Nicotine Dependency Levels Among Adult Electronic Cigarette Smokers in Jeddah, Saudi Arabia: An Analytical Cross-Sectional Study

Background: Electronic cigarettes (ECs) are a recent method to deliver nicotine with less harmful effects than traditional cigarettes. Studying nicotine dependence in adult EC users is a crucial area, but few measures are available to evaluate nicotine dependence induced by EC. Our study aims to estimate the levels of nicotine dependency among adult EC smokers using a modified Fagerstrom Test of Nicotine Dependence (e-FTND) in Jeddah, Saudi Arabia, and to identify EC-associated sociodemographic and smoking-related factors affecting nicotine dependency. Methods: An analytical cross-sectional study was conducted on adults 18 years of age and older in Jeddah, Saudi Arabia, from December 2023 to March 2024. Data were collected from the participants using a pretested structured self-administered questionnaire, and nicotine dependence was assessed using the modified e-FTND. Descriptive statistics such as frequency, mean, and standard deviation were applied. Chi-square was used to assess the association between categorical variables. Ordinal regression was used to predict the nicotine dependency levels with different variables. Results: A total of 344 participants were included in the study. The mean e-FTND score for EC users was 4.14 +/- 2.45. Females had a lower likelihood of experiencing higher dependence compared to males (OR = 0.52, 95% CI: 0.32, 0.85). Using ECs for more than three years was associated with higher odds of increased dependence (OR = 3.18, 95% CI: 1.28, 7.98; p < 0.001). The use of Pod system devices lowered the odds of developing high nicotine dependence (OR = 0.32, 95% CI: 0.13, 0.75; p = 0.01) compared to Iqos device users, while mechanical Mod device users exhibited a trend towards higher dependence, although it was not statistically significant. Nicotine concentration in ECs had a significant impact on the degree of nicotine dependence. Higher concentrations were associated with increased odds of higher dependence (12-18 mg: OR = 3.26, 95% CI: 1.55, 6.91; >18 mg: OR = 4.53, 95% CI: 2.37, 8.75; p < 0.001). Conclusion: Most exclusive EC users in the study developed a moderate nicotine dependence level. The EC device type and nicotine concentration were significant drivers of nicotine dependence. Additionally, the personal characteristics of the users, such as male gender and duration of use, were associated with a higher risk of dependence. An in-depth understanding of the magnitude of nicotine dependence among EC users will enhance the opportunity for tailored health-enhancing interventions and policies.