Front Public Health. 2026 Feb 25;14:1772045. doi: 10.3389/fpubh.2026.1772045. eCollection 2026.
ABSTRACT
BACKGROUND: This study employed a three-product agent-based model (ABM) to evaluate the potential population-level effects of granting market authorization for on! ® nicotine pouches, an oral tobacco-derived nicotine product. Previous research has typically relied on simplified two-product models comparing cigarette use in a “Base Case” with a “Modified Case” scenario, limiting the ability to reflect real-world multi-product tobacco use patterns. To address this, the ABM in this study incorporated cigarettes and smokeless tobacco (ST) products in the Base Case and added the on! ® nicotine pouches as the Test Product in the Modified Case.
METHODS: Developed in MATLAB® version 9.2, the model consisted of a transition sub-model, which simulated annual changes in product use based on national survey data and Test Product-specific studies, and a mortality sub-model, which linked survival outcomes to product transitions using an excess relative risk estimate of 5% for the Test Product relative to cigarettes. The simulation ran over an 80-year time horizon, predicting individual-level agent dynamics and annual transitions.
RESULTS: Model outputs indicated that introducing the Test Product could prevent approximately 476,000 premature deaths, reduce cigarette prevalence by 0.6 percentage points, and ST product use by 0.3 percentage points, while increasing Test Product use by 1.6 percentage points.
CONCLUSION: These findings suggest that regulatory authorization of on! ® nicotine pouches could yield a net public health benefit by lowering all-cause mortality and reducing the prevalence of use of tobacco products associated with greater health risks.
PMID:41822933 | PMC:PMC12975934 | DOI:10.3389/fpubh.2026.1772045
