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Nicotine Negatively Affects Its Users’ Health and Psychology in Saudi Arabia: A Cross-Sectional Study
Open accessAbstract
Background: Recently introduced nicotine pouches (NPs) are smokeless nicotine products. They are held between the lips and gums for 30 min to absorb nicotine into the bloodstream through the oral mucosa. Attractiveness may increase nicotine use, especially among young people and teens. The objective of this study is to investigate the health issues and psychological effects associated with nicotine pouch use among individuals in Saudi Arabia. Methods: A cross-sectional online survey using Google Forms. It was conducted between 13 February and 4 November 2025, in the Riyadh province of Saudi Arabia, restricted to users of nicotine pouches willing to answer a questionnaire on the occasion of buying them (at regional tobacco stores/supermarkets) or online via WhatsApp or the Telegram platform. Statistical analysis was conducted using SPSS Version 27, with a p < 0.05 indicating significance. Results: The current study included data of 489 participants, with a total of 395 participants using nicotine pouches. The most commonly reported symptoms were difficulty breathing and shortness of breath (both 40.5%), changes in taste or smell (36.7%), headache and stomach ulcers (33.4% each), and rapid or irregular heartbeat (28.4%). Most common psychological symptoms at any severity level (slightly to extremely) were appetite changes (78.7%), difficulty concentrating or focusing (75.4%), difficulty sleeping (74.9%), and increased anxiety or irritability (73.4%). Depression (72.2%), anger management (71.1%), and stress (70.4%) were also common. Regression analyses revealed that educational attainment was a significant predictor of both physical and psychological health outcomes. Conclusions: The findings show the most common physical symptoms were difficulty breathing and shortness of breath, followed by taste or smell changes, headaches, stomach ulcers, and rapid or irregular heartbeat. Appetite changes, concentration issues, sleep disturbances, and anxiety or irritability were common across all severity levels. Depression, anger issues, and stress were common.
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“36.7% of ONPs users reported problems with changes in taste or smell (Aldali 2026)”
From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as Aldali 2026
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“over one third of ONPs users had changes in taste or smell (36.7%) and almost one out of ten reported yellowing teeth (9.4%) (Aldali 2026).”
From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as Aldali 2026
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“negative pulmonary symptoms among ONP users, including chronic sinus infection or bronchitis (20.8% of respondents), frequent colds or flu (11.6% of respondents), difficulty breathing (40.5% of respondents), frequent coughing or wheezing (27.8% of respondents), shortness of breath (40.5% of respondents) (Aldali 2026).”
From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as Aldali 2026
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
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“one-third of ONPs users had problems with stomach ulcers (Aldali 2026).”
From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as Aldali 2026
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“rapid or irregular heartbeat among 28.4% of ONPs users (Aldali 2026).”
From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as Aldali 2026
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“33.4% of ONPs users reported problems witch stomach ulcers (Aldali 2026)”
From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as Aldali 2026
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“28.4% of ONPs users reported rapid or irregular HRT (Aldali 2026)”
From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as Aldali 2026
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In the citing paper
“9.4% of ONPs users reported problems with yellowing teeth (Aldali 2026)”
From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as Aldali 2026
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In the citing paper
“20.8% of ONPs users reported chronic sinus infection or bronchitis (Aldali 2026)”
From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as Aldali 2026
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Citations
Cites
Cigarette Smoking and Plasma Levels of Nicotine
ISAAC, P. F., & RAND, M. J. (1972) · Nature · doi:10.1038/236308a0 · Cited by 257
Flagged first, then by citations
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- Alwafi, 2025, Prevalence, safety, and role of nicotine pouches in smoking cessation among smokers and the public in Saudi Arabia, Sci. Rep., 15, 29758, 10.1038/s41598-025-15070-0 · DOI
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- Aldhahir, A.M., Siraj, R.A., Alqarni, A.A., Alqahtani, J.S., Alyami, M.M., Majrshi, M.S., Alwafi, H., Alqahtani, M.M., Monshi, S.S., and Al-Zalabani, A.H. (2024). The prevalence and sociodemographic determinants of tobacco and nicotine use among students in healthcare disciplines in Saudi Arabian universities: A cross-sectional survey. Front. Public Health, 12. · DOI
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Kopa-Stojak, P. N., & Pawliczak, R. (2026) · Exposure and Health · doi:10.1007/s12403-026-00812-w
Metadata
- Authors
- Aldali, J. A.
- Affiliations
- Imam Mohammad ibn Saud Islamic University (SA)
- Corresponding author
- Aldali, Jehad A.
- ORCID
- Aldali, Jehad A.
- Venue
- Healthcare
- Publisher
- MDPI AG
- Published
- 2026-01-23
- Volume
- 14
- Issue
- 3
- Pages
- 286
- ISSN
- 2227-9032 (ISSN-L)
- PMC
- PMC12896555
- OpenAlex
- W7125473939
- Cited by
- 4
- References
- 1
- Citations by year
- 2026: 4
- FWCI
- 20.11
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Healthcare (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion, cc-by)
- Funders
- Deanship of Scientific Research at Imam Mohammad Ibn Saud Islamic University (IMSIU-DDRSP2601)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Public Health Policies and Epidemiology
- Keywords
- nicotine pouches, smokeless tobacco, nicotine use, physical health effects, psychological impact, respiratory symptoms, sleep disorders, depression, anxiety, stress, educational attainment, Saudi Arabia
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