Self-Perceived Knowledge, Attitudes, Personal Use, and Willingness to Recommend Nicotine Pouches and Tobacco Harm Reduction Strategies Among Physicians in Saudi Arabia: A Cross-Sectional Study.

BACKGROUND: Tobacco harm reduction (THR), including tobacco-free nicotine pouches, has emerged as a potential complement to smoking cessation strategies. Evidence regarding physicians' self-perceived knowledge, attitudes, and practices toward THR in the Middle East remains limited. OBJECTIVE: To assess physicians' self-perceived knowledge, attitudes, personal use of nicotine pouches, and factors associated with willingness to recommend THR in Saudi Arabia. METHODS: A cross-sectional online survey was conducted among 325 physicians in Jeddah between August and December 2025. A study-specific questionnaire assessed demographics, THR awareness and self-perceived knowledge, attitudes, nicotine pouch use, perceived barriers, and willingness to recommend THR. RESULTS: Overall, 72.0% of participants were aware of THR, while 45.5% reported low self-perceived knowledge of its effectiveness. Two-thirds (66.5%) agreed that THR strategies are effective for smoking cessation, although 54.8% had neutral/moderate attitudes on the composite scale. Nicotine pouch ever-use was reported by 25.2%, and 61.5% expressed willingness to recommend THR. Willingness was associated with awareness of DZRT, a locally available nicotine pouch brand (aOR=2.09), belief in sufficient evidence for THR (aOR=2.89), higher self-perceived knowledge (aOR=2.35), and more positive attitudes (aOR=3.91). CONCLUSIONS: Self-perceived knowledge, attitudes, and product awareness were associated with willingness to recommend THR. Given the cross-sectional convenience sample and study-specific measures, these findings are exploratory and support balanced, evidence-based education rather than causal or routine clinical implementation conclusions.