Knowledge, perceptions, and usage patterns of nicotine pouches among Saudi medical students: A cross-sectional study

Tobacco smoking continues to pose a major global public health challenge. Medical students play a crucial role in shaping future smoking cessation practices. Nicotine pouches have recently emerged as a tobacco-free alternative with a potentially reduced harm profile. However, little is known about their use and perception among medical students in Saudi Arabia. This study aimed to assess medical students' knowledge and perceptions of nicotine pouches and to examine usage patterns among those who consume these products. A cross-sectional study was conducted between April and July 2024 among 295 medical students from three universities in Saudi Arabia. Data were collected through a self-administered electronic questionnaire covering demographics, smoking history, knowledge, perceptions, and usage behaviors. Statistical analyses, including chi-squared tests and logistic regression, were used to identify factors associated with knowledge and usage. Smoking prevalence among participants was 16.3%, with significantly higher rates among males. Overall, 58.6% of students demonstrated good knowledge of nicotine pouches. Higher knowledge scores were associated with male gender, senior academic year, and higher grade point average (GPA). Among users, 62.9% reported quitting smoking, and more than half noted health improvements. The 10 mg nicotine strength was the most commonly used. Social influence, particularly peer pressure, was the primary reason for use. Despite noting harm reduction potential, students expressed concern about nicotine dependence and the need for stronger regulation. Saudi medical students show moderate knowledge of nicotine pouches, influenced by academic and demographic factors. However, concerns about dependence and regulation highlight the need for targeted education and policy development. Integrating this topic into medical curricula may better prepare future physicians to address nicotine use in clinical practice.