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E-cigarette use is becoming popular among youth worldwide and represents an emerging threat to public health. No previous study has looked into the prevalence of e-cigarettes use in the Eastern Mediterranean region. We report here on the prevalence of e-cigarette use in a cohort of 496 school and university students from Lebanon (62% males; 17 - 23 years) and differences in perceived harm between e-cigarette smokers and nonsmokers. We used data from Wave 8 of an ongoing cohort study that started in 2015 investigating the development of nicotine dependence symptoms in waterpipe smokers compared to cigarettes in Grades 8 and 9. Methods In 2019, we added questions to examine e-cigarette use patterns, risk perceptions, dependence, and susceptibility for future use among this population. Results were described and compared by gender status, e-cigarette users vs. non-users and other modes of tobacco use. Results Overall, 14.5 % reported ever use of e-cigarette and 8 % reported current use (use in the last month). Most ever e-cigarette users were cigarette smokers (32.8%), waterpipe smokers (34.3%), or dual smokers (10.45%). Compared to ever users, non-users were more likely to perceive e-cigarettes as more harmful (42% vs. 27% respectively, p= .007) and more addictive (41 % vs. 36% respectively, p= .013) than conventional cigarettes. Among current users, 28 % used e-cigarettes within 5 minutes of waking up. Among non-users, males were more open than female to try e-cigarettes if offered by a close friend (28.8% vs. 17.1%). Conclusions Our study suggests significant nicotine dependence among current users. Qualitative studies are needed to better understand why youth are drawn to this new emerging tobacco product. Our preliminary results point to the need to monitor e-cigarette use nationally by introducing questions on e-cigarette use in national school wide surveys such as Global Youth Tobacco Survey or the Global School Health Survey. Key messages E-cigarette use is spreading among youth in Lebanon. Results reveal significant nicotine dependence among youth in Lebanon users of e-cigarette.

E-cigarette use among youth in Lebanon: Findings from Waterpipe Dependence in Lebanese Youth ‘WDLY’