E-cigarette (EC) and heated tobacco product (HTP) use in the United Arab Emirates, an emerging EC and HTP market: A cross-sectional analysis of the International Tobacco Control (ITC) UAE Survey.

Introduction: E-cigarettes (ECs) and heated tobacco products (HTPs) are recent arrivals to the nicotine product market in the Middle East, which are rapidly growing in popularity in the region. There is a lack of surveillance data at the country-level on use of these products and factors associated with their use.

Methods: This study analyzed a subset of data from the UAE Healthy Future Study, a population-based cohort study of the Emirati population, to determine the factors associated with EC and HTP use among a sample of Emirati adults (≥ 18 years). The baseline assessment and supplementary questionnaires, conducted from 2016 to 2023, included data on combustible tobacco use, EC, and HTP use and sociodemographic characteristics.

Results: Of the 2,041 individuals who answered questions on EC use, 32% reported ever using them. Of 521 people providing data on HTP, 30% reported ever using them. After adjusting for age, sex, education, perceived harms and perceived addictiveness of EC, current EC use was associated with baseline combustible tobacco smoking (aOR = 27.63, 95% confidence interval [CI] 14.39, 53.06), users of a younger age (aOR=0.91, 95%CI 0.88, 0.95), and users of male sex (OR = 2.15, 95% CI 1.21, 3.81). Current HTP use was less common, but was also associated with baseline combustible tobacco use.

Conclusions: Use of ECs and HTPs was more common among those who used combustible tobacco. Future research should examine use trajectories among those who do and do not smoke, as well as uptake of these products among youth.

Implications: Non-combustible nicotine products are growing in popularity in the Middle East Region. Our study found that EC and HTP use is associated with baseline combustible tobacco use and that concurrent users may use them to cut down on their combustible tobacco use. Continued comprehensive population-based monitoring of all tobacco and nicotine products, especially EC and HTP use, will provide current data to aid in appropriately informing public health and harm reduction messages and programming.