Smoking-related knowledge, attitudes, and beliefs regarding cardiovascular and respiratory harms among health sciences students who currently smoke in Saudi universities

Abstract

Tobacco smoking is a major preventable cause of cardiovascular and respiratory morbidity worldwide. Although conventional cigarettes are strongly linked to serious chronic diseases, e-cigarettes generally result in lower toxicant exposure than conventional cigarettes but are not risk-free, and their long-term effects remain uncertain. Waterpipe smoking also contributes to harmful toxicant exposure and cardiopulmonary risks. Health sciences students who currently smoke are an important population because their tobacco-related knowledge and behaviors may influence future cessation counseling and health promotion practices. This study aimed to assess current-smoking health sciences students’ knowledge, attitudes, and beliefs regarding the cardiovascular and respiratory harms of cigarettes, e-cigarettes, and waterpipe smoking; examine smoking patterns and cessation perceptions; determine nicotine dependence using the Heaviness of Smoking Index (HSI); evaluate perceptions of secondhand smoke (SHS) and addictive properties; and identify factors associated with confidence to quit. A descriptive cross-sectional multicenter study was conducted among 492 current-smoking health sciences students from universities in Saudi Arabia during the 2024–2025 academic year. Data were collected using an anonymous online questionnaire assessing demographic characteristics, tobacco use patterns, perceived health risks, cessation readiness, nicotine dependence, and tobacco-related knowledge and beliefs. Descriptive statistics, independent-samples t-tests, and one-way ANOVA were used for data analysis. Most participants were male (89.0%), aged 21–23 years (67.1%), and nursing students (48.0%). Cigarette smoking was the most common modality (40.2%), followed by e-cigarettes (27.2%) and waterpipe (24.4%). Most cigarette smokers exhibited moderate nicotine dependence (54.5%). Although knowledge of cigarette-related cardiovascular and respiratory harms was high (> 90%), e-cigarettes and waterpipe were perceived as less harmful. Awareness of SHS risks and health benefits of cessation was moderate. Fewer than half (39.8%) had attempted quitting, and perceived quitting difficulty was high. Confidence to quit was moderately high and was significantly associated with age, academic performance, prior quit attempts, nicotine dependence, and perceived difficulty ( p < 0.05). Among current-smoking health sciences students in Saudi Arabia, knowledge of cigarette-related harms was generally strong, but gaps remain in understanding the relative risks, limitations, and cessation implications of different nicotine products. These findings support the need for comprehensive tobacco education that promotes accurate risk communication and strengthens cessation support among future healthcare professionals.