Structural Pathway of Use of Electronic Cigarettes among Adult Cigarette Smokers: A Cross-Sectional Study in Samarahan and Kuching Division, Sarawak

The rapid increase in electronic cigarette use presents new challenges and opportunities in public health and policy. Currently, emphasis has been placed on electronic cigarettes, and there is a high trend of use among the adult population. This study examines the structural pathways of using e-smoking by applying an integrated technology acceptance model and the theory of planned behaviour. This cross-sectional study was conducted among 446 adult e-cigarette smokers in the Samarahan and Kuching Divisions. Adults were selected from vape outlets orderly and interviewed face to face using a structured questionnaire. IBM SPSS version 29 and Jamovi version 2.3.26 were used for data analysis. A p-value <.05 was considered statistically significant. The structural pathway highlighted that the intention to use ECs strongly predicted actual use (β = 0.760, p < .001), with perceived usefulness (β = 0.239, p < .001), ease of use (β = 0.216, p < .001), and positive attitudes towards ECs (β = 0.392, p < .001) significantly contributing to this intention. Subjective norms did not significantly influence intention (β = 0.038, p = 0.494), indicating a negligible role of social influence in CEs uptake. Furthermore, knowledge of e-smoking was negatively correlated with subjective norms (β = -0.086, p = 0.002), suggesting that increased awareness could dampen the effect of social pressures. The study concludes that the transition to ECs is significantly influenced by individual attitudes and perceptions rather than by social norms. This highlights the importance of targeting these factors in public health interventions and policies designed to address the use of EC. However, the findings should be interpreted in the context of the limitations of the study, including its geographical and methodological scope. Future research should be extended to a broader demographic to validate these findings and guide comprehensive health policy planning.