サウジアラビア北部国境大学の大学生における電子タバコの使用に関する知識・態度・行動のパラドックス

The proliferation of e-cigarette use among university students presents a critical public health challenge, yet the mechanisms driving adoption in non-Western sociocultural contexts remain inadequately theorized.

Guided by the Social Cognitive Theory and the Theory of Planned Behavior, this study investigated the prevalence and predictors of e-cigarette use among university students at Northern Border University in Saudi Arabia.

A cross-sectional survey of 670 students assessed knowledge, attitudes, and usage behaviors, with predictors identified via multivariable logistic regression.

The prevalence of current use was 20.6% (138/670), with a significant gender disparity where female students had lower odds of use (adjusted OR = 0.334**; 95% CI: 0.203-0.550**). A striking knowledge-attitude-behavior paradox emerged: while 77.6% (520/670) acknowledged addiction potential, substantial gaps in knowledge about respiratory risks (only 45%, 301/670) and nicotine content (35%, 234/670) persisted. Critically, medical students, despite having superior knowledge (53.2%, 141/265 vs 28.4%, 115/405 among non-medical students), exhibited only moderately more protective attitudes (61.5% vs 78.5% disapproving). More favorable attitudes significantly predicted current use (adjusted OR = 1.040 per one-point increase**; 95% CI: 1.008-1.073**), confirming the mediating role of attitudes.

These findings indicate that e-cigarette adoption is a socially embedded behavior shaped by gender norms and educational contexts, challenging information-deficit models. This underscores the necessity for theory-driven, multilevel interventions that address cognitive, affective, and normative determinants of behavior to inform culturally sensitive prevention strategies and campus policies.