Background: Nicotine use among the youth has been on the rise, especially with the introduction of E-cigarettes. This has sparked concerns regarding E-cigarettes and traditional cigarettes in terms of patterns, dependence, and perceptions within the youth population, which are issues this study aimed to investigate. Methods: A cross-sectional survey was conducted among university students at Ajman University, which is in the Middle East and North Africa (MENA) region. Using the Cigarette Dependence Scale (CDS-12) and Penn State Electronic Cigarette Dependence Index (PS-ECDI), dependence on both cigarettes and E-cigarettes was quantified. Results: Out of 1713 respondents, 18.9% were currently using nicotine products, including E-cigarettes (12.7%) and traditional cigarettes (5.1%). Nicotine use was significantly associated more with males than females with an odds ratio of 4.14. However, there was no difference between genders in the dependence scores. In addition, dual nicotine use and an earlier onset of nicotine consumption were associated with significantly higher dependence scores than single users and a late onset of smoking. Participants overall attributed cigarettes and E-cigarettes as equally harmful. Conclusions: Both cigarette and e-cigarette use were prevalent and associated with notable dependence. Although E-cigarettes are often promoted as cessation aids, their use in our sample did not appear to facilitate quitting and may instead sustain nicotine dependence. Targeted youth-focused cessation programs and stricter marketing and sales regulations are essential to prevent further normalization. Longitudinal studies are needed to track evolving patterns and health impacts in the MENA region.

Background: With the increasing use of cigarettes and electronic nicotine delivery systems (ENDS) in young adults, growing concern exists regarding lung health among university students. While the adverse respiratory effects of smoking are well established in older populations, early functional changes among young adults remain less well studied. Identifying such changes in this vulnerable population is crucial due to the risk of detrimental long-term health effects and the role of implementing early preventive measures. This study aims to compare the effects of nicotine use, sex, and body mass index (BMI) on the spirometric lung function parameters, including FEV₁, FVC, and FEV₁/FVC ratio, of smokers (including cigarette, ENDS, shisha, and midwakh users) and non-smokers in a university population. Methods: This cross-sectional study was conducted at Ajman University, United Arab Emirates. A convenience sample of 652 smokers and non-smokers students was initially recruited voluntarily, of whom 630 participants met the spirometry acceptability criteria and were included in the final analysis. Lung function was assessed using spirometry performed according to the guidelines of the American Thoracic Society and European Respiratory Society. Forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), and the FEV₁/FVC ratio were recorded and expressed as percentages of predicted values based on Global Lung Function Initiative reference equations. Lung function parameters were compared according to smoking status, sex, and BMI. Results: A total of 630 students were included (60.5% males; the majority aged 20–22 years). The prevalence of smoking was 28.9% and was significantly higher among males than females (38.6% vs. 14.1%; OR = 3.86, p < 0.001). Smokers demonstrated a significantly lower FEV₁/FVC ratio compared with non-smokers (0.84 ± 0.07 vs. 0.86 ± 0.07, p < 0.001), despite slightly higher predicted FEV₁ and FVC values. Males exhibited higher predicted lung volumes than females, whereas females had higher FEV₁/FVC ratios (p < 0.001). Lung function varied significantly across BMI categories (p < 0.001), with increasing BMI associated with higher predicted lung volumes but lower FEV₁/FVC ratios. Stratified analysis showed that male smokers had the lowest FEV₁/FVC ratios, while female non-smokers had the highest. Conclusions: Smoking, sex, and BMI significantly influenced lung function in this cohort. Smokers demonstrated reduced FEV₁/FVC ratios, indicating early airflow limitation. Males were more likely to smoke and had higher lung volumes, while females showed higher FEV₁/FVC ratios. Increasing BMI was associated with higher lung volumes but lower FEV₁/FVC ratios. These findings suggest that early pulmonary changes may occur in young adults, highlighting the importance of early screening, careful interpretation of spirometry, and the implementation of targeted public health interventions to reduce nicotine use, promote smoking cessation, and support lung health among university students.