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E-cigarette use is a growing public health concern, especially because of the potential health risks it poses. This study focuses on assessing e-cigarette dependence and the factors associated with it among Palestinian young adults. A cross-sectional survey was conducted from January to May 2023 among university students in the West Bank. A self-administered questionnaire was used to collect demographic data, knowledge, and attitudes regarding e-cigarettes. E-cigarette dependence was assessed using the Penn State Electronic Cigarette Dependence Index. The study included 386 university students who used e-cigarettes. Many of them started using e-cigarettes at a young age, and 54.7% were dual users of e-cigarettes and traditional tobacco. High levels of dependence were reported in 11.4% of participants, and moderate dependence in 28.8%. Several factors were identified through multivariate linear regression as significantly associated with e-cigarette dependence: a higher monthly allowance (β = 0.116, 95% CI: 0.128- 1.124, p = .014), having a father who uses tobacco (β = 0.095, 95% CI: 0.030- 1.638, p = .042), having a close friend who smokes traditional cigarettes (β = 0.095, 95% CI: 0.019- 1.667, p = .045), using e-cigarettes in areas where traditional smoking is prohibited (β = 0.175, 95% CI: 0.689-2.330, p < .001), using e-cigarettes to quit other forms of tobacco (β = 0.134, 95% CI: 0.434-2.314, p = .004), and a more negative attitude score (β = - 0.210, 95% CI: - 0.285- - 0.112, p < .001). The study revealed high levels of e-cigarettes dependence among the participants among young adults, with associated variables such as monthly allowance, attitudes, and age of e-cigarette initiation. Policymakers, educators, and healthcare professionals should collaborate to address e-cigarette dependence among young adults, taking into consideration social, environmental, and socioeconomic factors., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objectives: E-cigarettes have gained popularity, especially among young adults. This study aims to determine the prevalence of e-cigarette smoking, assess knowledge and attitudes and identify associated factors among Palestinian university students., Design: A cross-sectional study., Setting and Participants: The study was conducted among Palestinian university students in early 2023.A self-administered questionnaire was used to survey 1792 students from six Palestine universities in the West Bank. The questionnaire covered various aspects, including sociodemographic information, daily habits, exposure to smoking, attitudes and knowledge about e-cigarettes. Data were analysed using descriptive statistics, χ 2 tests and multivariate regression analysis., Results: The study revealed a high prevalence of tobacco use (41.2%), with e-cigarette use prevalent among 19.7% of participants. Knowledge about e-cigarettes was suboptimal, with misconceptions regarding their safety and health effects. Negative attitudes towards e-cigarettes were common, and students with negative attitudes were more likely to use e-cigarettes (aOR=2.6, 95% CI: 1.9 to 3.6). Gender (aOR=2.1, 95% CI: 1.4 to 3.0), waterpipe smoking (aOR=4.5, 95% CI: 3.2 to 6.3), physical inactivity (aOR=1.4, 95% CI: 1.1 to 1.9), high coffee consumption (aOR=1.6, 95% CI: 1.1 to 2.3), spending time with friends (aOR=2.4, 95% CI: 1.5 to 3.7), having a mother who is a smoker (aOR=1.5, 95% CI: 1.1 to 2.2) and having a friend who uses e-cigarettes (aOR=1.5, 95% CI: 1.1 to 2.1) were significantly associated with e-cigarettes use., Conclusions: E-cigarette use is a growing concern among Palestinian university students. Combating this trend should include educational initiatives, social interventions and policy measures to promote informed decision-making and discourage e-cigarette use. Comprehensive tobacco control programs considering various tobacco and nicotine products and involving multiple stakeholders are warranted., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)