Awareness, Perceptions, and Use of Oral Nicotine Pouches Among Jazan University Students in Saudi Arabia: A Cross-Sectional Study.

Background and Objectives: Oral nicotine pouches (ONPs) are rapidly expanding nicotine products with limited evidence from the Middle East, particularly among young adults. This study assessed the awareness, perceptions, and use of ONPs among university students in Jazan, Saudi Arabia. Materials and Methods: A cross-sectional survey (November 2024-April 2025) used multistage stratified random sampling across six colleges at Jazan University. A self-administered questionnaire captured sociodemographic characteristics, tobacco-use history, ONPs awareness (aided), ever use and current use (past 30 days), and self-reported perceptions items across nine domains. Multivariable logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results: Among 624 students (mean age = 20.9 ± 1.7 years; 50.5% female), ONPs awareness was 69.7%, ever use 11.5%, and current use 7.5%. Awareness and use were higher among males and other tobacco users (p < 0.001). In multivariable models, male sex predicted awareness, ever use, and current use; rural residence was linked to lower awareness (aOR = 0.67; 95% CI 0.45-0.98), and being a medical student was linked to lower current use (aOR = 0.08; 95% CI 0.003-0.51) Most students perceived ONPs as addictive (80%) and harmful (68%), yet accessible (61%) and attractive (55%). Conclusions: ONPs awareness and use were high, particularly among males and tobacco users. Despite recognizing potential harm, students viewed ONPs as accessible and attractive. Ongoing surveillance, education, and balanced regulation are needed to guide harm-reduction policy and prevent unintended nicotine uptake.