Sex-specific motivations, risk perceptions, and E-cigarette experimentation among adolescents and young adults: implications of public health intervention

Introduction Electronic cigarette (EC) use is growing exponentially among adolescents and young adults, alongside mental health challenges. In Mexico, despite a strict sales ban in effect in 2024, consumption remains a critical issue. This study evaluated EC and other substance use patterns among Mexican students, identifying factors associated with use based on sex. Methods This cross-sectional study surveyed 10,074 students from public and private institutions across four regions of Mexico. Data on knowledge, usage patterns, and perceptions regarding EC were collected via a 29-item digital questionnaire, with results stratified by sex. Results Awareness of EC was nearly universal (98.1%), and 33.4% of participants reported having experimented with them at some point in their lives, with no significant difference between sexes (p=0.868). However, females significantly increased their consumption during self-reported periods of sadness (7.9% vs. 6.0% for males; p<0.001) or when experiencing academic stress (10.5% vs. 8.3% for males; p<0.001) and showed strong motivation linked to the appeal of flavors (32.0% vs. 23.8%; p<0.001). Conversely, males exhibited higher rates of dual substance use, with greater consumption of combustible tobacco (21.3% vs. 17.9%; p<0.001) and THC derivatives (9.6% vs. 7.8%; p<0.001). Females perceived greater health risks and higher addictive potential (p<0.001). Conclusion Although lifetime experimentation was similar between males and females, differences were identified in self-reported emotional contexts, flavor preferences, risk perceptions, and associated substance use.