E-cigarettes in the Middle East: The known, unknown, and what needs to be known next.

Introduction:
This article summarizes the current state of e-cigarette use among youth and young adults in the Middle East, highlighting the limitations of the existing literature and identifying areas for future research. A reader will learn about the prevalence of e-cigarette use, the legislative landscape in the region, and the beliefs, perceptions, attitudes, and awareness surrounding e-cigarettes in the Middle East.

Key Points:

* The prevalence of e-cigarette use among youth and young adults in the Middle East is increasing, but there is limited evidence about this phenomenon in the region.
* Current literature on e-cigarette use in the Middle East has several limitations, including an overreliance on university-based samples, the overuse of non-user samples, a lack of studies on behavior change, high variance in existing data, and a lack of uniform instruments to measure e-cigarette use.
* There are differences in e-cigarette legislation in the Middle East, which impact beliefs, perceptions, attitudes, and awareness about e-cigarette users in the region.
* Most of the evidence on e-cigarettes originates from North America and Europe, but there are differences in reasons for initiating and maintaining e-cigarette use between these regions and the Middle East.
* Few studies in the Middle East have examined awareness about the availability of e-cigarettes, their harms, and tobacco use status of its users.
* Existing studies in the Middle East have found mixed beliefs about e-cigarettes as a smoking cessation tool, a reason for smoking initiation, an addictive product, a public health concern, and a product that should be regulated in public.
* The relationship between e-cigarette use and cigarette smoking is complex, with mixed evidence on the effectiveness of e-cigarettes as a smoking cessation tool and potential risks for smoking initiation and relapse.

Main Message:
The existing literature on e-cigarette use among youth and young adults in the Middle East has significant limitations, and there is a need for more national studies and studies examining e-cigarette beliefs, perceptions, and attitudes that underlie use, specifically among youth and young adults. Researchers should focus on current users, use uniform and validated measures, and consider cultural and geographic differences to better understand e-cigarette use in a global context. Expanding the evidence base about e-cigarettes in the Middle East will provide a solid foundation for developing effective strategies to better address e-cigarette use among youth and young adults, where exposure to nicotine in these populations is known to be harmful.

Al-Hamdani M, Brett Hopkins D. E-cigarettes in the Middle East: The known, unknown, and what needs to be known next. Preventive medicine reports. 2023;31:102089. doi:10.1016/j.pmedr.2022.102089