A study on the impact of social environmental exposure to e-cigarettes on the intention to use them among Chinese middle and high school students and the differences between genders

Early intervention to prevent the development of intention to use e-cigarettes and reduce the strength of such intention is a target for preventing subsequent use. This study aims to examine the impact of social environmental exposure factors on the intention of middle and high school students to use e-cigarettes, along with gender-based differences. A cross-sectional questionnaire survey was conducted among 4,113 never-used e-cigarette middle and high school students in Chengdu, China, between June and December 2021. The associations between social environmental exposures and the intention to use e-cigarettes, and their gender difference, were analyzed using zero-inflated negative binomial regression models. Of the 4,113 students surveyed, 10.67% expressed an intention to use e-cigarettes, with a male-to-female ratio of 1.25:1 within this group. Additionally, 25.33% of the students were exposed to social environmental factors associated with e-cigarette use. In the logit part, interpersonal exposure (AOR = 0.541, 95% CI: 0.372–0.787), offline point-of-sale exposure (AOR = 0.560, 95% CI: 0.414–0.758), online advertising exposure (AOR = 0.463, 95% CI: 0.246–0.874), and multiple exposures (AOR = 0.256, 95% CI: 0.159–0.413) were each associated with lower odds of zero e-cigarette use intention. In the count part, interpersonal exposure (AIRR = 1.370, 95% CI: 1.085–1.728), offline point-of-sale exposure (AIRR = 1.349, 95% CI: 1.082–1.680), and multiple exposures (AIRR = 1.682, 95% CI: 1.276–2.214) were associated with a higher expected count of intention. Multiple exposure exerted the strongest influence on the intention. The intention of boys was primarily linked to interpersonal exposure, school type, and parental supervision, whereas girls exhibited greater sensitivity to online advertising exposure and self-rated family relationships. The intention to use e-cigarettes among middle and high school students warrants rigorous investigation, and the gap in usage intention between girls and boys was relatively small. Multiple exposures represent a high-risk factor for intention to use e-cigarettes. Gender-specific interventions are essential: for boys, build healthy peer relationships and strengthen family supervision, with vocational high school boys as a priority group; for girls, enhance advertising literacy and provide psychological support through home-school collaboration.