Awareness and perceptions of nicotine replacement therapy among adults in Saudi Arabia: A cross-sectional study

Nicotine replacement therapies (NRTs) are established evidence-based interventions for smoking cessation. In Saudi Arabia, where tobacco use remains a significant public health concern, understanding public awareness, perceptions, and motivations related to NRT use is essential for designing effective cessation strategies. This study aimed to assess awareness, perceptions, motivation to quit smoking, and self-reported nicotine dependence related to NRT use among adults in Saudi Arabia.

Between February and May 2025, a cross-sectional online survey was distributed via social media platforms to adults aged ≥18 years across Saudi Arabia. The survey comprised four domains: demographics, NRT awareness/perception, the Questionnaire on Motivation to Quit (Q-MAT; 4 scored items, range 0-20), and the Nicotine Dependence Syndrome Scale (NDSS; 16 items, 5-point Likert scale). The Q-MAT and NDSS were administered only to current smokers. Internal consistency was assessed using Cronbach's alpha. Chi-squared tests examined associations between demographic variables and NRT awareness. Binary logistic regression identified predictors of NRT awareness. Independent samples t-tests compared NDSS scores by motivation level.

Among 425 eligible participants, 72.5% were male, and the largest proportion were aged 25-34 years (43.3%). Overall, 89.1% of the participants were aware of NRTs. However, 49.3% were unsure about the most effective NRT type, and 37.3% were uncertain about its side effects. The Q-MAT (Cronbach's α=0.729) yielded a mean motivation score of 12.3 ± 5.8 (out of 20), with 44.4% classified as highly motivated. The NDSS (α=0.876) revealed moderate-to-high dependence (overall mean 2.94 ± 0.78), with the Drive subscale scoring highest (3.25 ± 1.09). Logistic regression showed male gender was a significant predictor of NRT awareness (OR=1.98; 95% CI: 1.01-3.89; p=0.048). Two-thirds of participants (66.0%) supported NRT integration into academic curricula.

While general NRT awareness was high among our sample of Saudi adults, significant knowledge gaps persist regarding its effectiveness and safety. High motivation to quit combined with moderate-to-high nicotine dependence underscores the importance of this area for future investigation. Longitudinal and interventional studies are needed to determine whether targeted education, improved access to cessation support, and integration of smoking cessation content into healthcare training programs can effectively address these gaps.