This study is being done to understand how switching from cigarettes to oral nicotine pouches (ex. Zyn) or nicotine replacement therapy (ex. patches and lozenges) can help reduce smoking and improve health outcomes among smokers in rural Appalachia.

You may be able to join this study if you meet the following requirements, along with a few other conditions.

• Age 21+
• Smoke cigarettes daily
• Live in rural Appalachia
• Willing to use study-provided Oral Nicotine Pouches (ex. Zyn) or Nicotine Replacement Therapy

• 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 to participate.