About one in five male and female professional players who took part in a new survey are using snus, nicotine pouches or both. The study by ­Loughborough University, ­commissioned by the Professional Footballers’ Association (PFA), also identified that two out of five had tried the pouches at least once. The report states the true usage figures are likely to be higher owing to players not wanting to disclose use, even in an anonymous survey. Of the 628 male players surveyed, at Premier League or EFL clubs, 18% said they used it, while 22% of the 51 Women’s Super League players ­surveyed said they were users. Improved mental readiness was cited as a key perceived benefit by users (29% and 55% respectively), and 41% of male players users said they used it to help relax, most ­commonly after training and matches. That ­figure was 64% among female ­players. One of the 16 professional club performance and medical staff members interviewed said players used it as a “coping mechanism”. The pouches are also used as an appetite suppressant, the report found. The report highlighted the potential negative physical impacts, in particular of using snus. A review of available evidence suggests use is associated with an increased risk of oesophageal and pancreatic cancer in comparison with ­non‑smokers and with an increased risk of cardio­vascular disease. There is strong evidence of an association between snus use and mouth lesions. Snus contains tobacco and is not legally available to buy in the UK, whereas the tobacco-free nicotine pouches – that were found to be more commonly used among players – are legal to buy. The pouches are usually placed between the upper lip and gums. The survey found users often started using the products in an effort to fit in with other, often more senior, teammates – 56% of male users gave this as a ­reason, rising to 73% among women. This prevalence of use was identified as a barrier to quitting, with one surveyed player admitting: “I have quit twice for eight months but always seem to start doing it again. [I] find it hard to quit when I’m around it all day.” A staff member at a club said they had come across a player whose career had been spent mainly in the Premier League and ­Championship who described themselves as a “heavy user”, and had told the staff member: “I’d love to come off it, but I can’t. It’s just everywhere I look. Every other player’s taking it, [I] go to fill my car up and it’s at the pump stands. It’s just too easy.” Approximately half the users in the men’s game indicated wanting to quit in the next 12 months, but most users in the WSL did not intend to quit. Users reported experiencing primary indicators of nicotine dependence, such as using it without awareness or intention. Short-term withdrawal symptoms were also common: cravings, irritability, restlessness and anxiety. The report highlights the risk of an adverse anti-doping finding if products bought online or via social media have been contaminated. It found club bans had not been effective in deterring use and recommended personalised, external support and to avoid stigmatising those seeking help.