This is a research study to find out if treatment decision making can be improved for smokers who find it difficult to quit with medications. Everyone who participates in this study will receive free product, either nicotine replacement therapies (patches and lozenges), varenicline, or a harm reduction product (e-cigarette) for a full 12 weeks. Most participants will receive some combination of these treatments, depending on individual response to each.

All visits and study assessments will be entirely remote. All treatments will be provided free of charge for the first 12 weeks. After that, the study team will contact the participants 6 months after the first study phone call to complete another survey. The study lasts six months and will involve 8 surveys.

This is a research study to understand patterns of nicotine pouch use over time among three separate groups of people who: 1) co-use nicotine pouches and cigarettes, 2) co-use nicotine pouches and conventional smokeless tobacco (including chewing tobacco, dip, moist snuff, or snus), or 3) exclusively use nicotine pouches. This is a naturalistic survey study; there is nothing required or requested of participants other than to complete our surveys. Participants do not need to quit or reduce their pouch/smoking/smokeless tobacco product use if they do not want to. They do not need to travel for this study; it is completely remote, and they can participate from their home.
Participation in the study will take place over a period of 12 months in the form of: 1) Monthly Surveys (13 total), 2) Daily Diaries for the first 90 days, and 3) Follow-Up Diaries in each of the 7 days leading up to each monthly follow-up survey.