E-cigarette Dependence and the Appetite-BMI Nexus: A Cross-Sectional Moderation Analysis Among University Students in...

E-cigarette use among university students has surged across the Arab world, but its nutritional and metabolic effects are poorly understood. This study examined associations between e-cigarette dependence, dietary quality, appetite, and BMI among university students, and assessed whether e-cigarette use status moderated key nutritional relationships.

A cross-sectional study recruited 887 participants from six Jordanian universities, classified as exclusive current e-cigarette users or tobacco-naïve never-users. Dependence was assessed using the Penn State Electronic Cigarette Dependence Index (PSECDI), dietary quality using the Mini Eating Assessment Tool (Mini-EAT), and appetite using the Council on Nutrition Appetite Questionnaire (CNAQ). Associations were examined using chi-square tests and ordinary least squares moderation regression.

E-cigarette users had substantially lower appetite (operationally defined as CNAQ scores ≤ 28, reflecting a reduced desire to eat and a higher risk for clinically meaningful weight loss), lower dietary quality and greater BMI compared with tobacco-naïve never-users. Within users, dependence severity was significantly associated with BMI category (χ²(6)=28.32, p ≤ 0.001) and appetite category (χ²(2)=7.24, p = 0.027). E-cigarette use status significantly moderated the dietary quality-appetite association (β = 0.20, p ≤ 0.001), but not the appetite-BMI association (β= -0.04, p = 0.483).

Using e-cigarettes is strongly associated with a significant nutritional and physical burden among Jordanian university students, and greater dependence is independently associated with appetite dysregulation and excess weight. Tobacco-sensitive nutritional screening should be routinely integrated into campus health services.