The perceptions of nicotine pouches (Velo) among adolescents in Pakistan:A qualitative study

INTRODUCTION: There has been a rapid rise in nicotine pouch sales in Pakistan. One brand, Velo, dominates the market. No study has explored how adolescents view this product. METHODS: We conducted 16 focus groups with 10-16 year-olds (n=113) between October 2023 and April 2024. Groups were segmented by sex and school-going status (in school, out-of-school) to explore perceptions of Velo. Participants' use of nicotine products was not recorded at recruitment. Participants were from all four provinces of Pakistan and the federal capital, Islamabad. Groups lasted between 60 and 80 minutes. RESULTS: We identified four themes: 1) Exposure: Participants reported exposure to nicotine pouches displayed at the point-of-sale (POS), and through peers and social media. 2) Accessibility: Velo was perceived as easily accessible as participants did not feel that the shopkeepers would refuse purchase. 3) Appeal: Velo was considered stylish and a luxury product, a modern alternative to traditional smokeless tobacco. Appeal was shaped by the packaging, discrete use, display at POS, and social media. 4) Harm: Some participants considered Velo harmful, mentioning addiction, vomiting and headaches; and potentially as hazardous as cigarettes. For others, it was safer than tobacco, given that the packaging resembled confectionery and had no health warnings to indicate the products were harmful. CONCLUSIONS: Our findings suggest that regulating nicotine pouches to reduce adolescent exposure and perceived accessibility, could help reduce product appeal. Research is needed on the health effects of nicotine pouches on adolescents.