Prevalence of e-cigarette use and its association with knowledge and attitudes among palestinian medical students and physicians: a cross-sectional study

BACKGROUND: Electronic cigarette (e-cigarette) use has increased globally, particularly among adolescents and young adults, despite growing evidence regarding potential health risks. Healthcare professionals play a critical role in tobacco control and smoking cessation; however, limited evidence exists regarding knowledge, attitudes, and practices (KAP) toward e-cigarettes among medical students and physicians in Palestine. METHODS: A cross-sectional study was conducted between November and December 2025 among medical students and physicians from major universities and teaching hospitals across the West Bank, Palestine. Data were collected using a structured, self-administered questionnaire adapted from a validated instrument. The questionnaire assessed sociodemographic characteristics, smoking-related behaviors, e-cigarette knowledge, attitudes, and use patterns. Multivariable logistic regression analyses were performed to identify factors independently associated with high knowledge levels, positive attitudes, and current e-cigarette use. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were reported. RESULTS: A total of 433 participants were included, with a mean age of 25.55 ± 7.69 years; 55.4% were female. Overall, 34.2% reported current use of at least one tobacco or nicotine product, and 11.8% were current e-cigarette users. Current e-cigarette use was substantially higher among males than females (20.7% vs. 4.6%, p < 0.001). High knowledge level was observed in 73.0% of participants, while 24.7% had positive attitudes toward e-cigarettes. Positive attitude was inversely associated with high knowledge level (aOR = 0.26, 95% CI: 0.16-0.44), while current e-cigarette use was associated with positive attitude (aOR = 4.32, 95% CI: 1.61-11.59). In the final parsimonious model, current e-cigarette use was independently associated with positive attitude toward e-cigarettes (aOR = 7.45, 95% CI: 3.66-15.18), having close friends who currently smoked (aOR = 3.63, 95% CI: 1.06-12.40), and spending more than five hours per day at college (aOR = 2.68, 95% CI: 1.02-6.99). Among current e-cigarette users, 51.0% also used at least one combustible tobacco product. Self-reported symptoms after switching from conventional cigarettes to e-cigarettes were described as exploratory findings based on a small subgroup. CONCLUSIONS: E-cigarette use is relatively common among medical students and physicians in Palestine and frequently coexists with other tobacco products. Although overall knowledge was generally high, important gaps remain, and positive attitudes toward e-cigarettes were strongly associated with current use. These findings highlight the need for enhanced education on emerging nicotine products within medical curricula, strengthened tobacco-control policies, and targeted interventions addressing social influences and misconceptions regarding e-cigarettes among current and future healthcare professionals.