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Introduction There is a paucity of studies on e-cigarette use among adults with chronic lung disease. In the present study, we aimed to assess whether psychosocial or cognitive factors elucidate the relationship between chronic lung disease (CLD) and susceptibility to e-cigarette use and whether the relationship between CLD and e-cigarette use is conditional on the presence of respiratory symptoms. Methods We recruited adults aged ≥18 years in Alabama with CLD from university medical clinics (n=140) and individuals without CLD (n=123 as a reference group). Information on sociodemographics, susceptibility to e-cigarette use, psychosocial factors, and cognitive factors were collected. Mediation analysis was used to assess whether the psychosocial factors or cognitive factors explained the association between CLD and susceptibility to using e-cigarettes, and moderation analysis was conducted to determine if respiratory factors would change the association between CLD and susceptibility to e-cigarette use. Results Psychosocial factors (stress, depression, anxiety) and e-cigarette positive expectancy were notably high among individuals with CLD. Having CLD was associated with a lower likelihood of susceptibility to e-cigarette use. Higher levels of stress, being a smoker, boredom, taste/sensorimotor manipulation, and social facilitation were associated with higher odds of susceptibility to using e-cigarettes among individuals with CLD. Mediation analysis indicated a statistically significant indirect effect of CLD on the susceptibility to using e-cigarettes through stress and boredom reduction. We did not find a statistically significant interaction between CLD and respiratory symptoms affecting susceptibility to using e-cigarettes. Conclusions Individuals with CLD often exhibit stress, depression, and a positive view of e-cigarettes but are generally less inclined to use them. Stress, smoking habits, boredom, taste, and social influence can increase their susceptibility to e-cigarette use. Our findings call for further exploration to evaluate the temporal relationship between CLD status, psychosocial factors, cognitive factors, and susceptibility to using e-cigarettes. TRIAL REGISTRATION The study was registered on ClinicalTrials.gov, on 5 November 2019. Identifier: NCT04151784

Abstract Background Tobacco use remains a leading cause of premature death. To combat tobacco use, the Ministry of Health (MOH) improved access to smoking cessation clinics (SCCs) by developing fixed SCCs and mobile SCCs, which move based on demand across locations. The goal of this study was to investigate awareness and utilization of SCCs among tobacco users in Saudi Arabia and the factors that influence their awareness and utilization. Method This cross-sectional study used the 2019 Global Adult Tobacco Survey. Three outcome variables were employed, including tobacco users’ awareness of fixed SCCs, mobile SCCs, and utilization of fixed SCCs. Several independent variables were examined, including sociodemographic characteristics and tobacco use. Multivariable logistic regression analyses were performed. Results One thousand six hundred sixty-seven tobacco users were included in this study. There were 60%, 26%, and 9% of tobacco users who were aware of fixed SCCs, aware of mobile SCCs, and visited fixed SCCs, respectively. The likelihood of being aware of SCCs increased among users residing in urban areas (fixed SCCs: OR = 1.88; 95% CI = 1.31–2.68; mobile SCCs: OR = 2.09; CI = 1.37–3.17) while it decreased among those reported self-employed (fixed SCCs: OR = 0.31; CI = 0.17–0.56; mobile SCCs: OR = 0.42; CI = 0.20–0.89). The likelihood of visiting fixed SCCs increased among educated tobacco users aged 25–34 (OR = 5.61; CI = 1.73–18.21) and 35–44 (OR = 4.22; CI = 1.07–16.64) while the odds of visiting SCCs decreased among those who were working in the private sector (OR = 0.26; CI = 0.09–0.73). Conclusion The decision to quit smoking must be supported by an effective healthcare system that provides accessible and affordable smoking cessation services. Knowing the factors that influence the awareness and utilization of SCCs would help policymakers dedicate efforts targeting those who desire to quit smoking yet face limitations in using SCCs.

Introduction Saudi Arabia is expected to witness a slight reduction in tobacco use. The Saudi government offers free-of-charge smoking cessation services. Yet, factors influencing the desire to quit smoking are not comprehensively investigated in Saudi Arabia. This study examines the factors influencing the desire to quit among smoking adults in Saudi Arabia and investigates whether using alternative tobacco products, such as e-cigarettes, is associated with the desire to quit smoking. Methods Data from the 2019 nationally representative Global Adults Tobacco Survey (GATS) was used. GATS utilized a face-to-face household cross-sectional survey that collected data from adults aged ≥15 years. Several factors including, sociodemographic characteristics, use of alternative tobacco products, attitude toward tobacco control, and awareness of smoking cessation clinics (SCCs), were examined to predict the desire to quit. Logistic regression analysis was conducted. Results A total of 11381 individuals completed the survey. Of the total sample, 1667 participants were tobacco smokers. The majority of the tobacco smokers were interested in quitting smoking (82.4%); 58% of cigarette smokers and 17.1% of waterpipe smokers were interested in quitting smoking. The desire to quit smoking was positively associated with the awareness of SCCs (AOR=3; 95% CI: 1.8–5), attitude toward raising tobacco taxes (AOR=2.3; 95% CI: 1.4–3.8), and a strict rule of smoking inside the home (AOR=2; 95% CI: 1.1–3.9). No statistical association was found between the desire to quit smoking and the use of e-cigarettes. Conclusions The desire to quit tobacco smoking among Saudi smokers increased with awareness of SCCs, favoring taxes on tobacco products, and implementing strict rules of smoking inside the home. The study reveals valuable insights into the main factors that could inform the development of more effective policy interventions targeting smokers in Saudi Arabia.

Abstract Objective Vaping is advertised as a method to mitigate weight gain after smoking cessation; however, while there is an established inverse association between conventional tobacco use and body mass index (BMI), there is little research on the relationship between e‐cigarettes and BMI. This research tested whether e‐cigarette use was associated with BMI. Methods A secondary data analysis of 207,117 electronic medical records from the UAB was conducted. Patient data from 1 September 2017 through 1 June 2018 were extracted. To be included in the analysis, a patient's record had to include measures of e‐cigarette use and key sociodemographic information. Ordinary least squares regression was used to test the association between e‐cigarette use and BMI, controlling for covariates; unconditional quantile regression was used to determine whether the association varied by BMI quantile. For comparison with tobacco smoking, the association between current tobacco smoking and BMI was estimated in a sample from the same population. Results Respondents in the sample had an average BMI of 30.8 and average age of 50.0 years when BMI was measured. The sample was 51% female, 49.7% white, 46.7% black, and 1.0% Hispanic; 16.4% of the sample had less than a college education and approximately 5% reported currently using e‐cigarettes. Individuals who reported using e‐cigarettes had, on average, a lower BMI compared to those who did not report currently using e‐cigarettes; results indicated that this association did not significantly vary by BMI quantile. Individuals who reported being current smokers had a lower BMI, on average. Conclusion These findings suggest that using e‐cigarettes is associated with a lower BMI in a population of individuals seeking health care, consistent with the association between conventional tobacco use and BMI. This study is a springboard for future research investigating the associations between e‐cigarette use, BMI, and risk of obesity in the general population.

Objective . To describe heated humidified high-flow nasal cannulas (HHHFNC) utilization in level III neonatal intensive care units (NICUs) in Saudi Arabia. Methods . A prospective cross-sectional study using an electronic web-based questionnaire. The survey targeted level III NICUs hospitals using HHHFNCs, covering HHHFNC availability, protocols, patient characteristics, and indications. It also collected opinions on the benefits of HHHFNCs compared to nasal continuous positive airway pressure (nCPAP). Results . Out of 47 government-level III neonatal intensive care units, 35 (74%) responded to the survey. Among the included units, 46% had guidelines for HHHFNC use. Additionally, 51% reported using HHHFNC in infants of all gestational ages. The primary indication for HHHFNC use was weaning off nCPAP (34%), with 60% of the respondents noting its advantages for kangaroo care and breastfeeding. Conclusion . HHHFNC are increasingly prevalent in NICUs in Saudi Arabia. However, there remain no clear policies or guidelines regarding their use in preterm infants.

Abstract Background With the advances in neonatal intensive care, the survival rate of extremely preterm infants is increasing. However, bronchopulmonary dysplasia (BPD) remains a major cause of morbidity among infants in this group. This study examined the changes in respiratory support modalities, specifically heated humidified high-flow nasal cannula (HHHFNC), and their association with BPD incidence among preterm infants born at