This study is being conducted to learn how effective oral nicotine pouches and nicotine replacement therapies are at reducing cigarette use and improving health outcomes among smokers in rural Appalachian communities.

You may be eligible for this study if you meet the following criteria.

Inclusion Criteria:

• Ages 21+
• Smoke cigarettes daily
• Live in rural Appalachia
• Willing to use study-provided Oral Nicotine Pouches

• If you qualify and choose to participate, you will be randomly assigned to receive either oral nicotine pouches or nicotine replacement therapy (such as patches or lozenges). You will be asked to switch from cigarettes to your assigned product for 12 weeks. Throughout the 29-week study, you will complete five online surveys, brief phone check-ins with study staff, and simple at-home carbon monoxide tests. All participation is remote.

There is no cost for you to participate in our research study.