Factors Affecting Intention to Use E-Cigarette Among Female Secondary School Students

Abstract

Introduction Although the use of electronic cigarettes, (e-cigarette) is prohibited by law in Thailand, their prevalence has been increasing among students, particularly in female adolescents. Most existing research has focused on people aged 15 years and older, while studies specifically targeting early adolescent females remain limited. Furthermore, there is a lack of research grounded in clear theoretical frameworks. Intentions to use electronic cigarettes are a critical predictor of actual behavior and therefore represent an essential factor for surveillance and early prevention efforts targeting e-cigarette use among young females.

Objective This study aims to describe the intention to use electronic cigarettes among female lower secondary school students, as well as the factors influencing such intentions. These factors include prior experience with conventional cigarette smoking and substance use, current cigarette smoking behavior, perceived self-efficacy in resisting e-cigarette use, knowledge about electronic cigarettes, attitudes toward e-cigarette use, peer and parental use of conventional or electronic cigarettes, and access to media.

Design This study employed a cross-sectional correlational design, guided by the Triadic Influence Theory developed by Flay and Petraitis. This theoretical framework was selected for its comprehensive approach to explaining adolescent behavior, including intrapersonal, interpersonal, and socio-environmental factors. Each group of influence contributes to varying degrees of engagement in e-cigarette use, ranging from minimal to substantial. These factors also shape the intention to experiment with or initiate e-cigarette use, thereby serving as predictors of future behavior of e-cigarette use among adolescents.

Methodology The participants consisted of 193 female students enrolled in Grade 7 at state-supervised educational institutions. They were selected through multistage random sampling. The inclusion criteria were: 1) Thai nationality, 2) aged between 13 and 15 years, and 3) parental and/or school administrator consent, along with the students’ willingness to participate in the study. The sample size was calculated using a formula based on survey designed to estimate proportions according to the parameters of the Parell method. Data were collected using structured questionnaires including demographic information, smoking and substance use behaviors, peer and family use of conventional or electronic cigarettes, knowledge about e-cigarettes, perceived self-efficacy in resisting e-cigarette use, attitudes toward e-cigarettes, media access, and intention to use e-cigarettes. Reliability testing of the instruments yielded Cronbach’s alpha coefficients of .86 for the self-efficacy scale, .90 for the attitude scale, .80 for the media access scale, and .95 for the intention to use e-cigarette scale. The Kuder-Richardson 20 (KR-20) coefficient of the knowledge questionnaire was .83. Data were analyzed using descriptive statistics, including frequency distribution, percentage, mean, and standard deviation, and inferential statistics, specifically Binary Logistic Regression analysis.

Results The participants had a mean age of 13 years (SD = 0.279). The majority had a grade point average (GPA) of 3.00 or higher (94.3%), lived with both parents (66.3%), received a daily allowance of 100–199 Thai Baht (62.2%), and had parents who cohabited (67.9%). Notably, 29.5% of the participants reported an intention to use electronic cigarettes. Statistically significant factors influencing the intention to use e-cigarettes among female secondary school students included: attitudes toward e-cigarette use (Adjusted Odds Ratio: AOR = 8.81, 95% Confidence Interval: CI = 3.784–20.529), perceived self-efficacy in resisting e-cigarette use (AOR = 3.55, 95% CI = 1.559–8.061), and media access (AOR = 2.65, 95% CI = 1.177–5.948).

Recommendation The findings of this study are beneficial for school administrators, healthcare professionals, and public health personnel involved in developing strategies to prevent the initiation of e-cigarette use among female secondary school students within the school setting by identifying risk factors of intention to use e-cigarette including attitudes toward e-cigarette use, perceived self-efficacy in resisting e-cigarette use, and media access.