diseases (e.g. exacerbations of asthma or chronic obstructive pulmonary disease [COPD], requiring oxygen or oral prednisone), kidney disease (e.g. requiring dialysis), liver disease (e.g cirrhosis), or any medical disorder/medication that may affect participant safety or biomarker data
• Use of a nicotine pouch or other non-cigarette nicotine product (e-cigarette, pipe, cigar, chew, snus, hookah, IQOS) for 5 or more days in the past 28 days
• Use of illegal drugs daily or weekly in the past 3 months
• Use of combustible (smoked) recreational or medical marijuana weekly in the past 3 months (less frequent smoked medical marijuana or use of other forms of medical marijuana are ok)
• Other member of the household currently participating in the study
• Any other condition that in the opinion of the investigator would make it unlikely that the participant could comply with the study protocol

• Minimum Eligible Age: 21 Years
• Maximum Eligible Age: 70 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

National Institute on Drug Abuse (NIDA)

NIH

Sponsor Role: collaborator

Milton S. Hershey Medical Center

OTHER

Sponsor Role: lead

Responsible Party

Jonathan Foulds

Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Jonathan Foulds, PhD

Role: PRINCIPAL_INVESTIGATOR

Penn State College of Medicine

Locations

Penn State College of Medicine

Hershey, Pennsylvania, United States

Site Status: RECRUITING

University of Texas MD Anderson Cancer Center

Houston, Texas, United States

Site Status: RECRUITING

Countries

United States

Central Contacts

Nicolle M Krebs, MS

Role: CONTACT

nkrebs@pennstatehealth.psu.edu

717-531-5673

Jonathan Foulds, PhD

Role: CONTACT

jfoulds@pennstatehealth.psu.edu

717-531-3504

Facility Contacts

Nicolle M Krebs, MS

Role: primary

nkrebs@pennstatehealth.psu.edu

717-531-5673

Jason Robinson, PhD

Role: primary

jdrobinson@mdanderson.org

713-745-3581

Other Identifiers

1U54DA058271

Identifier Type: NIH

Identifier Source: secondary_id

View Link

STUDY00023056

Identifier Type: -

Identifier Source: org_study_id