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Within 24 weeks of using only nicotine pouches, most ex-smokers find they can comfortably step down one strength tier

6 However, most previous research on SLT use has primarily focused on urban populations or provided a broad overview, neglecting the unique socioeconomic and cultural contexts of rural communities.[6] This gap in the literature hinders our understanding of how these factors influence SLT initiation, dependency, and cessation attempts among rural dwellers.[7] Moreover, a lack of data on the effectiveness of past cessation interventions in rural settings may impede the success of future public health initiatives.[8] Previous research also suggests that cessation interventions often fail due to a lack of consideration for these contextual factors, leading to high relapse rates among users.[9] These insights are crucial for the development of effective and integrated SLT control policies and support services tailored to the specific needs of rural communities

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With the potential for additional local, state, and federal regulations, the findings will have broad applicability for regulators

Today, we are so far removed from the rites of passage traditions that would have formed a significant event in tribal life

A final thematic analysis of 28 interviews, after achieving thematic saturation, revealed four key themes: dynamics of addiction, risk perception, cessation journey, and socioeconomic factors