Prevalence, awareness and self-reported health effects of oral nicotine pouch use among university students in Saudi Arabia: a cross-sectional study

Background and aim Oral nicotine pouches (ONP) are marketed as tobacco-free alternatives, perceived as safer than traditional tobacco; however, they carry significant health risks. This study aims to assess the prevalence of ONP use among students at King Saud University, awareness of ONP, and explore perceived health impacts. Methods A cross-sectional study was conducted by distributing a structured, self-administered and pilot-tested online questionnaire among the students of King Saud University. Data were collected on demographics, ONP use, awareness and perceived health risks. Chi-square tests, one-way ANOVA, Kruskal–Wallis tests and binary logistic regression were used for analysis. Results The respondents were 1,028 students. The prevalence of ONP use was 36.0%, and use was significantly more prevalent among males (47.1%) than females (6.7%); males constituted 94.9% of all users. Among users, the most frequently reported adverse effects were increased salivation (43.0%), nausea (40.3%) and upset stomach (31.4%). Awareness of ONP was high (86.8%); however, knowledge of specific health risks, such as cardiovascular effects (49.8%), was considerably lower. Conclusion ONP use is notably high among students at King Saud University, particularly males, compared to other countries. Although general awareness was high, a critical deficit exists in knowledge of specific health risks, especially cardiovascular effects. Increased salivation (43.0%) and nausea (40.3%) were the most frequently reported adverse effects. These findings underscore the urgent need for targeted public health campaigns to educate young adults about the potential harms of ONP use. Future research should explore longitudinal designs to explore long-term health effects, assess the impact of awareness initiatives, and examine psychosocial and cultural influences on ONP use across diverse populations.