Prevalence, Safety, Perceptions, and Association of Nicotine Pouches (DZRT) with Smoking Cessation Among Adult Smokers in Abha City, Saudi Arabia

Abstract

Background: Oral nicotine pouches are tobacco-free products increasingly marketed as smoke-free alternatives to combustible tobacco. Regional data on their prevalence, safety, and relationship with smoking cessation in southern Saudi Arabia remain scarce. Objective: To determine the prevalence and patterns of DZRT nicotine pouch use among adults in Abha City, and to examine its association with smoking status and smoking cessation. Methods: A cross-sectional, community-based online survey was conducted among 655 adults in Abha City in 2026. Data were analyzed using SPSS v29. Chi-square tests examined categorical associations, and multivariate logistic regression identified independent predictors of DZRT use. Results: The prevalence of ever having used DZRT nicotine pouches was 27.5% (180/655). Among nicotine-pouch users with a smoking history, former smokers were significantly more likely than current smokers to report having quit smoking (83.2% vs. 20.6%; χ² = 60.879, p < 0.001; Kendall's τ-b = 0.621). On multivariate logistic regression, DZRT use was independently associated with male sex (OR 8.05, 95% CI 2.18–29.75), current smoking (OR 41.60) and former smoking (OR 54.81) relative to never-smoking, younger age (18–44 years; OR 41.18), and the belief that nicotine-replacement products are a healthy alternative (OR 6.44) (Nagelkerke R² = 0.740). The most frequently reported adverse effects among users were gastrointestinal symptoms (37.2%) and anxiety/stress (32.8%). Conclusion: DZRT nicotine pouch use was common among adult smokers in Abha City and was strongly associated with a history of tobacco use and self-reported cessation. While the cross-sectional design precludes causal inference, these findings support a possible role for nicotine pouches in smoking cessation behavior, alongside a need for continued safety surveillance given the frequency of self-reported psychological and gastrointestinal symptoms.