Characterizing Heterogeneity in Behavioral Phenotypes Among Oral Nicotine Pouch Users in Saudi Arabia: A Latent Class Analysis

Background The rapid proliferation of oral nicotine pouches has polarized public health discourse, framing these products as either reduced-risk alternatives or catalysts for novel addiction pathways. Conventional research frequently obscures the functional heterogeneity underlying these outcomes. This investigation employs a person-centered framework to identify distinct behavioral phenotypes among adult users in Saudi Arabia and evaluate their clinical implications. Methods A cross-sectional analytical study assessed adult pouch consumers (N=310) residing in the Jazan province. Latent class analysis-derived user typologies are mathematically grounded in behavioral indicators, encompassing consumption frequency, nicotine strength preference, poly-product utilization, and functional motives. Results The analysis revealed three divergent trajectories. The "Harm Reduction-Motivated De-escalator" phenotype (n=65, 21.0%) exhibited low-intensity consumption driven by tapering intent. Conversely, the "Stable, Affect-Regulating Dual-User" (n=117, 37.7%) displayed a maintenance pattern characterized by homeostatic mood management. Most critically, the "Escalating, High-Intensity Poly-Product User" (n=128, 41.3%) emerged as a high-risk cohort defined by a distinct preference for supratherapeutic nicotine strengths (≥10 mg) alongside the highest rate of simultaneous poly-product use (n=67, 52.3%). Consequently, this escalating group demonstrated significantly elevated odds of experiencing localized gum irritation (aOR = 3.25) compared to the de-escalator baseline. Conclusions Consumers do not appear to constitute a monolithic population; clinical risk appears to be shaped primarily by user behaviors and functional motivations rather than inherent product properties alone. Although a minority utilizes these products for rational harm reduction, the concerning prevalence of escalating poly-users highlights a potential toxicity trap driven by high-intensity stacking behaviors. Public health strategies might benefit from transitioning toward targeted behavioral profiling and customized therapeutic interventions.