Nicotine Dependence and Mental Health Among Syrian University Students: The Role of E‐Cigarette Use: A Cross‐Sectional Study

ABSTRACT Background and Aims Nicotine dependence is a growing concern, particularly among young adults. While e‐cigarettes are marketed as smoking cessation tools, evidence suggests they may contribute to increased dependence and dual use. Additionally, nicotine use has been linked to mental health disorders, yet research exploring these associations among Syrians is limited. This study examines e‐smoking patterns among Syrian university students, assesses nicotine dependence, and investigates correlations with anxiety and depression. Methods A cross‐sectional web‐based survey was distributed via social media, targeting university students. A 53‐item questionnaire collected demographic and smoking data, while validated scales, namely Hooked on Nicotine Checklist (HONC), E‐cigarette Dependence Scale (EDS), Patient Health Questionnaire‐9 (PHQ‐9), and Generalized Anxiety Disorder‐7 (GAD‐7), were used to assess nicotine dependency, depression, and anxiety. Results Among 1092 participants, 661 (60.5%) were female. A total of 376 (34.4%) were current or past smokers. High nicotine dependence was observed, with 61% of e‐cigarette users scoring above 21 on the EDS. Mean dependence scores among vapers were 28.85 ± 20.1 (EDS) and 5.8 ± 3.07 (HONC). Daily e‐cigarette use correlated positively with dependence ( p < 0.0001). Weak but significant associations were found between dependence and anxiety ( p = 0.032) and depression ( p = 0.002). Conclusion E‐cigarette use among Syrian university students is linked to nicotine dependence and mental health concerns. Our findings challenge their role in smoking cessation and highlight the need for regulatory policies and public health interventions.