Knowledge, attitudes, practices, and prevalence of nicotine pouches in Pakistan: where do we stand?

Abstract

Background: Nicotine pouches (NPs) are a relatively new type of oral smokeless tobacco-free nicotine product which are considered an alternative nicotine delivery system to help quit smoking. There is little information available about the safety and composition of NPs, and yet they are being widely endorsed by various influential institutions. Our study aimed to assess knowledge, attitude, and practices (KAP) regarding NPs among the Pakistani population. Methods: A large cross-sectional study was conducted using an anonymous online survey. The survey included questions regarding demographics, and KAP of NPs. Descriptive, univariate and multivariate analyses were performed to establish any relationship between the exposure variables (sociodemographic factors) and the outcome variables (KAP scores). Results: A total of 1749 participants were included in the final analysis. The mean age of the respondents was 20.6 years. The overall mean score of knowledge and attitude was 3.0 and 4.75 respectively. Around 40.0% of participants had adequate knowledge while 50.6% had a negative attitude towards NPs. Overall, 17.2% of the respondents reported using NPs. Results showed that there was no difference in cigarettes used before and after the start of nicotine pouches (median=3, IQR=2-6). Conclusions: NPs are being marketed in Pakistan at a rapid rate despite very little information about their adverse effects. Our study demonstrates scanty knowledge of NP in the Pakistani population, and advocates education about harmful effects of NP. Larger interventional studies are needed to investigate potential adverse effects of NP consumption which can aid in the regulation and marketing of this product.