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Head and Neck Surgery

(635) Oral Nicotine Pouches and Head and Neck Cancer: Results from a Nationally Representative Survey

Saturday, October 17, 2026

Presenting Author(s)

SH

Song Hon Hwang, MD

PGY-5
UCLA Department of Head & Neck Surgery
Los Angeles, CA, United States
ML

Matthew E. Lin, MD

Resident Physician
UCLA Department of Head and Neck Surgery
Los Angeles, California, United States

Co-Author(s)

Oluwatobiloba O. Ayo-Ajibola, BS

Medical Student
Keck School of Medicine of University of Southern California, Los Angeles, California, USA
Los Angeles, California, United States
AA

Abdul Abdel-Reheem, MD

Resident Physician
UCLA Health, United States
Tyler JS Gallagher, MD MPH

Resident Physician
Caruso Department of Otolaryngology - Head and Neck Surgery
Los Angeles, California, United States

Senior Author(s)

MS

Maie A. St. John, MD, PhD, F.A.C.S.

Director of Department of Otolaryngology - Head and Neck Surgery
Johns Hopkins University School of Medicine
Baltimore, Maryland, United States

Introduction: Oral nicotine pouches (ONP), a relatively new smokeless nicotine product, are rapidly increasing in popularity in the United States. While ONPs contain carcinogens and their chronic use can induce mucosal trauma and cytotoxicity, data evaluating the association between ONPs and head and neck cancer (HNC) remains limited. This study explores the association between ONP use and HNC using nationally representative survey data.

Methods: Cross-sectional analysis of adults (≥18 years old) participating in the 2024 Health Information National Trends Survey (HINTS 7). Any use of nicotine pouches was the primary exposure. Outcomes included self-reported history of HNC overall and oral cavity cancer (OCC) specifically. Analyses accounted for the complex survey design using final sample weights and replicate weights using the jackknife replication method according to HINTS 7 guidelines. Multivariable survey-weighted logistic regression was performed using a quasibinomial model. Models of HNC were adjusted for age, sex, smoking history, and alcohol use. Due to the limited number of OCC cases, analyses were intentionally limited to age adjustment alone.

Results: Among 7,278 respondents, 18 reported a history of HNC and 12 reported a history of OCC. In multivariable survey-weighted regression, use of ONPs was not significantly associated with HNC. Increasing age was independently associated with head and neck cancer (OR 1.15; 95% CI 1.05–1.25). Analysis of only OCC showed a higher weighted prevalence among respondents who used ONPs compared to never users (0.52% vs 0.15%). However, in survey-weighted regression, ONP use was not significantly associated with OCC; effect estimates demonstrated substantial imprecision due to small case counts.

Conclusions: Oral cavity cancer was three times as common among those endorsing past ONP use, but ONP use was not independently associated with either HNC or OCC survey-weighted regression. These results, although limited by the rarity of HNC, OCC, and ONP use in this dataset, underscore the need for future studies to further elucidate the association between OCC and ONP use.