Nicotine Pouch Use and Adolescents' and Children's Grades in School, National Youth Tobacco Survey 2022-23.

Abstract

Background: The prefrontal cortex is not fully developed in middle/high school students, therefore many substances, including nicotine, have the potential to affect it, impair learning, and hinder academic performance. Nicotine in pouches is an emerging, heavily marketed, explicit public health concern. Adolescents may not know of the risks associated with nicotine pouches, especially with social media and marketing claims that they help with weight loss, athletic abilities, mood, and focus. The purpose of this study is to examine the relationship between nicotine pouches and poor academic performance in middle/high school students.

Methods: Data for this cross-sectional study were from the 2022 and 2023 U.S. National Students Tobacco Survey (n = 39,575) of students in grades 6-12 (mean age, 14.7 years). Current nicotine pouch use was defined as self-reporting its use for ≥1 day in the past thirty days. School grades were the self-reported grades in school during the past 12 months with two categories (A/B and C/D/F). Covariates included sex, race/ethnicity, English/not English language spoken at home, social media use, and depression.

Results: Current nicotine pouch use was 0.9%. Middle/high school students' nicotine pouch use was associated with C/D/F grades (unadjusted odds ratio: 2.50 [95% confidence interval: 1.49, 4.27], p = 0.0007; adjusted odds ratio: 2.07 [95% confidence interval 1.17, 3.69], p = 0.0132).

Conclusion: Lower academic performance (mostly C/D/F grades) was associated with middle/high school students' use of nicotine pouches. Longitudinal research is needed in this new area of tobacco-derived product development.