Assessment of awareness, usage, and attitudes toward nicotine pouches in Saudi Arabia: a cross-sectional study.

BACKGROUND: Nicotine pouches (NPs) are emerging smokeless nicotine products marketed as tobacco-free alternatives to traditional smokeless tobacco products. Despite their growing popularity, particularly among youth, limited research exists on their awareness, usage, and attitudes in Saudi Arabia. OBJECTIVES: This study aimed to assess awareness, usage patterns, and attitudes toward NPs among adults in Saudi Arabia. METHODS: A cross-sectional, online survey targeting Arabic-speaking adults was conducted between 6 March and 6 June 2025. The self-administered questionnaire covered demographics, NP awareness, usage, and attitudes. Descriptive statistics and logistic regression were used to analyze predictors of awareness, usage, and favorable attitudes. RESULTS: Among 1,004 participants, 69.9% had heard of nicotine pouches, yet comprehensive knowledge regarding their composition and regulatory aspects remains limited. NP use was reported by 25.5%, with the primary motivation for continued use being for smoking cessation (62.4%). Higher awareness was significantly associated with younger age (aOR = 0.452, 95% CI: 0.247-0.830, p = 0.010), male gender (aOR = 7.610, 95% CI: 2.462-23.529, p < 0.001), and residence in the Western, Central, or Southern regions (all p < 0.05). Use was also more likely among younger males, employed individuals, and those with higher income. Regarding overall attitudes, 62.9% of participants perceived NPs as easier to use and more discreet than traditional tobacco products, 49.9% believed they could help people quit smoking, and 49.3% considered them safer than e-cigarettes. Conversely, 69.6% believed NPs are addictive, 68.9% expressed concern about oral health risks, and 62.1% agreed that their long-term health effects are not well understood. Favorable attitudes were more common among males, ex-smokers, and current NP users (p < 0.001). CONCLUSION: Awareness and use of NPs are rising in Saudi Arabia, especially among young males and ex-smokers. Despite their potential role in harm reduction, misconceptions and unclear perceptions persist. These findings highlight the need for targeted public education and appropriate regulatory oversight to manage the public health impact of NP use.