Sex Differences in Perceptions and Behavioral Context of Electronic Cigarette Use: A Cross-Sectional Study in Jeddah, Saudi Arabia.

Importance Understanding sex-based differences in vaping-related perceptions and behaviors is critical for informing targeted public health interventions, particularly in regions where e-cigarette use is emerging. Objective To examine sex differences across multiple vaping-related domains, including behavioral context, perceived utility, risk perception, social norms, and media influence among young adults in Saudi Arabia. Design, Setting, and Participants This cross-sectional study was conducted among 388 young adults aged 18-24 years in Jeddah, Saudi Arabia. Data were collected using a structured, theory-informed questionnaire adapted from established tobacco-use instruments. Exposure Sex (male vs. female), monthly income, and marital status. Main Outcomes and Measures Domain-specific scores were derived from 12 vaping-related items grouped into 5 conceptual domains. Scores were categorized into low, medium, and high levels using tertiles. Associations were assessed using ordinal logistic regression. Results Among 388 participants, 228 (58.8%) were male and 160 (41.2%) were female. Males consistently demonstrated higher levels of endorsement across domains. In adjusted models, females had significantly lower odds of higher domain scores across situational use (OR, 0.62; 95% CI, 0.45-0.86), perceived utility (OR, 0.58; 95% CI, 0.41-0.81), risk perception (OR, 0.54; 95% CI, 0.39-0.75), social norms (OR, 0.63; 95% CI, 0.45-0.88), and media influence (OR, 0.49; 95% CI, 0.35-0.69). Lower income was also associated with reduced endorsement across multiple domains. Conclusions and Relevance Significant sex-based differences exist in vaping-related perceptions and behaviors among young adults. These findings highlight the need for sex-specific prevention strategies addressing perceived benefits and marketing exposure in emerging vaping contexts.