Prevalence and correlates of ever and current dual use of cigarettes and e-cigarettes among adolescents in Saudi Arabia.

Dual use of electronic and combustible cigarettes among adolescents is an emerging public health concern, particularly in countries experiencing rapid shifts in tobacco and nicotine product availability. This study examined the prevalence and correlates of ever and current dual use among adolescents aged 13-15 in Saudi Arabia. We analysed data from the 2022 Saudi Arabia Global Youth Tobacco Survey (GYTS), a nationally representative, school-based cross-sectional survey. Ever dual use was defined as having ever tried both cigarettes and e-cigarettes, while current dual use was defined as past 30-day use of both products. We used survey-weighted logistic regression to examine predictors of dual use. In the 2022 GYTS, 12.6% of adolescents had ever smoked cigarettes and 14.4% had ever used e-cigarettes; 2.9% and 5.4% were current users, respectively. Among 5,436 adolescents aged 13-15, 5.3% (95% CI: 4.3-6.4) reported ever dual use and 1.4% (95% CI: 1.1-1.9) reported current dual use. Ever dual use was associated with being aged 15 compared to 13 years (AOR = 1.82, 95% CI: 1.14-2.91, p = 0.013), having ≥ 50 SAR weekly spending money compared to none (AOR = 1.60, 95% CI: 1.04-2.45, p = 0.032), having at least one parent who smoked vs none (AOR = 1.64, 95% CI: 1.18-2.28, p = 0.004), having close friends who smoked vs none (AOR = 5.01, 95% CI: 3.62-6.92, p < 0.001), being offered free nicotine products vs not offered (AOR = 2.96, 95% CI: 2.30-3.81, p < 0.001), and perceiving quitting nicotine as difficult vs not difficult (AOR = 1.85, 95% CI: 1.41-2.43, p < 0.001). Supporting both indoor and outdoor smoking bans vs not supporting bans (AOR = 0.40, 95% CI: 0.29-0.55, p < 0.001) and perceiving tobacco as less attractive vs more attractive (AOR = 0.63, 95% CI: 0.43-0.94, p = 0.023) were protective. Similar correlates were found for current dual use, notably having close friends who smoked vs none (AOR = 8.61, 95% CI: 4.21-17.61, p < 0.001) and being offered free nicotine products vs not offered (AOR = 2.82, 95% CI: 1.59-5.01, p = 0.001). Dual use among Saudi adolescents appears to be influenced by peer dynamics, product availability, and permissive social norms. Caution is warranted in interpreting associations due to potential reverse-causal explanations. These findings highlight the urgent need for tailored prevention and stronger policy enforcement.