Association between smoking and vaping behaviors and self-perceived voice handicap in young medical trainees

To assess the association between smoking behaviors, including cigarettes, shisha, and vaping, and self-reported voice handicap among medical trainees.

A cross-sectional study was conducted between November 2024 and August 2025 at Jordan University Hospital, Amman, Jordan. Medical students, interns, and residents completed an anonymous online survey assessing demographics, smoking behaviors, and vocal health using the validated Arabic version of the Voice Handicap Index-10 (VHI-10). Smoking exposure was standardized using cigarette-equivalent measures and pack-year history. Group differences and associations between smoking variables and VHI-10 scores were analyzed using nonparametric statistical methods.

A total of 326 medical trainees participated (49.7% male). Current smokers comprised 23.9% of the sample, with vaping being the most commonly used product. The median total VHI-10 score was 1 (interquartile range, 0-4). There were no significant differences in total VHI-10 scores or abnormal VHI-10 classification across smoking status groups, and pack-year history was not significantly associated with VHI-10 scores. Male participants had significantly higher total and physical VHI-10 scores compared with females. Lower household income was associated with higher perceived voice handicap. Neither age group nor training level was significantly associated with VHI-10 outcomes.

Among young medical trainees, smoking and vaping behaviors were not associated with self-reported voice handicap. However, gender and socioeconomic disparities in perceived vocal impairment were observed. These findings suggest that if early laryngeal effects of smoking and vaping occur in this population, they are not detected by the VHI-10, which demonstrates a significant floor effect in young healthy adults, and support the need for preventive strategies and longitudinal studies incorporating objective voice assessment.