Prevalence, knowledge, attitudes, and practices related to e-cigarette use among students in Kuwait: a cross-sectional study

Abstract

Background The global increase in electronic cigarette (e-cigarette) use represents a significant public health concern, especially among young adults in high-income countries and the Middle East. Although e-cigarette use is rising in Kuwait, comprehensive data regarding the knowledge, attitudes, and practices of university students are limited. Objective This study assessed the prevalence of e-cigarette use and identified demographic, social, and cognitive factors associated with its use among students in Kuwait. Methods A cross-sectional study was conducted from November 2025 to February 2026 using a stratified one-stage cluster sampling method across public, private, and Public Authority for Applied Education and Training (PAAET) institutions. A self-administered questionnaire was distributed to 550 students (57.3% male; mean age 20.89 years) to assess knowledge, attitudes, and patterns of e-cigarette use. Results Approximately 50.4% of participants reported ever using e-cigarettes, and 22.5% reported current daily use. Overall knowledge (42%) and attitude scores (47%) were low, reflecting limited awareness of risks and generally non-accepting attitudes. Ever-users demonstrated significantly higher knowledge and more permissive attitudes compared to non-users. Multivariable logistic regression identified having friends who use e-cigarettes as the strongest predictor of use (AOR = 4.53), followed by male gender (AOR = 3.70) and enrollment in PAAET or private universities. Conclusion The prevalence of e-cigarette use among Kuwaiti students is high relative to regional averages, primarily influenced by social and demographic factors. Public health interventions should extend beyond basic education to address the “knowledge-attitude paradox” and promote stricter regulations, including taxation and retail controls.