Self-Perceived Knowledge, Attitudes, Personal Use, and Willingness to Recommend Nicotine Pouches and Tobacco Harm Reduction Strategies Among Physicians in Saudi Arabia: A Cross-Sectional Study.

Authors

Najim Z Alshahrani, Ahmed K Shukri, Ali Saad Alqahtani, Yasser M Alkatheeri, Faisal Mohammed Alzahrani, António Raposo, Saad Abdullah Alotaibi, Sarah Almutairi, Ramy Samargandi

Published in

Respiratory medicine. Pages 109170. Sep 19, 2026. Epub Sep 19, 2026.

Abstract

Tobacco harm reduction (THR), including tobacco-free nicotine pouches, has emerged as a potential complement to smoking cessation strategies. Evidence regarding physicians' self-perceived knowledge, attitudes, and practices toward THR in the Middle East remains limited.
To assess physicians' self-perceived knowledge, attitudes, personal use of nicotine pouches, and factors associated with willingness to recommend THR in Saudi Arabia.
A cross-sectional online survey was conducted among 325 physicians in Jeddah between August and December 2025. A study-specific questionnaire assessed demographics, THR awareness and self-perceived knowledge, attitudes, nicotine pouch use, perceived barriers, and willingness to recommend THR.
Overall, 72.0% of participants were aware of THR, while 45.5% reported low self-perceived knowledge of its effectiveness. Two-thirds (66.5%) agreed that THR strategies are effective for smoking cessation, although 54.8% had neutral/moderate attitudes on the composite scale. Nicotine pouch ever-use was reported by 25.2%, and 61.5% expressed willingness to recommend THR. Willingness was associated with awareness of DZRT, a locally available nicotine pouch brand (aOR=2.09), belief in sufficient evidence for THR (aOR=2.89), higher self-perceived knowledge (aOR=2.35), and more positive attitudes (aOR=3.91).
Self-perceived knowledge, attitudes, and product awareness were associated with willingness to recommend THR. Given the cross-sectional convenience sample and study-specific measures, these findings are exploratory and support balanced, evidence-based education rather than causal or routine clinical implementation conclusions.

PMID:
42763088
Bibliographic data and abstract were imported from PubMed on 20 Sep 2026.

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