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Donna Shelley, professor and vice dean for research at the New York University School of Global Public Health, said that while nicotine pouches don't cause the same health problems as products containing tobacco, she wouldn't call them "safe." "Some of the negative health effects of the nicotine pouches include gastrointestinal symptoms, like nausea, gum soreness and ulcers, and also some cardiovascular risks like elevated heart rate," said Shelley, who researches tobacco control, adding, "We don't know the full safety profile yet." A 2023 study that compared Zyn pouches to smokeless tobacco and nicotine replacement products found that while Zyn doesn't contain "nitrosamines or some of those real known cancer-causing agents, it does contain some chemicals like formaldehyde that the FDA has said are potentially harmful," she said

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Respondents were asked to assess the cigarette packs on a five-point Likert Scale (5Strongly Agree to 1Strongly Disagree) and according to attractiveness, quality, taste, cost, social appeal, appeal to youth, noticeability of the GHWs, appeal to non-smokers, attempt to quit, ease of quitting, discourage to smoke, and perceived harm to health