{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T17:26:54Z","timestamp":1790270814374,"version":"4.1.0"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2024,5,8]],"date-time":"2024-05-08T00:00:00Z","timestamp":1715126400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Recent reports indicated accelerated rates of e-cigarette use, especially among youth in various Middle Eastern countries, including Palestine. Nevertheless, little is known about knowledge, attitudes, and perceptions regarding this topic in Palestine. This study aimed to assess the prevalence of e-cigarette use among Palestinian university students, along with their knowledge, attitudes, and perceptions about e-cigarette use.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>An observational cross-sectional study, utilizing an online self-administered questionnaire, was conducted on Palestinian students from five universities between 17\/04\/2023 and 04\/11\/2023.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 1002 Palestinian university students completed the questionnaire. The prevalence of e-cigarette use among students was 18.1%. The mean knowledge score about e-cigarettes was significantly lower among the users of e-cigarettes compared to non-users. E-cigarette use was significantly associated with the participants\u2019 smoking status. Among e-cigarette users, 43.6% were also current traditional cigarette users, and 66.9% were current waterpipe users. E-cigarette use was significantly associated with having a friend who is a smoker and\/ or a smoking mother. Binary logistic regression revealed a significant positive effect between the participant\u2019s smoking status, the mother\u2019s smoking status, knowledge about e-cigarettes, and the use of e-cigarettes (p-value &lt; 0.05). Among e-cigarette users, 18.8% used them in indoor places at the university, and 25% reported using them daily in the past month. Affordability of e-cigarettes was the most reported reason for their use (47.5%).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>This study concluded that e-cigarette use is prevalent and rapidly rising among university students in Palestine. This is worrisome as it is significantly associated with insufficient knowledge about the adverse health effects of E-cigarette use, and its addictive nature. These findings focus on the importance of improving the students\u2019 knowledge about e-cigarette use by implementing educational campaigns and considering age regulations on e-cigarette availability and use.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0302946","type":"journal-article","created":{"date-parts":[[2024,5,8]],"date-time":"2024-05-08T17:28:41Z","timestamp":1715189321000},"page":"e0302946","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":19,"title":["E-cigarette use among university students in Palestine: Prevalence, knowledge, and determinant 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Ndunda","year":"2019","journal-title":"Stroke"},{"key":"pone.0302946.ref028","article-title":"(2021) Comparison between smoking and nonsmoking palestinian medical students in the health-promoting behaviors and lifestyle characteristics","author":"N Al-Othman","year":"2021","journal-title":"BioMed Research International"},{"key":"pone.0302946.ref029","article-title":"Smoking, awareness of smoking-associated health risks, and knowledge of national tobacco legislation in Gaza","author":"RT Abu Shomar","year":"2014","journal-title":"Palestine"},{"issue":"5","key":"pone.0302946.ref030","doi-asserted-by":"crossref","first-page":"454","DOI":"10.26719\/2012.18.5.454","article-title":"(2012) Smoking habits and attitudes among university students in Palestine: a cross-sectional study","volume":"18","author":"S Musmar","year":"2012","journal-title":"EMHJ-Eastern Mediterranean Health 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Damiri","year":"2021","journal-title":"Neuropsychiatric disease and treatment"},{"key":"pone.0302946.ref034","doi-asserted-by":"crossref","first-page":"e080881","DOI":"10.1136\/bmjopen-2023-080881","article-title":"Exploring the prevalence, knowledge, attitudes and influencing factors of e-cigarette use among university students in Palestine: a cross-sectional study","volume":"14","author":"Z Nazzal","year":"2024","journal-title":"BMJ open"},{"key":"pone.0302946.ref035","doi-asserted-by":"crossref","first-page":"682355","DOI":"10.3389\/fpubh.2021.682355","article-title":"Prevalence, risk factors, harm perception, and attitudes toward e-cigarette use among university students in Qatar: a cross-sectional study","volume":"9","author":"R Kurdi","year":"2021","journal-title":"Frontiers in public health"},{"key":"pone.0302946.ref036","first-page":"16","article-title":"Tobacco-free generation campus initiative: a program to increase the number of tobacco-free colleges in the United States","author":"B Sinha","year":"2018","journal-title":"Tobacco Induced Diseases"},{"key":"pone.0302946.ref037","first-page":"996","volume-title":"Using Multivariate Statistics. Fourty Edition Allyn and Bacon","author":"B Tabacnick","year":"2001"},{"key":"pone.0302946.ref038","doi-asserted-by":"crossref","first-page":"e0262090","DOI":"10.1371\/journal.pone.0262090","article-title":"E-cigarettes use among university students in Jordan: Perception and related knowledge","volume":"16","author":"NA Al-Sawalha","year":"2021","journal-title":"PLoS One"},{"key":"pone.0302946.ref039","first-page":"21","article-title":"Public awareness, prevalence, and regulations for the sale of electronic cigarettes in Arab countries: A narrative review","author":"F Jirjees","year":"2023","journal-title":"Tobacco induced diseases"},{"key":"pone.0302946.ref040","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.sdentj.2015.12.002","article-title":"Experimentation and correlates of electronic nicotine delivery system (electronic cigarettes) among university students\u2013A cross sectional study","volume":"28","author":"K Awan","year":"2016","journal-title":"The Saudi dental journal"},{"key":"pone.0302946.ref041","doi-asserted-by":"crossref","first-page":"e0276191","DOI":"10.1371\/journal.pone.0276191","article-title":"Knowledge, beliefs, attitude, and practices of E-cigarette use among dental students: A multinational survey","volume":"17","author":"MN Alhajj","year":"2022","journal-title":"Plos one"},{"key":"pone.0302946.ref042","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-020-09572-x","article-title":"E-cigarettes use in the United States: reasons for use, perceptions, and effects on health","volume":"20","author":"S Sapru","year":"2020","journal-title":"BMC public health"},{"key":"pone.0302946.ref043","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1007\/s10900-016-0196-4","article-title":"Reasons for using electronic cigarettes and intentions to quit among electronic cigarette users in Malaysia","volume":"41","author":"LP Wong","year":"2016","journal-title":"Journal of community health"},{"key":"pone.0302946.ref044","doi-asserted-by":"crossref","first-page":"e11","DOI":"10.1155\/2023\/1330946","article-title":"Prevalence, Correlates, and Perception of E-cigarettes among Undergraduate Students of Kathmandu Metropolitan City, Nepal: A Cross-Sectional Study","volume":"2023","author":"G Khanal","year":"2023","journal-title":"Journal of Smoking Cessation"},{"key":"pone.0302946.ref045","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1108\/JHR-01-2020-0008","article-title":"Factors associated with electronic cigarettes use among adolescents in Jakarta, Indonesia","volume":"36","author":"R Fauzi","year":"2022","journal-title":"Journal of health research"},{"key":"pone.0302946.ref046","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1617-9625-12-21","article-title":"Electronic cigarettes: patterns of use, health effects, use in smoking cessation and regulatory issues","volume":"12","author":"MA Rahman","year":"2014","journal-title":"Tobacco induced diseases"},{"key":"pone.0302946.ref047","doi-asserted-by":"crossref","first-page":"11","DOI":"10.59049\/2790-0231.1092","article-title":"Gender differences in health-promoting behaviors and psychological well-being of Palestinian medical students based on the HPLP II","volume":"7","author":"M Ghanim","year":"2021","journal-title":"Palestinian Medical and Pharmaceutical Journal"},{"key":"pone.0302946.ref048","doi-asserted-by":"crossref","first-page":"e069083","DOI":"10.1136\/bmjopen-2022-069083","article-title":"Association between socioecological factors and electronic cigarette use among Thai youth: an institution-based cross-sectional study","volume":"13","author":"A Seeherunwong","year":"2023","journal-title":"BMJ open"},{"key":"pone.0302946.ref049","first-page":"392","article-title":"Factors affecting waterpipe tobacco smoking among university students in qatar. 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