Alshahrani Najim Z, Alarifi Abdullah M, Algethami Mohammed R, Aljunaid Mohammed A, Shukri Ahmed K, Alzain Mohannad A
Department of Family and Community Medicine, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia.
Deputyship of Population Health, Ministry of Health, Riyadh, Saudi Arabia.
Front Public Health. 2025 Aug 4;13:1649537. doi: 10.3389/fpubh.2025.1649537. eCollection 2025.
The rising use of e-cigarettes among adolescents presents a growing public health concern, particularly in countries like Saudi Arabia, where tobacco marketing regulation is still evolving. Although marketing is a known driver of youth tobacco uptake, evidence from the Eastern Mediterranean region remains limited. This study examined the association between exposure to e-cigarette marketing and current use among Saudi adolescents using nationally representative data.
We analysed cross-sectional data from the 2022 Global Youth Tobacco Survey (GYTS) in Saudi Arabia, a nationally representative, school-based survey of adolescents aged 13-15 years. Key exposures included seeing a point-of-sale (POS) advertisement and being offered a free e-cigarette. A composite marketing exposure score (0, 1, or 2 exposures) was created. The outcome was current e-cigarette use, defined as use on at least one day in the past 30 days. Survey-weighted logistic regression models estimated crude and adjusted odds ratios (aORs), adjusting for age, sex, parental smoking, and peer smoking. Sex-stratified analyses were also conducted.
Among 5,610 adolescents, 300 (5.4%) reported current e-cigarette use. Of all respondents, 5.7% had been offered a free e-cigarette and 19.7% had seen a POS advertisement. Both exposures were significantly associated with current e-cigarette use: free product offer (aOR: 6.57; 95% CI: 4.61-9.36; < 0.001) and POS ad exposure (aOR: 2.66; 95% CI: 1.79-3.97; < 0.001). A dose-response relationship was observed, with those exposed to both forms of marketing having 15 times the odds of current use (aOR: 15.05; 95% CI: 7.81-29.02; < 0.001). Associations were significant for both males and females.
Exposure to e-cigarette marketing is a strong and consistent predictor of adolescent use in Saudi Arabia. These findings support urgent policy action to restrict youth-targeted tobacco promotions.
青少年中电子烟使用的增加引发了越来越多的公共卫生关注，尤其是在沙特阿拉伯等国家，那里的烟草营销监管仍在不断发展。尽管营销是青少年烟草使用的一个已知驱动因素，但东地中海地区的相关证据仍然有限。本研究利用具有全国代表性的数据，调查了沙特青少年接触电子烟营销与当前使用之间的关联。
我们分析了2022年沙特阿拉伯全球青少年烟草调查（GYTS）的横断面数据，这是一项针对13至15岁青少年的具有全国代表性的基于学校的调查。主要暴露因素包括看到销售点（POS）广告和获得免费电子烟。创建了一个综合营销暴露得分（0、1或2次暴露）。结果变量是当前电子烟使用情况，定义为在过去30天内至少有一天使用过电子烟。调查加权逻辑回归模型估计了粗比值比和调整后的比值比（aOR），并对年龄、性别、父母吸烟情况和同伴吸烟情况进行了调整。还进行了按性别分层的分析。
在5610名青少年中，300人（5.4%）报告当前使用电子烟。在所有受访者中，5.7%的人获得过免费电子烟，19.7%的人看到过POS广告。这两种暴露都与当前电子烟使用显著相关：获得免费产品（aOR：6.57；95%置信区间：4.61-9.36；<0.001）和接触POS广告（aOR：2.66；95%置信区间：1.79-3.97；<0.001）。观察到一种剂量反应关系，即同时接触两种形式营销的人当前使用的几率是其他人的15倍（aOR：15.05；95%置信区间：7.81-29.02；<0.001）。男性和女性的关联均显著。
在沙特阿拉伯，接触电子烟营销是青少年使用电子烟的一个强有力且一致的预测因素。这些发现支持采取紧急政策行动，限制针对青少年的烟草促销活动。
