Do youth e-cigarette users perceive smoking as attractive? The dynamics of demographics and contextual factors.

Objective: This study examines whether youth e-cigarette users perceive smoking as attractive and how comfort-based norms, industry promotion, and media or environmental exposures shape these perceptions. Methods: Using a nation-wide representative 2022 Global Youth Tobacco Survey data from Saudi Arabia, we analyzed e-cigarette users' perceptions of smoking attractiveness with descriptive statistics and a multivariable regression model to identify associated covariates. Results: Among 5,455 students aged 13-15 years, 14.3% had ever used e-cigarettes, and 26% of users viewed smoking as attractive. More males rated smoking favorably in crude analyses. However, adjusted model showed males had lower odds versus females. Youth exposed to secondhand smoke in enclosed public places, point-of-sale marketing, anti-smoking messages, and counter-branding marketing had reduced odds of viewing smoking as attractive, whereas those who found it as socially comfortable, offered free tobacco products by a company representative, or owning branded items had higher odds. Secondhand smoke at school or home was not significant. Conclusion: Findings suggest prevention may benefit from targeting comfort-based norms and industry promotion, and future research should examine causal effects to guide youth-focused policy.