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According to a 2022 study led by Dr.Nadja Mallock, Department of Chemical and Product Safety, German Federal Institute for Risk Assessment showed that out of 44 nicotine pouches and two non-nicotine pouches, 26 of them contained carcinogens called TSNAs, which are tobacco-specific nitrosamines, that are cancer-causing as well that 29 labels of nicotine content were missing and nicotine strength was ambiguous

Conclusions Our study highlights the importance of smoking reduction and smoking cessation in lowering the risk of lung cancer development in patients with COPD who smoked less than 30 pack-years

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