The effect of electronic cigarette use on nicotine dependence among university students

This study aimed to evaluate the impact of electronic cigarette use on nicotine dependence among students at Trakya University and to identify the factors associated with dependence, as well as to compare the dependence levels of electronic cigarettes with traditional cigarettes. The research was conducted during the 2024–2025 academic year, and a total of 2,682 voluntary participants were included. Data were collected using a 26-item questionnaire comprising questions on sociodemographic characteristics and tobacco product use; in addition to these items, the 6-item Fagerström Test for Nicotine Dependence and the 6-item Electronic Cigarette Fagerström Test for Nicotine Dependence were administered. The ages of the participants ranged from 17 to 51 years, with 889 males (33.1%) and 1,793 females (66.9%). Of the students, 1,857 (69.2%) were enrolled in health-related academic programs, while 825 (30.8%) were studying in non–health-related fields. A total of 1,778 participants (66.3%) reported not using any tobacco products, whereas 855 (31.9%) smoked cigarettes, 157 (5.9%) used electronic cigarettes, 121 (4.5%) used hookah, 79 (2.9%) used cigars, and 15 (0.6%) used pipes. Among cigarette users, 63.1% had low and 11.2% had high nicotine dependence, while among e-cigarette users, 77.1% had low and 7.0% had high dependence. Factors significantly associated with nicotine dependence included gender, age, academic year, family members using tobacco, field of study, income, marital status, daily cigarette consumption, daily nicotine intake, duration of use, and age of initiation. Among e-cigarette users, family tobacco use, daily nicotine intake, and duration of e-cigarette use were significantly associated with dependence. Nicotine dependence was lower among e-cigarette users compared to cigarette smokers. Dual users demonstrated the highest levels of nicotine dependence and a greater tendency to use other tobacco products such as hookah, cigars, and pipes. These findings highlight the importance of considering multiple tobacco product use when assessing nicotine dependence and determining individualized treatment strategies.