The availability and marketing of nicotine pouches at tobacco-selling points-of-sale in Pakistan.

Introduction: Nicotine pouches are gaining popularity among young people. Within five years of their introduction, Pakistan has become the third-largest market for Velo, a leading brand among nicotine pouches. However, more information is needed to know about the availability and marketing of these products at point-of-sale (POS).

Methods: In August 2023, we surveyed 711 POS across nine districts covering all four provinces of Pakistan. We collected data on the availability of different brands of nicotine pouches and their flavours, nicotine strengths, prices, and pack features. Furthermore, we recorded any POS advertising in a subsample of 382 POS.

Results: In Pakistan, nicotine pouches were available in all four provinces, eight of nine surveyed districts, and 56 of 711 (7.9%) POS. Urban settings had wider availability and more variety than rural settings. Velo, available in six flavours and three different strengths, captured 85% of the market. On average, nicotine pouches cost 133 Pakistani Rupees (SD 18.9, range 100-190 PKR) or 0.44 US dollars. Display stands advertising nicotine pouches were observed in 12.3% (46/382) POS.

Conclusions: Nicotine pouches are widely available across Pakistan. A range of flavours and strengths are being sold at an affordable price, making it attractive, particularly for young people. Continued surveillance of these products is needed. Their perceptions and use, and their impact on the tobacco uptake in youth, also need further research.

Implications: We observed widespread availability of Velo and the growing nicotine pouch market in Pakistan, underscoring the urgent need for regulation. These products appeal to youth with diverse flavors and affordability, raising concerns about experimentation leading to addiction. Policymakers must prioritize regulating manufacturing, sales, and marketing to limit youth access. Limited research in Asia necessitates longitudinal studies to explore oral health impact of using these products. Continued monitoring of promotions at points of sale, along with studies on youth perceptions, usage patterns, and influence on tobacco uptake, is critical for effective policy development.