Some people who smoke cigarettes try to switch to oral nicotine pouches but are not able to fully stop smoking. This study tests two new strategies for people who previously tried to switch using nicotine pouches. Participants who were unable to fully switch will either be asked to increase the nicotine strength of their pouches or to use a nicotine patch along with pouches. The goal of the study is to see whether these strategies are feasible, acceptable, and helpful, and to inform the design of larger future studies.

Inclusion Criteria:

• Age 21 years or older
• Currently enrolled in and completed the Pack2Pouch parent study
• Current combustible tobacco smoking at extension study enrollment
• Able to attend in-person visits in the Charleston, SC area
• Access to internet and mobile communication

Exclusion Criteria:

• Pregnancy, breastfeeding, or nursing
• Medical contraindications to nicotine replacement therapy
• Current use of smoking cessation medications
• Non-English proficiency
• Use of other combustible tobacco or frequent non-combustible nicotine products outside study protocol

Data from this study may be shared, by reasonable request, with other investigators not affiliated with the tobacco industry.