Prevalence and associated factors of e-cigarette use tendency among adolescents in a rural community, Thailand: A cross-sectional study

INTRODUCTION: Adolescent electronic cigarette (e-cigarette) use has increased globally despite regulatory bans. In Thailand, e-cigarettes have been prohibited since 2014; however, adolescent tendency toward e-cigarette use remains a concern. This study aimed to determine the prevalence and associated factors of e-cigarette use tendency among secondary school students in Chachoengsao, Thailand. METHODS: A descriptive cross-sectional study was conducted during 18-22 January 2025, among 1848 students aged 13-18 years from 19 secondary schools in Chachoengsao. Participants completed an online self-administered questionnaire on demographics, behaviors, social influences, and e-cigarette knowledge. Tendency was defined as self-reported thoughts about using e-cigarettes. Data were analyzed using descriptive statistics and univariate and multivariate logistic regression, with adjusted odds ratios (AORs), 95% confidence intervals (CIs), and p<0.05 indicating significance. RESULTS: Among 1848 students, 17.6% (n=326) reported a tendency to use e-cigarettes. Being female (AOR=1.66; 95% CI: 1.20-2.30) and low household monthly income (<5000 compared with 20000-29999 THB; AOR=2.81; 95% CI: 1.26-6.25) were associated with a higher tendency. Cigarette smoking was the strongest predictor (AOR=6.71; 95% CI: 4.59-9.82) and alcohol use was also significant (AOR=1.71; 95% CI: 1.16-2.54). Peer influence, including neutral attitudes (AOR=1.42) and prior encouragement (AOR=1.95), increased the likelihood of tendency. Perceived social acceptance (AOR=1.75) and misconceptions - such as believing secondhand vapor is harmless (AOR=3.68) or that e-cigarettes aid smoking cessation (AOR=1.93) - were independently associated with tendency. CONCLUSIONS: Nearly one in six students tended toward e-cigarette use despite the national ban. Female gender, low household monthly income (<5000 THB), risk behaviors, peer influence, and misconceptions were significantly associated factors. Further longitudinal studies are warranted to clarify causal relationships and provide stronger evidence for targeted interventions.