Association Between Perceived <scp>COVID</scp> ‐19 Risk and Current Use of Any Nicotine Product Amongst Adolescents in Saudi Arabia

INTRODUCTION: The COVID-19 pandemic created a unique context for tobacco-related risk communication amongst adolescents. This study examined the link between COVID-19-related smoking risk perceptions and current nicotine use amongst Saudi school adolescents. METHODS: Data were drawn from the 2022 Saudi Arabia Global Youth Tobacco Survey, a nationally representative school-based survey (overall response rate: 92.3%). The analytic sample included 4984 adolescents aged 13-15 years. The primary outcome was current use (≥ 1 day in the past 30 days) of any nicotine product, including cigarettes, shisha, smokeless tobacco, heated tobacco products and electronic cigarettes. Key exposures were beliefs about whether smoking affects COVID-19 infection risk and illness severity. Survey-weighted logistic regression estimated crude and adjusted odds ratios (aOR), adjusting for sex, grade, weekly spending, parental and peer smoking and school tobacco education. Product-specific sensitivity analyses were performed. RESULTS: Overall, 10.7% of adolescents reported current nicotine use. Adolescents who believed smoking reduced the risk of COVID-19 infection had higher odds of nicotine use compared with those who believed it increased risk (aOR = 3.77; 95% CI 2.52-5.65). Similarly, perceiving that smoking reduced COVID-19 severity was associated with higher odds of use (aOR = 2.34; 95% CI 1.49-3.67). In sensitivity analyses, associations for perceived reduced infection risk were observed for both cigarette smoking (aOR = 4.44; 95% CI 2.83-6.99) and non-cigarette nicotine use (aOR = 4.09; 95% CI 2.96-5.66). DISCUSSION AND CONCLUSIONS: Beliefs that smoking lowers COVID-19 risks are strongly linked to adolescent nicotine use, underscoring the need for accurate risk communication in youth tobacco prevention.