Prevalence of E-Cigarettes and Its Role in Shaping Physical Activity and Mental Health in Saudi Arabia: A Cross-Sectional Survey

The rise of electronic cigarettes (e-cigarettes) has attracted both former smokers and teenagers looking for an alternative nicotine source. This study aimed to assess the prevalence of e-cigarette use, the determinants associated with its use, dependence, and the impact of e-cigarette use on physical activity and mental health among the Saudi population.

A cross-sectional study was conducted from September 27, 2024, to October 21, 2024. We used Penn State Nicotine Dependence Index, the Kessler Psychological Distress Scale, and the Global Physical Activity Questionnaire. Convenience and snowball sampling methods were used to recruit participants using an electronic survey questionnaire and face-to-face interviews.

Among 3092 participants, the prevalence of e-cigarette use was 9.8%.Nicotine dependence was notable among users, with 41.7% exhibiting medium dependence and 22.2% reporting high dependence. Physical activity levels varied: 22.3% engaged in high activity, 34.1% in moderate, and 24.3% in low activity. Regarding mental health, 42.2% experienced high psychological distress. Participants with high physical activity had significantly higher odds of e-cigarette use [crude odds ratio (cOR) = 1.79, 95% confidence interval (CI): 1.29-2.49], while those with high distress had lower odds [cOR = 0.27, 95% CI: 0.19-0.39]. Path analysis revealed that mental distress positively predicted e-cigarette dependence ($\beta =0.118$), whereas physical activity showed a small positive association with dependence ($\beta =0.209$).

E-cigarette use in this population is significantly influenced by socio-demographic factors, physical activity levels, and mental health status. The complex relationship observed, where high physical activity is associated with use and mental distress is protective against initiation but predictive of dependence, highlights the need for integrated public health strategies. Interventions should focus on high-risk groups and address the dual role of lifestyle and psychological factors in both prevention and dependence management.