# Traditional and Electronic Cigarette Usage Patterns, Dependence, and Perceptions Among Ajman University Students

## TL;DR

This study examines nicotine use, including e-cigarettes and traditional cigarettes, among university students in the MENA region, finding high dependence linked to dual use and early initiation.

## Contribution

The study provides insights into nicotine use patterns and dependence among young adults in the MENA region, emphasizing the role of e-cigarettes.

## Key findings

- E-cigarettes were the most commonly used nicotine product among students.
- Dual use and early initiation were associated with higher dependence levels.
- Participants viewed both cigarettes and e-cigarettes as equally harmful.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Nicotine use among university students is an emerging public health issue in the MENA region.This study evaluates cigarette and e-cigarette use patterns, dependence, and perceptions in young adults.

Nicotine use among university students is an emerging public health issue in the MENA region.

This study evaluates cigarette and e-cigarette use patterns, dependence, and perceptions in young adults.

Public health significance—Why is this work of significance to public health?
E-cigarettes were the most commonly used nicotine product among students.Dual use and early initiation were associated with higher dependence levels.

E-cigarettes were the most commonly used nicotine product among students.

Dual use and early initiation were associated with higher dependence levels.

Public health implications—What are the key implications or messages for practitioners, policy makers, and/or researchers in public health?
Youth-focused cessation strategies should be prioritized within university health programs.The stronger regulation of e-cigarette marketing and sales is needed to reduce youth uptake.

Youth-focused cessation strategies should be prioritized within university health programs.

The stronger regulation of e-cigarette marketing and sales is needed to reduce youth uptake.

Background: Nicotine use among the youth has been on the rise, especially with the introduction of E-cigarettes. This has sparked concerns regarding E-cigarettes and traditional cigarettes in terms of patterns, dependence, and perceptions within the youth population, which are issues this study aimed to investigate. Methods: A cross-sectional survey was conducted among university students at Ajman University, which is in the Middle East and North Africa (MENA) region. Using the Cigarette Dependence Scale (CDS-12) and Penn State Electronic Cigarette Dependence Index (PS-ECDI), dependence on both cigarettes and E-cigarettes was quantified. Results: Out of 1713 respondents, 18.9% were currently using nicotine products, including E-cigarettes (12.7%) and traditional cigarettes (5.1%). Nicotine use was significantly associated more with males than females with an odds ratio of 4.14. However, there was no difference between genders in the dependence scores. In addition, dual nicotine use and an earlier onset of nicotine consumption were associated with significantly higher dependence scores than single users and a late onset of smoking. Participants overall attributed cigarettes and E-cigarettes as equally harmful. Conclusions: Both cigarette and e-cigarette use were prevalent and associated with notable dependence. Although E-cigarettes are often promoted as cessation aids, their use in our sample did not appear to facilitate quitting and may instead sustain nicotine dependence. Targeted youth-focused cessation programs and stricter marketing and sales regulations are essential to prevent further normalization. Longitudinal studies are needed to track evolving patterns and health impacts in the MENA region.