Perceptions and Vaping Use among Adolescents and Adults in Southern Saudi Arabia: A Cross-Sectional Survey

Electronic cigarette (e-cigarette) use has increased rapidly, especially among adolescents and young adults, driven by social acceptability and online promotion. Nicotine exposure may lead to dependence, and population-level risks remain uncertain, particularly for young non-smokers. Evidence from Saudi Arabia suggests notable uptake among youth and adults, but data from southern regions are limited, and few studies concurrently assess knowledge, perceptions, and practices with multivariable predictors. A cross-sectional analytical study was conducted among residents aged ≥13 years in Jazan and Aseer, Saudi Arabia. Participants were recruited using a convenience online sample via social media platforms. An Arabic questionnaire adapted from a CDC vaping-related instrument assessed sociodemographics, vaping-related knowledge (categorized as poor/moderate/good), perceptions (negative/neutral/positive), and vaping practices. Chi-square tests examined associations with vaping status, and binary logistic regression identified independent predictors (p < 0.05). A total of 1,305 participants were included (mean age 24.53 ± 7.91 years; range 13-68; 67.7% female). Overall, 34.0% were ever or current vapers. Vaping prevalence peaked at 28-32 years (50.5%) and was lowest in 13-17 years (11.7%) and ≥38 years (19.9%). Most participants had good knowledge (75.8%), while perceptions were mainly negative (59.2%). Knowledge level was not associated with vaping (p = 0.418). Perception showed a strong association: 90.0% of those with positive perceptions and 75.1% with neutral perceptions were vapers, compared with 5.1% with negative perceptions (p < 0.001). In adjusted regression, vaping was independently associated with male sex (OR 4.42; 95% CI 3.22-6.09), age 28-32 years (OR 7.01; 95% CI 3.69-13.31), and perception (neutral vs negative: OR 38.65; 95% CI 25.13-59.45; positive vs negative: OR 135.11; 95% CI 54.12-337.30), while knowledge remained non-significant. Vaping prevalence in southern Saudi Arabia was high and concentrated in early adulthood. Perceptions, not knowledge, were the strongest predictors of vaping, highlighting the need for interventions targeting misperceptions and social norms, particularly among young adults and males.