Abstract
Background: Nicotine pouches are a rapidly emerging class of oral nicotine products promoted as smoke-free alternatives to cigarettes and traditional smokeless tobacco. Their increasing availability, especially through social media—has raised concerns about youth uptake and misinformation. In Pakistan, little is known about young people’s awareness and perceptions of these products. This study evaluated knowledge, perceptions, and regulatory attitudes toward nicotine pouches among male college students in Swat and compared responses between government and private colleges.
Methods: A cross-sectional survey was conducted from August to October 2025 among 309 male intermediate students (≥18 years) from four colleges in Swat District. Participants completed a structured, self-administered questionnaire. Descriptive statistics and chi-square tests were used to assess differences between government and private colleges (p < 0.05).
Results: Awareness of nicotine pouches was significantly higher among private-college students (89.6%) compared with government-college students (15.5%). Private-college students demonstrated better knowledge of product composition and use, while misconceptions about tobacco content and uncertainty regarding addictiveness were common in government colleges (p < 0.001). Private-college students were more likely to view nicotine pouches as less harmful and fashionable, with social media and peers as primary information sources. Despite varying perceptions, more than 90% of all participants supported health warnings, age restrictions, and educational measures.
Conclusion: Substantial differences exist in awareness and perceptions of nicotine pouches between government and private college students in Swat. High exposure, misinformation, and favorable perceptions among private-college students highlight the need for targeted education and stronger regulatory action in Pakistan.