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2Firsts, September 4, 2025 — On August 14, 2025, Frontiers in Public Health published an original research article titled “Electronic cigarette use in Saudi Arabia: a cross-sectional study on emerging trends and public health concerns” The authors are from Imam Abdulrahman Bin Faisal University, King Saud University, and the College of Pharmacy at Taif University, among other institutions. Using a nationwide online questionnaire, the study describes adult e-cigarette use patterns, acquisition channels, motivations, and risk perceptions in Saudi Arabia, and reports self-reported adverse effects and subgroup differences, providing reference data for future regulation and public-health interventions.
Main content and conclusions
Methods
The study used a descriptive cross-sectional design* and received ethics approval (IRB-2024-05-735). The survey was conducted from October to January via convenience and snowball sampling, recruiting respondents through social media. Inclusion criteria were adults (≥18 years) in Saudi Arabia who were current smokers or former smokers.
A “descriptive cross-sectional study” surveys a group of people at a single point in time to describe their current status and distribution; it does not determine causality.
The questionnaire, adapted from validated instruments and finalized after expert review in pharmacy and a small pilot, consisted of closed-ended items covering demographics (age, sex, marital status, region, education, income), behaviors (initiation time, frequency, duration, whether nicotine is used and at what strength), acquisition channels (retail stores, online), motivations (cessation, flavor preference, cost and convenience), risk and addiction perceptions, and self-reported adverse effects.
Statistical analyses included descriptive statistics, chi-square tests, one-way ANOVA, correlation analysis, and multinomial logistic regression (significance threshold p≤0.05), with group comparisons among dual users, exclusive e-cigarette users, and former users.
Key findings
Study design
- Type: Cross-sectional survey
- Sample: 441 adults (current and former smokers)
- Method: English questionnaire distributed via social media using convenience and snowball sampling
- Analysis: Descriptive statistics, chi-square, ANOVA, correlation, and multinomial logistic regression
Population characteristics
Sex: 86% male
Age: 63% were 18–28 years old
Socioeconomics/education: Higher usage among those with lower income (<US$1,333/month) and lower education
Geography: 53% lived in the Eastern Province
User types:
- 47% dual users (e-cigarettes + conventional cigarettes)
- 31% former users (previously used e-cigarettes to aid quitting)
- 22% exclusive e-cigarette users
Use patterns
- 50% used e-cigarettes daily
- 26% preferred high-nicotine liquids (≥16 mg/mL)
- 43% purchased from retail stores; 27% purchased online
- 44% reported adverse effects (most commonly shortness of breath, phlegm, and chest pain)
Motivations
- 45% to quit smoking
- 35% for flavor variety
- 29% believed e-cigarettes are safer than conventional cigarettes
- 22% cited cost
Perceptions and attitudes
- Information sources: 69% learned about e-cigarettes from friends/neighbors; 37% from the internet
- 61% supported stronger government regulation
- While most believed e-cigarettes are less harmful and less addictive than cigarettes, nearly half thought they might cause cancer or stroke
Conclusions
- The sample reveals a usage profile dominated by young men, with a high proportion of dual use.
- Self-reported adverse effects are not uncommon, and a majority support stronger regulation.
- The authors offer data to inform policies on nicotine strength, sales channels, age verification, and health education.
Limitations (as noted by the authors)
- Cross-sectional design and self-report may limit causal inference and introduce recall/social desirability bias.
- The questionnaire was only in English, and the sample skewed male and young, limiting representativeness.
- Convenience/snowball sampling constrains generalizability; future studies should expand sample size, balance sex and age, and offer multilingual versions.
Paper information
Title: Electronic cigarette use in Saudi Arabia: a cross-sectional study on emerging trends and public health concerns
Authors: Farah Kais Alhomoud et al.
Publication date: August 14, 2025
Journal: Frontiers in Public Health (Original Research)
DOI: 10.3389/fpubh.2025.1574623
Ethics approval: IRB-2024-05-735
All images in the article are from the paper.
Cover image generated by ChatGPT.
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