Factors influencing Electronic Cigarette use among Young Adults in Sarawak, Malaysia: A Hierarchical analysis

Introduction: The rapid global rise in electronic cigarette (e-cigarette) use has led to increasing research interest, yet factors influencing its adoption remain underexplored in Malaysia. This study investigates sociodemographic and psychosocial determinants of e-cigarette use in the Samarahan and Kuching divisions of Sarawak, Malaysia. Methods: A cross-sectional study was conducted among smokers aged 18 and above. A total of 474 participants were recruited using cluster sampling. Data collection was performed through face-to-face interviews using a structured questionnaire. Hierarchical multinomial logistic regression was applied to identify key predictors of e-cigarette use. Results: Among participants, 27.8% were e-smokers, 25.8% were switchers, and 46.4% were dual smokers. The analysis revealed that females were more likely to be e-smokers (AOR = 5.889, p < .001) and switchers (AOR = 2.647, p = .021) than males. Additionally, degree holders were more likely to be e-smokers than dual smokers (AOR = 4.106, p = .025). Psychosocial factors, such as subjective norms (AOR = 1.435, p = .023) and perceived usefulness (AOR = 1.616, p = .016), were significant predictors of e-cigarette use. Conclusion: Sociodemographic and psychosocial factors, such as gender and education, influence e-cigarette use in Sarawak. These findings provide valuable insights for designing targeted public health strategies to regulate e-cigarette use and support smoking cessation efforts in Malaysia.