BACKGROUND-AIM:
Oral nicotine pouches (ONP) represent an emerging nicotine product that has expanded rapidly across global markets, including Europe and North America.. Adolescent use in the United States (US) has increased in recent years , and is expected to rise exponentially. ONPs are frequently promoted on social media platforms such as TikTok through influencer marketing. Given extensive evidence linking social media to promotion of emerging tobacco and nicotine products, social media may similarly influence adolescent ONP awareness and use. However, this relationship remains unexplored. This study aimed to examine associations between social media use frequency and ONP awareness and ever use among US adolescents and assess temporal changes during evolving ONP marketing.

METHODS:
This cross-sectional study analysed data from the National Youth Tobacco Survey spanning 2021-2023, including 65944 respondents weighted to represent 16.8 million US students (mean age 14.7±2.0 years; 50.3% females; 44.0% Non-Hispanic (NH) White, 25.8% Hispanic, 22.5% NH Black, and 25.3% other NH). Self-reported social media use frequency was categorized as low (never to a few times per week), medium (less than 1 hour to 3-4 hours daily), or high (>4 hours daily). ONP outcomes included awareness (heard of ONP) and ever use. Survey-weighted logistic regression analyses were conducted, controlling for demographic and tobacco-related covariates, with interaction terms testing temporal effect modification, followed by year-stratified analyses.

RESULTS:
Overall, across the three years, ONP awareness was reported by 35.1% [95% confidence interval (CI), 25.7%-44.4%] of students, with 2.1% [95% CI, 0-4.9] reporting ever use. Social media use frequency showed positive associations with ONP awareness across all three years: medium social users (adjusted odds ratio [AOR] =1.42, 95% CI: 1.31-1.54) and high users (AOR=1.37, 95% CI: 1.24-1.52) had greater odds of being aware of ONPs compared to low users. However, no significant associations were found between social media use frequency and ONP ever use. Temporal effect modification emerged for ever use, with significant social media × year interactions (p<0.05) indicating the strength of association between social media use and ever use of ONP varied over time.

CONCLUSIONS:
Social media use frequency was associated with higher ONP awareness across 2021-2023, but no significant association was found for ONP ever use. These findings suggest that adolescents may be directly or indirectly exposed to ONPs through social media platforms. This is concerning given the largely unregulated nature of ONP marketing on social media, although we found no direct association with actual use, which may be determined by multiple factors.