Farah A Yahya, Reem F Alnemari, Asma Alahmari, Saad A Alghamdi
Background Tobacco use continues to be a significant global public health issue, causing over 8 million deaths each year. People with mental health conditions face a higher risk, and new nicotine products have increased the complexity of the challenge. Despite this, there is limited information on psychological distress, nicotine dependence, and quality of life among cigarette and e-cigarette users. Objective The primary objective of this study was to compare psychological distress and quality of life among cigarette smokers, e-cigarette users, and non-smokers in Jeddah, Saudi Arabia. The secondary objective was to examine the association between nicotine dependence severity and psychological distress and quality of life among cigarette smokers and e-cigarette users. Methods A cross-sectional study was conducted among 368 adults (≥18 years) living in Jeddah from April to June 2026. Participants were recruited using stratified quota convenience sampling through online distribution via Telegram and WhatsApp applications, and community networks. The participants were divided into three groups: cigarette smokers (n=117), e-cigarette users (n=95), and non-smokers (n=156). Data were collected using a self-administered questionnaire covering sociodemographics, smoking history, psychological distress (K6), quality of life (World Health Organization Quality of Life - Brief Version (WHOQOL-BREF)), and nicotine dependence (Fagerström Test for Nicotine Dependence (FTND)/electronic Fagerström Test for Cigarette Dependence (e-FTCD)). Results Non-smokers scored higher than both smoking groups on most WHOQOL-BREF domains (p < 0.05). The mean K6 score was 15.20 (SD = 5.67), and 64.9% of participants screened positive for serious psychological distress. The proportion of serious psychological distress did not differ significantly by smoking status (p = 0.111). Among cigarette smokers and e-cigarette users, nicotine dependence severity showed a significant non-linear association with psychological distress (p = 0.001 and p = 0.004, respectively). Conclusion Non-smokers had higher WHOQOL-BREF scores than cigarette smokers and e-cigarette users on most domains. Although 64.9% of participants screened positive for serious psychological distress, this finding should be interpreted cautiously given the convenience sampling approach and may not be generalizable to the broader population. Further research is needed to clarify the relationship between nicotine dependence, psychological distress, and quality of life and to assess the potential implications for tobacco cessation and mental health interventions in Saudi Arabia.