Public awareness, knowledge, and risk perceptions of nicotine pouches

Nicotine pouches (NP) are newly emerging tobacco-free nicotine products. Manufacturers claim that they deliver nicotine to the body while avoiding harmful chemical compounds produced by tobacco combustion. Therefore, the present study aimed to investigate public awareness, knowledge, and perceptions of NP. A cross-sectional design with a convenience sampling strategy was utilized. Participants’ sociodemographic characteristics, as well as their knowledge and perceptions regarding NP, were collected. A survey was used to assess patterns of NP use, underlying motivations, and the desire to smoke among current users. A total of 1,112 individuals completed the survey, and 1,105 responses were deemed eligible and included in the analysis. A total of 836 participants (75.6%) were aware of NP, of whom 404 (48.3%) were current or former smokers. Men had significantly higher awareness than women. Younger and middle-aged participants also had significantly higher awareness ( p < 0.05). Current NP use correlated with awareness (adjusted odds ratio (aOR) = 8.81, 95% confidence interval (CI): 4.70–16.54, p < 0.001), male sex (aOR = 8.00, 95% CI: 3.75–17.10, p < 0.001), and education level (aOR = 0.70, 95% CI: 0.50–0.99, p = 0.041). No significant associations occurred for age group, occupation, or income. The main information sources were digital and mass media (479 mentions), personal experience (371 mentions), and social/interpersonal networking (305 mentions). More than half of the awareness group perceived NP as safer than cigarettes (50.8%) and vaping (58.6%). A total of 445 participants (53.6%) believed that NP contain carcinogens, and 656 (79%) believed that they may be addictive. Most NP users ( n = 194, 58.6%) were former smokers who switched from conventional cigarettes. Among current NP users, 17.2% ( n = 57) reported no previous history of traditional cigarette smoking. The present findings suggest that most participants demonstrate awareness of NP. They believed that NP are addictive and not free of health risks. Also, most participants believed that NP contain carcinogens but perceived them as safer than cigarettes and vaping.