Abstract
Electronic cigarettes (e-cigarettes) are an emerging global public health threat. In Palestine, tobacco use poses a significant challenge, but little is known about the prevalence of e-cigarette use and Palestinians' knowledge and perceptions of e-cigarettes. A cross-sectional study was conducted between 02/05/2024 and 16/06/2024 using a questionnaire composed of three sections. The first section collected sociodemographic data. The second section focused on the participants' sources of information about e-cigarettes and their current smoking status. The third section was designed to evaluate participants' knowledge and perceptions of e-cigarettes. The questionnaire was distributed through online platforms to Palestinians aged 18 years and above. Among the total number of 1160 participants, 14.9% were e-cigarette users. Out Of the 173 e-cigarette users, 45.7% were dual users of tobacco and e-cigarettes, and 20.8% had replaced tobacco with e-cigarettes. There was significant variation between e-cigarette users and non-users in terms of sex and age. Moreover, there were significant variations between the reported level of knowledge about e-cigarettes and all of the assessed knowledge and perception in terms of e-cigarette users and non-users (p-value < 0.05). More than 60.0% of the participants agreed that e-cigarettes contain nicotine and carcinogenic substances. More than half of the participants disagreed with the statement that e-cigarettes are safe to use compared to cigarettes. 17.2% of the participants agreed that using e-cigarettes can aid in smoking cessation. 41.9% of the participants thought that e-cigarettes are cost-effective compared with cigarettes. Additionally, the presence of nicotine in e-cigarettes had a significant positive association with using e-cigarettes, while the presence of carcinogenic compounds in e-cigarettes had a significant negative association with using e-cigarettes. Disagreement about the greater safety of e-cigarette use compared to cigarettes, and support for the application of regulations on e-cigarette use had significant negative associations with using e-cigarettes. E-cigarette use is a growing and overlooked public health threat among Palestinians. Immediate actions are needed not only to increase awareness of e-cigarettes, but also to implement stricter regulations on their availability.