Background: Tobacco consumption continues to represent a major public health concern, contributing substantially to preventable disease, premature mortality, and healthcare costs worldwide. Oral nicotine pouches (ONPs) are a relatively new category of tobacco-free nicotine products that have gained increasing popularity as alternatives to combustible tobacco. Despite their expanding use, evidence regarding their prevalence, safety profile, and potential role in smoking cessation within Saudi Arabia remains scarce.

Objective: This study aimed to determine the prevalence of oral nicotine pouch use among adult tobacco users in Al-Baha City, Saudi Arabia, examine its relationship with smoking cessation status, and assess self-reported adverse effects associated with their use.

Methods: A descriptive cross-sectional study was carried out among 441 adult tobacco users living in Al-Baha City. Information was obtained through a structured online questionnaire covering demographic characteristics, tobacco use history, oral nicotine pouch use, smoking cessation status, and self-reported adverse effects. Before launching the main survey, the questionnaire was pilot-tested with 30 participants to evaluate its clarity and content validity. Data analysis was performed using SPSS version 29. Descriptive statistics were used to summarize the data, while associations between categorical variables were examined using the Chi-square test. Statistical significance was established at p < 0.05.

Results: Oral nicotine pouch use was reported by 61.0% of the participants. The study population consisted predominantly of males (95.2%), Saudi nationals (93.8%), and individuals aged 18–30 years (55.5%). No significant differences in ONP use were observed across the examined sociodemographic variables. However, ONP use showed a statistically significant association with smoking cessation status (χ² = 92.574, p < 0.001). Among users, the most frequently used nicotine strength was 10 mg (42.2%), while more than half (57.8%) reported using six to ten pouches each day. Most reported physical adverse effects—including tachycardia, gastrointestinal complaints, headache, weight gain, sleep disturbances, and gingival bleeding—were not significantly associated with ONP use. In contrast, anxiety, stress, depression, and other psychological symptoms were reported significantly more often among ONP users than non-users (23.8% vs. 14.0%, p = 0.002).

Conclusion: Oral nicotine pouch use was common among adult tobacco users in Al-Baha City and was associated with smoking cessation status. Although no significant relationship was identified between ONP use and most reported physical adverse effects, psychological symptoms were more frequently reported by users. Because of the cross-sectional design, causal inferences cannot be drawn. Longitudinal and controlled studies are needed to clarify the long-term safety and effectiveness of oral nicotine pouches as smoking cessation interventions.

Keywords: Oral nicotine pouches; nicotine replacement products; smoking cessation; tobacco harm reduction; nicotine; Saudi Arabia.