Factors Associated with Electronic Cigarette Use in University Students

Abstract

Introduction The use of electronic cigarettes (e-cigarette) has emerged as a growing public health problem among university students. This trend is attributed to the increased accessibility of e-cigarettes and the potential perception of their use in a positive way. However, research on the factors associated with e-cigarette use among Thai university students remains limited, as most existing studies have been conducted in international contexts. Therefore, this study is necessary to address this gap. 

Objective This study aims to: 1) examine the prevalence and behavioral patterns of e-cigarette use among the participants, and 2) investigate the associations between e-cigarette use and various factors, including intrapersonal factors (gender, academic achievement, stress, cigarette smoking, and self-efficacy in abstaining from smoking), cultural environment/ attitudinal factors (attitudes toward e-cigarette), and social factors (peer influence, peer smoking behaviors, family smoking behaviors, family acceptance of e-cigarette use, access to e-cigarettes, access to E-cigarette advertising, perceived price of e-cigarettes, and living arrangement).

Design This study employs a descriptive correlational design, guided by the Triadic Influence theory as its conceptual framework. The factors associated with e-cigarette use among university students are categorized into three groups: (1) intrapersonal factors, (2) cultural-environmental/ attitudinal factors, and (3) social factors.

Methodology The sample consisted of 374 university students from three institutions located in Chanthaburi Province. A multistage random sampling technique was employed. Inclusion criteria were: 1) being 18 years of age or older, and 2) having a mobile phone or device capable of accessing an online questionnaire. Exclusion criteria included health conditions that contraindicate e-cigarette use, such as asthma, heart disease, pneumonia, or chronic obstructive pulmonary disease (COPD). Data were collected between October and November 2024 through self-administered questionnaires distributed via Google Forms. The questionnaire comprised sections on demographic data, traditional and e-cigarette use, attitudes toward e-cigarette use, stress levels, and self-efficacy in abstaining from smoking. Data were analyzed using descriptive statistics (frequency, percentage, mean, and standard deviation) and binary logistic regression analysis.

Results The mean age of the participants was 20.3 years (SD = 1.35), with the majority being female (70.6%). The prevalence of e-cigarette use among the participants was 21.9%, with 11.5% reporting daily use. The mean age at initiation of e-cigarette use was 16.7 years (SD = 2.46). Factors significantly associated with e-cigarette use included: peer smoking (OR = 11.37, 95% CI = 4.468–28.919), traditional cigarette smoking (OR = 10.41, 95% CI = 5.955–18.210), favorable attitudes toward e-cigarette use (OR = 8.32, 95% CI = 4.541–15.226), low self-efficacy in abstaining from smoking (OR = 7.54, 95% CI = 4.242–13.409), family acceptance of e-cigarette use (OR = 6.16, 95% CI = 3.354–11.320), male (OR = 5.62, 95% CI = 3.330–9.494), low academic achievement (OR = 2.87, 95% CI = 1.735–4.739), peer influence to use e-cigarette (OR = 2.21, 95% CI = 1.344–3.631), family smoking behavior (OR = 2.13, 95% CI = 1.262–3.593), and access to e-cigarette advertising (OR = 1.87, 95% CI = 1.140–3.071).

Recommendation Health professionals and related stakeholders should actively monitor and support university students, particularly male students, those with low academic achievement, and those who smoke traditional cigarettes. An emphasis should be placed on addressing these risk factors and enhancing intrapersonal competencies, such as self-efficacy in resisting e-cigarette use. This includes training in refusal and negotiation skills when faced with peer influence to use e-cigarette, as well as promoting attitude change toward e-cigarette use. Additionally, support should be provided to students who currently use e-cigarettes or traditional cigarettes to help them quit. Creating a smoke-free peer environment is essential, as peers represent a primary social context for adolescents. Furthermore, families should be encouraged to actively participate in the prevention of e-cigarette use.