Prevalence and psychosocial determinants of nicotine vaping among Majmaah University students, Saudi Arabia

Introduction:

The use of electronic nicotine delivery systems (ENDS), known colloquially as ‘vaping’ or e-cigarette use, continues to grow in popularity, particularly among young adults aged 18–25 years.^1,2 Vaping is the use of e-cigarette devices that doesn’t include burning tobacco, this makes it different from traditional smoking habits.³ The devices consist of a power unit, an electric atomizer, and a replaceable cartridge containing a liquid that is vaporized and inhaled when sucking at the mouthpiece. The main ingredients of the liquids are propylene glycol and/or glycerin, flavors (tobacco flavor, fruit flavors, chocolate, menthol, rum, Coca-Cola, piña colada, ice cream, candy floss, and many others).⁴ Users of an e-cigarette inhale the mist that constitutes nicotine.⁵ Vaping behaviors might vary greatly between male and female students, depending on social, behavioral, and psychological aspects. Studies found that male students are more likely than girls to vape and use devices with higher nicotine concentrations. Males also report increased exposure to peer pressure and advertisement, making them more vulnerable to vaping beginning. 1,2 The prevalence of using vaping among different studies among university students was ranging between 5.7%-43.7%.6-10

Social media platforms have become significant influences in shaping smoking behaviors. Research shows that regular social media use among adolescents who had never previously used e-cigarettes was linked to a greater likelihood of becoming open to trying e-cigarettes, having used them in the past, or being current users.¹¹ Young adults exhibit a strong sense of self-efficacy when it comes to accessing e-cigarettes from various retailers and are proactive consumers of e-cigarette marketing. This indicates that they feel confident in their ability to obtain these products and are significantly influenced by marketing strategies aimed at promoting vaping among their peers.¹²

E-cigarettes pose significant health risks, however, among different population, it is considered safer alternative to traditional tobacco products. Despite these dangers, their use and promotion continue to rise globally, especially among young adults and within families of high social and economic status. Regrettably, the media plays a role in this trend by portraying e-cigarettes as less harmful compared to other smoking methods.⁶ Psychological factors such as stress and depression are significant determinants of vaping.¹³ Social influences like peer pressure and social media also play a crucial role in promoting e-cigarette use among young adults.^11,14

Given the limited research on nicotine vaping among university students in Majmaah, Saudi Arabia, there is a pressing need to determine the prevalence of this behavior and identify the underlying psychological and social determinants. Understanding these factors is crucial for developing effective prevention and intervention strategies, as they may contribute significantly to the initiation and maintenance of vaping behavior among young adults. Moreover, studies suggest that smoking behaviors initiated during university years often persist in adulthood, making it crucial to address vaping behaviors early on.⁵ By identifying and addressing these behaviors, we can help reduce the prevalence of vaping, mitigate its potential long-term health risks, and prevent young adults from developing nicotine dependence in the future. There is also insufficient research on the effectiveness of e-cigarettes as smoking cessation tools. Therefore, the aim of the current study was to study the prevalence of nicotine vaping among Majmaah University students. In addition, it aimed to assess psychological, and social determinants of nicotine vaping.

Methodology:

Study design and setting:

This is a cross-sectional study, designed to study the prevalence and the psychological and social determinants of nicotine vaping among the students of Majmaah University. The study was conducted at Majmaah University, located in Al-Majmaah, a city in the Riyadh region of Saudi Arabia. Majmaah University served as a major educational institution for the Majmaah locality, with students from a variety of academic disciplines, including health sciences, engineering, business, and humanities. The diverse student population provided an ideal setting to explore the prevalence of nicotine vaping and its psychological and social determinants. The research was conducted over seven months, starting from October 2024, and ending in May 2025.

Study Population:

The study targeted students from all faculties within the university to ensure a comprehensive representation. The study population consisted of male and female university students enrolled in Majmaah University. The inclusion criteria were being current enrollment at Majmaah University, aged older than 18 years, and provided a willingness to participate in the study by providing informed consent.

Sampling:

Stratified random sampling was used to ensure a proportional representation of male and female students across different faculties at Majmaah University. According to the university’s data, the total student population was 24,227, with 10,745 males and 13,482 females.

To determine the sample size, the study used Cochran’s formula for large populations: n = (Z² × p × q) ×2 / d² where Z: standard normal deviate = 1.96 (for 95% confidence level), p = expected prevalence = 0.29915, and d = acceptable margin of error = 0.05. This resulted in a required sample size of 644 participants. However, 555 valid responses were obtained and analyzed. Although slightly below the calculated requirement, this sample remains statistically acceptable for the study’s scope.

Data Collection:

Data was collected through a pre-tested, self-administered questionnaire that was distributed to participants online using university channels (student emails, learning platforms). The questionnaire was divided into the following sections: sociodemographic characteristics, social determinant, psychological determinants, and awareness and impact of smoking cessation programs at Majmaah University.

The Likert scale was used to determine the sociodemographic effect of vaping. Ten questions were asked; each question has five responses: strongly agree, agree, neutral, disagree, and strongly disagree. if the respondent has a total of 10-23 is classified as having a low sociodemographic effect. If scored 24-37 and 38 – 50 was classified as moderate and high sociodemographic effects respectively.

The Likert scale was used to determine the psychological effect of vaping. Nine questions were asked; each question had five responses: strongly agree, agree, neutral, disagree, and strongly disagree. If the respondent has a total of 9-21 it is classified as having a low psychological effect. If scored 22-31 and 32 – 45 was classified as moderate and high psychological effects respectively.

Data Analysis:

The data collected were coded and analyzed using SPSS version 26. The descriptive data was presented using mean, standard deviation, frequencies, and percentages. Chi-square (χ2) test analysis and the Fisher Exact test were employed for inferential statistics analysis.

Ethical Concerns:

Ethical approval was obtained from the Institutional Review Board (IRB) at Majmaah University. (Ethics Number: MUREC-Nov.26/COM-2024/71). Participation was voluntary, and informed consent was obtained electronically from all participants before data collection. The anonymity and confidentiality of participants were maintained, with data securely stored and used solely for study purposes.

Results:

Figure 1 illustrates that 20.4% (n=113) of surveyed students reported using nicotine-based e-cigarettes. Table 1 summarizes the demographics of the 555 participants. The mean age was 21.46 ± 2.39 years. Males were 309 (55.7%) and females 246 (44.3%). Urban residents were 262 (47.2%) and rural 293 (52.8%). Fathers with no formal education were 33 (5.8%), and mothers 72 (13.0%). Income distribution was: <1000 SAR – 188 (33.9%), 1000–2000 SAR – 180 (32.4%), >2000 SAR – 187 (33.7%). Most students were from Medicine 137 (24.7%) and Business Administration 93 (16.8%). Fourth-year students were the largest group at 135 (24.4%). Most lived with the family, 313 (56.4%), and 113 (20.4%) reported using e-cigarettes.

Table 1. Demographic characteristics of the study population (n=555).
Variable	Category	n (%)
Age	Mean ± SD	21.46 ± 2.388
Sex	Male	309 (55.7%)
Female	246 (44.3%)
Residence	Urban	262 (47.2%)
Rural	293 (52.8%)
Fathers’ Education	No formal education	33 (5.8%)
General education	255 (45.9%)
Bachelor’s degree/postgraduate	267 (48.2%)
Mothers’ Education	No formal education	72 (13.0%)
General education	262 (47.2%)
Bachelor’s degree/postgraduate	221 (39.8%)
Personal monthly Income in SAR	Less 1000 SR	188 (33.9%)
1000-2000 SR	180 (32.4%)
Above 2000 SR	187 (33.7%)
College in Majmaah University	Applied college	57 (10.3%)
College of medicine	137 (24.7%)
College of Dentistry	43 (7.7%)
College of engineering	51 (9.2%)
College of Applied Medical Sciences	40 (7.2%)
College of computer and information science	48 (8.6%)
College of Business and Administration	93 (16.8%)
College of Education	40 (7.2%)
College of Science	46 (8.3%)
Academic Year.	1st year	104 (18.7%)
2nd year	109 (19.6%)
3rd year	95 (17.1%)
4th year	135 (24.4%)
5th year	56 (10.1%)
6th year	31 (5.6%)
Internship	25 (4.5%)
With whom do you live while in college?	At home with family	313 (56.4%)
With relatives	35 (6.3%)
With friends	85 (15.3%)
Alone	122 (22.0%)

A total of 46 participants (41%) were classified as highly influenced, while 67 participants (59%) were moderately influenced.

Table 2 shows that 23 (20.4%) participants indicated that their family members knew they used e-cigarettes, and most of them 72 (63.7%) avoided using e-cigarettes around them. Thirteen respondents, 11.5 %, agreed and 15 (13.3%) strongly agreed that their friends were encouraging them. Moreover, (forty 35.4%) strongly agreed and thirty-four (30.1%) agreed that they felt pressured to use e-cigarettes when with friends who smoke. The results also show that 28 (16.8%) of participants agreed and 41 (36.3%) strongly agreed that observing others use e-cigarettes makes the activity seem more acceptable. While 28 (24.8%) strongly agreed and 24 (21.2%) agreed that avoiding e-cigarettes impacts family relations, 19 (16.8%) strongly agreed and 20 (17.7%) agreed that using them aids in social integration. Nonetheless, 19 (16.8%) of participants strongly agreed, and 11 (9.7%) agreed that using electronic cigarettes has a detrimental effect on their academic performance, with 21 (18.6%) strongly agreeing and 20 (17.7%) agreeing that media is a major influencing factor. Their use of electronic cigarettes is also influenced by the attitudes of their smoking society. This was indicated by 30 (26.6%) of the participants who strongly agreed and 33 (29.2%) who agreed on the same.

Table 2. Social Determinant of Nicotine Vaping Among Majmaah University Students (n=113)
Variables	Strongly agreen (%)	Agreen (%)	Neutraln (%)	Disagree n (%)	Strongly disagree n (%)
My family is aware of my use of electronic cigarettes	23(20.4%)	26(23.0%)	23(20.4%)	15(13.2%)	26(23.0%)
I avoid using electronic cigarettes around family members	72(63.7%)	17(15.0%)	11(9.7%)	7(6.3%)	6(5.3%)
My friends encourage me to use electronic cigarettes	15(13.3%)	13(11.5%)	18(15.9%)	36(31.9%)	31(27.4%)
I feel urged to use electronic cigarettes when I’m with friends who smoke	40(35.4%)	34(30.1%)	24(21.2%)	9(8.0%)	6(5.3%)
Seeing people around me using electronic cigarettes makes it seem more acceptable to use them	41(36.3%)	28(24.8%)	19(16.8%)	12(10.6%)	13(11.5%)
I believe using electronic cigarettes helps me fit in better with my social group	19(16.8%)	20(17.7%)	22(19.5%)	27(23.9%)	25(22.1%)
Avoiding electronic cigarettes affects the time spent with the family	28(24.8%)	24(21.2%)	26(23.0%)	20(17.7%)	15(13.3%)
My academic performance is negatively affected by my use of electronic cigarettes	19(16.8%)	11(9.7%)	25(22.1%)	32(28.4%)	26(23.0%)
Media in general, such as social media, movies, and TV shows, normalizes the use of electronic cigarettes, making it seem acceptable to me	21(18.6%)	20(17.7%)	26(23.0%)	26(23.0%)	20(17.7%)
I believe my culture or community’s view on smoking influences my use of electronic cigarettes	30(26.6%)	33(29.2%)	29(25.7%)	11(9.7%)	10(8.8%)

Table 3 shows that among all the variables assessed, only the type of college showed a statistically significant association with sociodemographic factors influencing the use of electronic cigarettes (P = 0.019). The College of Business and Administration showed the highest relation compared to the other colleges (30.4%).

Table 3. Association between sociodemographic characteristics and Social Determinants of vaping among Majmaah University students
Variable	Category	High	Medium	P-value
n (%)	n (%)
Sex	Male	33(77.7%)	57(85.1%)	0.084
Female	13(23.3%)	10(14.9%)
Residence	Urban	33(71.7%)	38(56.7%)	0.104
Rural	13(28.3%)	29(43.3%)
Fathers Education	No formal education	1(2.2%)	6(9.0%)	0.338
General education	18(39.1%)	25(37.3%)
Bachelor’s degree/postgraduate	27(58.7%)	36(53.7%)
Mothers Education	No formal education	4(8.7%)	9(13.4%)	0.640
General education	24(52.2%)	30(44.8%)
Bachelor’s degree/postgraduate	18(39.1%)	28(41.8%)
Personal monthly Income in SAR	Less 1000 SR	11(29.9%)	19(28.4%)	0.864
1000-2000 SR	17(37.0%)	24(35.8%)
Above 2000 SR	18(39.1%)	24(35.8%)
College in Majmaah University	Applied college	8(17.4%)	2(3.0%)	0.019
College of medicine	7(15.2%)	18(26.9%)
College of Dentistry	4(8.7%)	11(16.4%)
College of engineering	3(6.5%)	16(23.9%)
College of Applied Medical Science	1(2.2%)	1(1.5%)
College of computer and information science	3(6.5%)	2(3.0%)
College of Business and Administration	14(30.4%)	118(16.4%)
College of Education	5(10.9%)	4(6.0%)
College of Science	2(3.2%)	1(2.0%)
Academic Year.	1st year	5(10.9%)	11(16.4%)	0.655
2nd year	6(13.0%)	14(20.9%)
3nd year	15(32.6%)	16(23.9%)
4th year	10(27.7%)	17(25.4%)
5th year	6(13.0%)	5(7.5%)
6th year	2(4.3%)	3(4.5%)
Internship	2(4.3%)	1(1.5%)
With whom do you live while in college?	At home with family	13(28.3%)	24(35.8%)	0.579
With relatives	2(4.3%)	6(9.0%)
With friends	14(30.4%)	17(25.4%)
Alone	17(37.0%)	20(29.9%)

A total of 83 participants (73.4%) were classified as highly influenced, 29 participants (25.7%) were moderately influenced, and 1 participant (0.9%) as having low influence.

Table 4 shows that most of the participants 61 (54.0%) indicated that they feel more likely to use e-cigarettes when they are under pressure or during stressful events like tests. They also (58 (51.3%) strongly agreed, 21 (18.6%) agreed) find it psychologically challenging to quit smoking e-cigarettes even when they are aware of the risks since they think they help control their emotions. No one strongly disagreed with this assertion. It is shown that 47(41.6%) of participants were worried about their dependence on e-cigarettes, while 32 (28.3%) felt they had control over use. The majority (48 (42.5%) strongly agreed, 32 (28.3%) agreed) concurred that it was difficult to use e-cigarettes when bored or restless, while more than two thirds of the participants showed agreement that quitting was a substantial struggle. According to the study, 46 percent or 52 participants strongly agreed with unsuccessful attempts to quit, and 18 (15.9%) also agreed. 41 or 36.3% of users strongly agreed and 29 (25.7%) agreed with withdrawal symptoms after discontinuing usage.

Table 4. Psychological Determinant of Nicotine Vaping Among Majmaah University Students (n=113)
Variables	Strongly agree1n (%)	Agree2 n (%)	Neutral3 n (%)	Disagree4 n (%)	Strongly Disagree5 n (%)
My use of electronic cigarettes increases during stressful times, such as exam periods or high-pressure situations	61(54.0%)	27(23.9%)	18(15.9%)	7(6.2%)	0(0.0%)
I believe using electronic cigarettes helps me manage my emotions	37(32.7%)	28(24.8%)	27(23.9%)	13(11.5%)	8(7.1%)
Psychologically, I find it difficult to stop using electronic cigarettes even though I know they have risks	58(51.3%)	21(18.6%)	22(19.5%)	4(3.5%)	8(7.1%)
Psychologically, I believe I have control over my use of electronic cigarettes	32(28.3%)	24(21.3%)	28(24.8%)	19(16.8%)	10(8.8%)
I worry about my dependence on electronic cigarettes	47(41.6%)	24(21.2%)	27(23.9%)	9(8.0%)	6(5.3%)
I turn to electronic cigarettes when I’m feeling bored or restless	48(42.5%)	32(28.3%)	20(17.7%)	8(7.1%)	5(4.4%)
I believe quitting electronic cigarettes would be very challenging for me	48 (42.5%)	32(28.4%)	20(17.7%)	6(5.3%)	7(6.1%)
When I stop using Electronic Cigarettes, I experience withdrawal symptoms (irritability, Anxiety, insomnia etc..)	41(36.3%)	29(25.7%)	23(20.4%)	14(12.3%)	6(5.3%)
I have tried to quit using Electronic Cigarettes before, but my attempts were unsuccessful	52(46.0%)	18(15.9%)	22(19.5%)	12(10.6%)	9(8.0%)

Table 5 indicates that among all the variables examined, only the college in which participants are enrolled at Majmaah University demonstrated a statistically significant association with the psychological determinants influencing electronic cigarette use (P = 0.016)

Table 5: Association between Sociodemographic factors and Psychological Determinants
Variable	Category	High	Low	Medium	P-value
n (%)	n (%)	n (%)
Sex	Male	69(83.1%)	1(100.0%)	20(69.0%)	0.234
Female	14(16.9%)	0(0.0%)	9(31.0%)
Residence	Urban	56(67.5%)	0(0.0%)	15(51.7%)	0.136
Rural	27(32.5%)	1(100.0%)	14(48.3%)
Fathers Education	No formal education	5(6.0%)	0(0.0%)	2(6.9%)	0.774
General education	32(38.6%)	1(100.0%)	10(34.5%)
Bachelor’s degree/postgraduate	46(55.4%)	0(0.0%)	17(58.6%)
Mothers Education	No formal education	9(10.8%)	1(100.0%)	3(10.3%)	0.092
General education	41(49.4%)	0(0.0%)	13(44.8%)
Bachelor’s degree/postgraduate	33(39.8%)	0(0.0%)	13(44.8%)
Personal monthly Income in SAR	Less 1000 SR	21(25.3%)	0(0.0%)	9(31.1%)	0.358
1000-2000 SR	34(41.0%)	0(0.0%)	7(24.1%)
Above 2000 SR	28(33.7%)	1(100.0%)	13(44.8%)
College in Majmaah University	Applied college	10(12.0%)	0(0.0%)	0(0.0%)	0.016
College of medicine	17(20.5%)	0(0.0%)	8(27.6%)
College of Dentistry	5(6.0%)	0(0.0%)	10(34.5%)
College of engineering	16(19.3%)	1(100.0%)	2(6.9%)
College of Applied Medical Sciences	1(1.2%)	0(0.0%)	1(3.4%)
College of computer and information science	5(6.0%)	0(0.0%)	0(0.0%)
College of Business and Administration	21(25.3%)	0(0.0%)	4(13.8%)
College of Education	7(8.4%)	0(0.0%)	2(6.9%)
College of Science	1(1.2%)	0(0.0%)	2(6.9%)
Academic Year.	1st year	11(13.3%)	0(0.0%)	5(17.2%)	0.557
2nd year	11(13.3%)	0(0.0%)	9(31.0%)
3nd year	26(31.3%)	0(0.0%)	5(17.2%)
4th year	19(22.9%)	1(100.0%)	7(24.1%)
5th year	10(12.0%)	0(0.0%)	1(3.4%)
6th year	4(4.8%)	0(0.0%)	1(3.4%)
Internship	2(2.4%)	0(0.0%)	1(3.4%)
With whom do you live	At home with family	28(33.7%)	0(0.0%)	9(31.0%)	0.575
With relatives	4(4.8%)	0(0.0%)	4(13.8%)
With friends	24(28.9%)	0(0.0%)	7(24.1%)
Alone	27(32.5%)	1(100.0%)	9(31.0%)

Table 6 shows that among the 113 respondents, 50 (44.2%) were aware of smoking cessation clinics at Majmaah University however, only 11 (9.7%) had ever visited the clinic. Regarding the impact of awareness programs, 35 participants (31.0%) agreed or strongly agreed that these programs influenced their decision to reduce or quit nicotine vaping. Meanwhile, 37 (32.7%) remained neutral, and 41 (36.3%) disagreed or strongly disagreed with the statement.

Table 6. The effectiveness of Majmaah University campaigns and educational programs aimed to reduce nicotine vaping (n=113)
Variables	Categories	No. (%)
I am aware of the existence of smoking cessation clinics at Majmaah University	No	63(55.8%)
Yes	50(44.2%)
I have visited a smoking cessation clinic at Majmaah University in the past	No	102(90.3%)
Yes	11(9.7%)
The awareness programs at Majmaah University have influenced my decision to quit or reduce nicotine vaping.	Strongly Agree	15(13.3%)
Agree	20(17.7%)
Neutral	37(32.7%)
Disagree	21(18.6%)
Strongly Disagree	20(17.7%)

Table 7 shows that among all the variables assessed, only fathers’ level of education showed a statistically significant association with awareness of the campaigns (P = 0.037). This suggests that students whose fathers had higher educational attainment (bachelor’s or postgraduate degrees) were significantly more likely to be aware of the clinics compared to those whose fathers had general or no formal education. All other variables, including sex (P = 0.184), residence (P = 0.344), mothers’ education (P = 0.090), income (P = 0.813), college affiliation (P = 0.092), academic year (P = 0.081), and living arrangement (P = 0.677), did not show statistically significant associations (P > 0.05).

Table 7. Association between social demographics and awareness of the existence of smoking cessation clinics.
Variable	Category	No	Yes
N (%)	N (%)	P-value
Sex	Male	53(84.1%)	37(74.0%)	0.184
Female	10(15.9%)	13(26.0%)
Residence	Urban	42(66.7%)	29(58.0%)	0.344
Rural	21(33.3%)	21(42.0%)
Father Education	No formal education	2(3.2%)	5(10.0%)	0.037
General education	30(47.6%)	13(26.0%)
Bachelor’s degree/postgraduate	31(49.2%)	32(64.0%)
Mother Education	No formal education	5(7.9%)	8(16.0%)	0.090
General education	27(42.9%)	27(54.0%)
Bachelor’s degree/postgraduate	31(49.2%)	15(30.0%)
Personal monthly Income in SAR	Less 1000 SR	18(28.6%)	12(24.0%)	0.813
1000-2000 SR	23(35.5%)	18(36.0%)
Above 2000 SR	22(34.9%)	20(40.0%)
College in Majmaah University	Applied college	4(6.3%)	6(12.0%)	0.092
College of Medicine	15(23.8%)	10(20.0%)
College of Dentistry	3(4.8%)	12(24.0%)
College of engineering	14(22.2%)	5(10.0%)
College of Applied Medical Sciences	1(1.6%)	1(2.0%)
College of computer and information science	3(4.8%)	2(4.0%)
College of Business and Administration	17(27.0%)	8(16.0%)
College of Education	4(44.4%)	5(55.6%)
College of Science	2(3.2%)	1(2.0%)
Academic Year.	1st year	11(17.5%)	5(10.0%)	0.081
2nd year	9(14.3%)	11(22.0%)
3rd year	16(25.4%)	15(30.0%)
4th year	19(30.2%)	9(16.0%)
5th year	4(6.3%)	7(14.0%)
6th year	1(1.6%)	4(8.0%)
Internship	3(4.8%)	0(0.0%)
With whom do you live	At home with family	20(31.7%)	17(34.0%)	0.677
With relatives	3(4.8%)	5(10.0%)
With friends	19(61.3%)	12(38.7%)
Alone	21(33.3%)	16(32.0%)

Discussion:

E-cigarette use represents a growing public health concern, particularly among medical students who are expected to serve as future healthcare professionals and educators¹. The survey revealed that 20.4% of participants used nicotine-based e-cigarettes, with most being influenced by social factors, including peers and family. The study found that college type, particularly Business Administration, had a significant association with e-cigarette use. Psychological challenges like stress and emotional control were key factors influencing continued use, with many participants struggling to quit despite awareness of health risks. Additionally, while some students were aware of smoking cessation programs, only a few had visited them, and awareness was linked to the father's education level.

Vaping behaviors differ by gender: male students often use devices with higher nicotine concentrations and are more influenced by peer pressure and advertising¹,², while female students tend to be affected by stress, body image concerns, and gender-specific marketing³.

The results of this study showed that 20.4% of the students reported using nicotine vaping. This rate is relatively high compared to other Saudi universities: 10.6% at Qassim University7, 12.2% at Al-Faisal University16, and 31.8% at Umm Al-Qura University8. Internationally, Majmaah prevalence exceeds figures from several regions, including 1.7% in Shanghai17, 5.9% in Kathmandu9, and 14% in Qatar18. However, higher usage was reported in Central and Eastern Europe, where 43.7% of students had ever tried e-cigarettes19. These comparisons suggest that nicotine vaping is notably prevalent at Majmaah University, reinforcing the urgency of tailored prevention strategies. This finding also corresponds with the study by Alshomran et al., who reported that 3.3% of medical students used e-cigarettes and 20.7% used tobacco products, with usage being more common among males20.

The study also revealed that while many students avoided vaping in front of family members likely due to perceived social judgment—43.4% acknowledged that their families were aware of their behavior. Social factors, including peer pressure, cultural attitudes, and media exposure, were found to significantly influence e-cigarette use. Similar findings were reported by Aljohani et al., where 61.4% of users indicated they used e-cigarettes primarily to quit traditional smoking, although this was often linked to reduced daily activity and increased psychological distress21. Likewise, Bhatt observed that current users tended to underestimate the associated risks of e-cigarette use22.

E-cigarette use was reported to increase notably during periods of stress, with emotional reliance identified as a significant contributing factor. The presence of withdrawal symptoms, repeated failed attempts to quit, and a general sense of physical dependence were also evident. Boredom emerged as an additional driver of use. These findings are consistent with those of Wattick et al., who noted that motivations for e-cigarette use frequently included stress relief, peer influence, and attempts at smoking cessation23. Their research further linked vaping to underlying psychological factors such as anxiety, depression, adverse childhood experiences, and alcohol consumption—underscoring the need for comprehensive intervention strategies.

Janjua et al. reported that students who smoked, vaped, or engaged in both behaviors tended to have lower academic performance24. While self-esteem levels did not differ significantly across groups, both smoking and vaping were associated with reduced levels of overall happiness. In our study, 44.2% of students were aware of the university’s smoking cessation clinics, yet only 9.7% had ever attended. This low engagement rate raises concerns about potential barriers such as limited accessibility, lack of motivation, or doubts regarding the program’s effectiveness. Nevertheless, 31.0% of students reported that awareness campaigns influenced their decision to reduce or quit vaping. Similarly, Qanash et al. found that 56.7% of students were able to quit, with younger users more likely to succeed using fruit-flavored e-cigarettes. Their findings also indicated that e-cigarette use was more prevalent than traditional smoking25.

The higher prevalence of vaping among students in the Business College could be attributed to several factors, such as social dynamics and stress related to academic pressures. Business students may face unique pressures, including a competitive environment or long study hours, which can contribute to a higher likelihood of using e-cigarettes as a coping mechanism. Additionally, peer influence may play a larger role in this college, with students potentially being more exposed to vaping through their social networks. The combination of stress, peer influence, and the need for quick emotional relief may explain why vaping is more prevalent in this group27.

Among the various social and psychological determinants examined in this study, only the participants’ college demonstrated a statistically significant association with awareness levels related to e-cigarette use (P = 0.016). This suggests that a student’s academic background, particularly the field of study may shape their level of awareness and attitudes toward vaping. Students enrolled in health-related disciplines such as medicine and dentistry are likely more exposed to educational content on smoking risks and cessation strategies, which may enhance their understanding of associated psychological and behavioral factors. These observations align with the findings of Ghamri et al., who noted that medical students were more inclined to use e-cigarettes as a transitional tool for quitting traditional tobacco26. Furthermore, Teah et al. reported that certain psychological traits, including anxiety and low conscientiousness, were predictive of increased susceptibility to vaping27. This supports the notion that both academic context and individual psychological profiles play a role in influencing vaping behavior.

The current study had some limitations. This study was conducted at a single institution, which may limit the generalizability of the findings. Additionally, the reliance on self-reported data introduces the potential for recall or social desirability bias. Given the cross-sectional nature of the study, the identified psychological determinants of e-cigarette use, such as stress, emotional control, and the difficulty in quitting, are likely correlational rather than causal. Since the study captures data at a single point in time, it cannot establish a direct cause-and-effect relationship between these psychological factors and vaping behavior. Instead, the findings suggest that these psychological factors are associated with increased e-cigarette use, but further longitudinal research would be necessary to determine whether these factors directly contribute to or result from vaping habits.

Conclusion

The findings of this study indicate that the prevalence of nicotine vaping among Majmaah University students is high. Nicotine vaping among Majmaah University students is primarily shaped by psychological factors such as stress and emotional reliance, along with strong social influences including peer pressure and media exposure. The cessation clinics exist; however, awareness and utilization remain low.

Source of funding:

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

The authors declared no conflict of interest

Ethical approval was obtained from the Institutional Review Board (IRB) at Majmaah University. (Ethics Number: MUREC-Nov.26/COM-2024/71).

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Legends of Tables and Figures:

Fig. (1) Prevalence of Nicotine Vaping Among Majmaah University Students

Fig (2) Social Determinant of Vaping among Majmaah University Students

Fig (3) Psychological Determinants of Nicotine Vaping among Majmaah University students

Table 1. Demographic characteristics of the study population (n=555).

Table 2. Social Determinant of Nicotine Vaping Among Majmaah University Students (n=113)

Table 3. Association between sociodemographic characteristics and Social Determinants of vaping among Majmaah University students

Table 4. Psychological Determinant of Nicotine Vaping Among Majmaah University Students (n=113)

Table 5: Association between Sociodemographic factors and Psychological Determinants

Table 6. The effectiveness of Majmaah University campaigns and educational programs aimed to reduce nicotine vaping (n=113)

Table 7. Association between social demographics and awareness of the existence of smoking cessation clinics.

E Y M: Preparing the main concept of the research and supervision of the whole preperation of the manuscript.

T H R: Preparing the main concept of the research and supervision of the whole preperation of the manuscript.

F A A: Preparing the proposal and the questionnaire, and collection of the data for the study.

O A A: Collecting the data for the study, data analysis, and preparing the manuscript.

O M A: Collecting the data for the study, data analysis, and preparing the manuscript.

M G T: Collecting the data for the study, data analysis, and preparing the manuscript.

J S A: Collecting the data for the study and preparing the manuscript.

Tables and Figures:

Fig. (1) Prevalence of Nicotine Vaping Among Majmaah University Students

Data has been presented as n and %. The statements were rated on Likert scale

Data has been presented as n and %, P<0.05 was considered significant.