Background: Electronic cigarette (e-cigarette) use has risen sharply among young adults worldwide, and university students in Saudi Arabia are considered a population of particular vulnerability given dense peer networks, digital media exposure, and reduced direct oversight. Integrated, survey-based evidence combining prevalence estimation with demographic, social, and attitudinal correlates within a single Saudi university sample has remained comparatively limited.

Objective: This study estimated the prevalence of e-cigarette use among Saudi university students and tested five hypotheses concerning peer influence, social-media exposure, perceived harm/addiction risk, perceived policy enforcement, and family influence.

Methods: A cross-sectional, bilingual (Arabic/English) online questionnaire was administered to 201 Saudi university students using non-probability convenience sampling. Descriptive statistics, bivariate tests (chi-square and Mann-Whitney U with Benjamini-Hochberg correction), and a multivariable modified Poisson regression with robust standard errors were used to estimate adjusted prevalence ratios (PR) for current use.

Results: Current e-cigarette use prevalence was 29.4% (95% CI: 23.5–36.0%), and lifetime use was 51.2%. Peer influence (H1) and perceived harm/addiction risk (H3) were significantly associated with current use in both bivariate and multivariable analysis (adjusted PR for friends’ encouragement = 1.30, p = 0.018; adjusted PR for perceived long-term risk = 0.73 per one-point increase, p < 0.0001). Social-media exposure (H2), perceived policy enforcement (H4), and family influence (H5) were not significant.

Conclusion: Peer influence and risk perception, rather than social-media exposure or perceived enforcement, are the strongest correlates of current e-cigarette use in this sample. University prevention programming is likely to be most effective when it targets specific risk-perception gaps — particularly comparative-harm beliefs — and leverages peer- based intervention formats rather than general health-education messaging alone.