Awareness and use of nicotine pouches among adults in the Kingdom of Saudi Arabia

The use of nicotine pouches (NPs) has increased rapidly worldwide; however, their prevalence and use patterns in the Kingdom of Saudi Arabia (KSA) remain unclear. This study examined NP awareness and use among adults in the KSA. This cross-sectional study recruited adults across the KSA to participate in a structured self-administered online questionnaire. The main outcomes were NP awareness, ever use, and current (past 30 days) use. Univariate analyses were used to describe the main outcomes and demographic, socio-economic, and behavioural characteristics; bivariate associations were examined using the chi-squared (χ²) test; and multivariable logistic regression analyses were performed separately for each outcome to identify factors associated with NP awareness, ever use, and current use. Among the 1,361 respondents, 66.5% had heard of NPs, 37% had ever used them, and 27.6% reported current use. Males had higher odds of awareness (adjusted odds ratio AOR = 3.12, 95% confidence interval CI: 2.27-4.31), ever use (AOR = 9.34, 95% CI: 5.56-15.69), and current use (AOR = 11.71, 95% CI: 6.13-22.37) of NPs than females. Employment was associated with higher odds of ever (AOR = 2.09, 95% CI: 1.11-3.92) and current (AOR = 2.57, 95% CI: 1.35-4.88) use. Current smoked tobacco use was negatively associated with current NP use (AOR = 0.47, 95% CI: 0.33-0.68), whereas current smokeless tobacco use (AOR = 4.98, 95% CI: 2.87-8.65) and ever heated tobacco use (AOR = 1.84, 95% CI: 1.12-3.01) were positively associated with NP use. Participants from the Northern region had lower odds of NP awareness and use than those from the Central region. NP awareness and use in the KSA are higher among men, younger adults, employed individuals, and users of other nicotine products. These findings inform policies to monitor and regulate NP use, particularly among high-risk groups.