Prevalence and Associated Factors of E-Cigarette Use among Adolescents in Southeast Asia: A Systematic Review

Behavioral intention to use electronic cigarettes in the Philippines: The role of social influence, knowledge, price and health impact

Electronic cigarettes or e-cigarettes have gained significant popularity as an alternative to traditional cigarettes, yet limited research has examined the factors influencing their adoption, particularly in developing nations like the Philippines, where usage is rising. This study investigates the behavioral drivers of e-cigarette use, with a particular focus on the role of knowledge, alongside social influence, perceived price impact, perceived health impact, and perceived usefulness. Using purposive sampling, 310 valid responses were collected from current e-cigarette users, traditional cigarette users, or individuals with prior experience with these products. A structured questionnaire with 21 indicators was administered, and data were analyzed using Partial Least Square-Structural Equation Modeling (PLS-SEM). The findings reveal that knowledge is the strongest predictor of behavioral intention, highlighting the critical role of informed awareness about the risks and impacts of e-cigarettes in shaping user decisions. Social influence, perceived price impact, and perceived health impact also significantly influence behavioral intention, demonstrating the interconnectedness of cognitive, social, and economic factors. Interestingly, perceived usefulness did not have a significant effect, challenging assumptions about the importance of functional benefits in driving e-cigarette adoption. These results underscore the importance of education and awareness campaigns in addressing misconceptions about e-cigarettes. Policymakers, regulators, and health professionals should prioritize knowledge-driven interventions to empower individuals to make informed decisions and mitigate e-cigarette use, particularly among younger and economically vulnerable populations.

Vaping among young adults in Singapore: a qualitative study of motivations, challenges and antivaping intervention perceptions

INTRODUCTION

The increasing use of electronic cigarettes among young adults in Southeast Asia is concerning. This study explores the motivations and challenges faced by young adults in quitting vaping and their perceptions of current public health messages and interventions in Singapore, which has stringent antivaping laws and active public health campaigns.

METHODS

A qualitative descriptive study was conducted involving in-depth interviews with 15 participants aged 18-35. Thematic analysis was performed by two independent researchers trained in qualitative methods.

RESULTS

Participants identified negative health outcomes and legal risks as major motivations for quitting vaping. Challenges included nicotine addiction, psychological dependency and entrenched vaping routines. The study revealed general scepticism towards current antivaping messages, which were seen as too generic and lacking credibility. Participants recommended that public health messages be more specific, transparent and engaging, incorporating independent research and visual aids to highlight vaping risks. They also suggested regulating e-cigarette sales instead of implementing blanket bans, ensuring anonymity for those seeking help and providing comprehensive nicotine cessation support. Additionally, the use of real-life testimonials and influencers was proposed to improve message relatability and effectiveness.

CONCLUSION

This study provides valuable insights into the motivations and barriers of quitting vaping among young adults. Enhancing the transparency and specificity of antivaping messages, along with more tailored and supportive interventions, could increase their effectiveness and offer guidance for other Southeast Asian countries facing similar issues.

Lifetime and active use of electronic cigarettes among Brazilian adolescents: The 2019 national school health survey - PeNSE 2019

OBJECTIVES

To investigate the prevalence and the factors associated with experimentation and use of e-cigarettes.

STUDY DESIGN

Cross-sectional study.

METHODS

Cross-sectional analysis of data from the National School Health Survey (PeNSE 2019), with students attending elementary school and high school in Brazil. Two outcomes were investigated: experimentation and last 30-day use of e-cigarettes. Potential exposures included family and adolescents' socio-demographic, mental health, and behavioral characteristics. Adjusted prevalence ratios (PR) were obtained by Poisson regression with robust variance.

RESULTS

133,237 adolescents aged ≥13 years were included. Prevalence of experimentation and last 30-day use was higher in males (20.7 % and 4.1 %, respectively) than in females (15.4 % and 2.6 %, respectively). The higher PR were with ever use of hookah in males (PR = 3.34 for e-cigarettes experimentation and PR = 4.05 for last 30-day use) and females (PR = 3.26 for experimentation and PR = 4.14 for last 30-day use). For males who ever used alcoholic beverages, the PR for e-cigarettes experimentation ranged from 2.86 to 3.18, and the PR for last 30-day use ranged from 3.09 to 3.39, depending upon the age of first alcoholic beverage experimentation. Among the females who ever used alcoholic beverages, PR for experimentation ranged from 3.46 to 4.31 and PR for last 30-day use ranged from 2.44 to 4.09.

CONCLUSION

About a quarter of school age adolescents had already tried e-cigarettes and 3.4 % used e-cigarettes in the prior 30 days. There were sex differences in the prevalence and in factors associated with experimentation and last 30-day use of e-cigarettes.

E-cigarette use among adolescents in Latin America: A systematic review of prevalence and associated factors

Background

Electronic cigarettes, introduced as a safer tobacco alternative, have unintentionally exposed millions of youths to nicotine and harmful chemicals. Adolescence, a key period for forming lifelong habits, has seen rising e-cigarette use, particularly in developing regions like Latin America, warranting thorough investigation.

Objective

To describe the prevalence and factors associated with e-cigarette use among adolescents in Latin America.

Methods

A systematic review was conducted according to PRISMA guidelines, covering studies published between 2003 and May 2024. Database searches included PubMed/Medline, Web of Science, Scopus, Google Scholar, Scielo, and LILACS. A total of 582 studies were identified, of which 14 met the inclusion criteria. Study data were synthesized and assessed using the Newcastle-Ottawa Scale and Joanna Briggs Institute checklist.

Results

The prevalence of e-cigarette among adolescents in six Latin American countries ranged from 2.6 % to 64.2 %, with a pooled mean prevalence of 18.9 %, and lifetime use higher than current use. Key associated factors included male sex, concurrent use of tobacco and other substances, social influences, and exposure to online advertising. A widespread lack of knowledge regarding e-cigarette risks, coupled with limited regulatory oversight, may be contributing to higher usage rates.

Conclusion

This review underscores critical gaps in data on adolescent e-cigarette use in Latin America and highlights the need for expanded research and targeted public health interventions. Nearly one-fifth of adolescents reported using e-cigarettes. Comprehensive prevention programs addressing factors associated with adolescent e-cigarette use in Latin America, involving diverse stakeholders and integrating education, school-based policies, social media campaigns, and policy restrictions, are strongly recommended.

Childhood traumatic experiences and vaping among Australian adolescents: A prospective investigation

INTRODUCTION

Childhood traumatic experiences (CTE) have been identified as a robust risk factor for a range of substance use behaviours. However, little is known about their association with adolescent vaping. We explored prospective associations between CTEs and vaping among a sample of Australian adolescents.

METHODS

The sample comprised 2234 adolescents (baseline Mage = 12.7 years, SD = 0.5; 49.9% female) enrolled in the Health4Life cluster randomised controlled trial. Using mixed effects logistic regression analyses, data from the baseline and 36-month assessment waves were used to examine whether CTEs (by ~ age 12) were associated with current or lifetime vaping and future intentions to vape (~ age 15).

RESULTS

Adjusting for socio-demographic variables, CTE exposure at baseline was associated with higher odds of ever having vaped (odds ratio 1.64, 95% confidence interval 1.34, 2.02), and of being a current regular vape user (odds ratio 1.63, 95% confidence interval 1.11, 2.39). Experiencing CTEs was also associated with higher odds of intending to vape in the future (odds ratio 1.44, 95% confidence interval 1.11, 1.86).

DISCUSSION AND CONCLUSIONS

This study is the first to identify CTEs as a risk factor for vaping, and intentions to vape in the future, among Australian adolescents. These findings align with global research and highlight another common risk factor across various forms of substance use. CTE exposed adolescents represent a priority group who may require earlier and more targeted vaping intervention.

Electronic cigarettes use and parental factors among children and adolescents, Jeddah. A cross-sectional study

E-cigarettes are gaining popularity worldwide, necessitating their control. This study investigated the impact of parental factors on E-cigarette use among children-adolescents in Jeddah, Saudi Arabia. A cross-sectional survey involving 1,044 parents of children aged 10- to 21 was conducted in malls. A structured questionnaire assessed parental socio-economic status, smoking/vaping habits, and attitudes toward E-cigarette use.Data were analysed using chi-square, Mann-Whitney, and binary logistic regression (significance set at 0.05). Results showed 176 (16.9%) parents reported their children using E-cigarettes. Older adolescents (18-21 age group) were significantly more likely to use E-cigarettes compared to younger ones (adjusted odds ratio [AOR]:6.456, 95% CI:3.664-11.374). Parents with a permissive attitude were more likely to have children who vape. (AOR:1.643, 95% CI:1.149-2.348). While open parent-child communication about traditional smoking reduced E-cigarettes use (AOR:0.772, 95% CI:0.639-0.934). Parental attitudes and open communication are crucial for mitigating youth E-cigarette use.

Prevalence of Electronic Cigarette Use Among Female Residents of Al-Ahsa, Kingdom of Saudi Arabia: A Cross-Sectional Study

Background Electronic cigarettes (e-cigarettes) have gained considerable popularity on a global scale, with an increasing prevalence among younger adults. The objective of this study was to investigate the prevalence, patterns, and determinants of e-cigarette use among women in Al-Ahsa, Saudi Arabia. Methodology A cross-sectional study was conducted between October 2023 and July 2024 involving 491 adult female participants. The data were collected using a structured questionnaire and subsequently analyzed using SPSS Version 26.0 (IBM Corp., Armonk, NY, USA). Descriptive and inferential statistics, including chi-square tests, were employed to assess relationships between e-cigarette use and various independent variables. Results The prevalence of e-cigarette use among participants was 17.5%. Significant factors associated with e-cigarette use included age (highest among women aged 21 to 30 years, p = 0.038), unemployment (p = 0.011), perceived poor health (p = 0.002), and having friends or family members who use e-cigarettes (p = 0.001). The primary reasons for using e-cigarettes were influence from friends (70.9%) and family members (54.7%), curiosity (33.7%), and appealing flavors (30.2%). A considerable proportion of users reported experiencing dependence and difficulty quitting. Conclusions The prevalence of e-cigarette use among female residents of Al-Ahsa is influenced by a complex interplay of social, demographic, and perceptual factors. The findings underscore the necessity for comprehensive interventions targeting social environments and educational initiatives and addressing misconceptions about the potential risks of e-cigarettes.

Prevalence, perception, and attitude regarding electronic cigarettes usage among young adults in Riyadh, Saudi Arabia. A cross-sectional study

OBJECTIVES

To determine the prevalence of electronic cigarette (e-cigarette) usage among young adults in Riyadh, Saudi Arabia; their perceptions of its harm and legal age, and the reasons and factors influencing their use.

METHODS

This cross-sectional study was carried out within the general community of Riyadh, Saudi Arabia, between December 2023 and April 2024. Participants aged 18-25 years were included. A self-administered online questionnaire was used to gather demographic data, perceptions, and attitudes toward e-cigarettes and reasons for their use.

RESULTS

The majority of the 476 participants were female (n=378, 79.4%) and Saudi nationals (n=451, 94.7%). Current e-cigarette usage was 10.5% (n=50), being more prevalent among males (n=46, 46.9%) and non-Saudis (n=12, 48%). Respondents living alone (n=11, 34.4%) or with friends (n=4, 80%), those who perceived e-cigarettes as safer than cigarettes (n=38, 42.2%), or were unsure of age restrictions demonstrated high usage. Key motivators included flavors available, stress relief, and curiosity.

CONCLUSION

Eelectronic cigarette use among Riyadh's youth was remarkable, especially among males. Reducing the e-cigarette usage prevalence in Saudi Arabia should be prioritized.

Knowledge, attitude, and practice of e-cigarette use among undergraduate students: A comparative study between China and Indonesia

INTRODUCTION

The health risks associated with e-cigarettes are currently the focus of tobacco control efforts and public health initiatives. Given that China and Indonesia have the highest rates of adult smoking worldwide, it is imperative to gain a comprehensive understanding of e-cigarette prevalence among college students in these two nations.

METHODS

From May to June 2023, a cross-sectional study was employed to conduct an online questionnaire survey among college students in three universities located in Kunming (China) and Jakarta (Indonesia), respectively. The chi-squared test was utilized to compare the rates/ratios, while binary logistic regression analysis was applied to examine the factors influencing e-cigarette knowledge, attitude, and practice.

RESULTS

A total of 1327 individuals were included in the investigation. The proportion of Indonesian students (75.6%) with a high level of e-cigarette knowledge was lower than that observed among Chinese students (87.4%) (χ2=29.7, p<0.001). Additionally, the prevalence of e-cigarette use among Indonesian students (9.4%) was higher compared to their Chinese counterparts (3.0%) (χ2=22.32, p<0.001). Binary logistic regression analysis revealed that age, place of residence, studies, gender, and e-cigarette use by friends and family, significantly influenced knowledge levels and attitudes toward e-cigarettes in both countries (p<0.05).

CONCLUSIONS

Despite the positive knowledge, attitudes, and practices towards e-cigarettes among undergraduate students in both countries, a notable knowledge gap exists concerning the harmful effects of e-cigarettes. Chinese students had better e-cigarette knowledge and demonstrated lower usage rates, suggesting that heightened awareness plays a favorable role in preventing e-cigarette use. Furthermore, it becomes imperative for policymakers and health educators to focus on specific factors, such as the influence of close friends and family members, as well as the area of residence.

US adolescents' response to nicotine warning labels in influencer e-cigarette marketing social media posts: a survey-based randomised between-subject experiment

BACKGROUND

E-cigarette promotional posts with misleading nicotine warning labels on social media may lower adolescents' risk perceptions of e-cigarettes. A between-subject experiment assessed effects of influencers' e-cigarette promotional posts with different nicotine warning labels on adolescents' e-cigarette harm perceptions, susceptibility to e-cigarette use and perceptions of influencer credibility.

METHODS

In 2022, adolescents (N=1864, Mage=17 (SD=0.6)) were randomised to view six images and videos featuring influencers promoting e-cigarettes in one of five experimental conditions: two conditions with a 'tobacco-free nicotine' warning label (placed on an e-cigarette in the post or at the top of the post), two conditions with the US Food and Drug Administration (FDA) nicotine warning label (on an e-cigarette in the post or at the top of the post (control)) and one no-label condition. Participants rated influencers' credibility (eg, honesty). Harm perceptions of, and susceptibility to use, e-cigarettes were then assessed.

RESULTS

Participants who viewed posts with the FDA warning label at the top of the post perceived influencers as more honest, trustworthy and informed than in all the other conditions. E-cigarette never-users who viewed posts with a 'tobacco-free nicotine' warning label pictured on an e-cigarette (compared with the FDA label at the top of a post) were more likely to report susceptibility to e-cigarette use (adjusted OR 1.79, 95% CI 1.17 to 2.73).

CONCLUSIONS

Alterations of the required nicotine warning labels can make them less effective in deterring e-cigarette use behaviour. Tobacco control authorities could increase enforcement of the FDA-required nicotine warning labels and harness influencers for antitobacco messaging.

E-cigarettes in Nigeria: A scoping review of evidence

Background and Aims

E-cigarettes will continue to be a public health issue in Nigeria. To curb the growing menace of the e-cigarette use in Nigeria through evidence-based approach, it is crucial to first map the empirical research landscape of e-cigarettes in Nigeria. No known study has mapped the existing empirical evidence and gaps concerning e-cigarettes in Nigeria; hence, this scoping review was conducted.

Methods

This scoping review adopted the research design by Arksey and O'Malley. Four databases (PubMed, SCOPUS, CINAHL Complete, and APA PsycINFO) were searched to retrieve literature on e-cigarettes in Nigeria. With the aid of Rayyan web application, all retrieved literature were deduplicated and screened based on the review's eligibility criteria. Only those peer-reviewed journal papers meeting the inclusion criteria were included in the review. Relevant data from the included papers were charted, collated, and summarized.

Results

A total of six papers were included in this review. The reviewed papers reported a lifetime prevalence of e-cigarette use (or vaping) ranging from 5.8% to 19.8%, with a current e-cigarette use prevalence of 11.8%, among different population groups in Nigeria. The major determinants of e-cigarette use, as reported in these articles, include being a youth, having a health condition, severe anxiety, tobacco use, peer influence, and current alcohol use. Dry mouth and oral lesions (gingival inflammation and oral ulcers) were also identified to be the medical conditions associated with e-cigarette use in Nigeria. Lastly, one of the included papers identified a lack of clear regulation on e-cigarettes in Nigeria.

Conclusion

There is an urgent need for more scientific investigations on the sociodemographic, economic, health, and regulatory landscape of e-cigarettes in Nigeria, as robust empirical evidence is needed for the effective planning, implementation, and evaluation of evidence-based policies and interventions on e-cigarettes control and regulation in Nigeria.

Prevalence and Covariates of Electronic Cigarette Use among Students Aged 13-15 Years in the Philippines: 2019 Global Youth Tobacco Survey

Electronic cigarette use is growing in popularity and accessibility among youth in the Southeast Asia region. We analyzed data on 6670 students, aged 13-15 years, from the Philippines' 2019 Global Youth Tobacco Survey. Prevalence estimates and 95% confidence intervals (CI) were estimated for current use (i.e., past 30 days), ever use, and awareness of e-cigarettes. Chi-square tests compared prevalence differences between groups. Multiple logistic regression models assessed factors associated with e-cigarette use while controlling for sociodemographic characteristics, current use of other tobacco products, and secondhand smoke exposure. Prevalence of current e-cigarette use was 14.1% (95% CI = 12.4%, 15.8%), ever use was 24.6% (95% CI = 22.4%, 26.9%), and awareness was 75.5% (95% CI = 73.0%, 78.0%). Current use of any other tobacco products and exposure to secondhand smoke at home, school, or other public places were positively associated with current and ever use of e-cigarettes. Boys and youth living in Luzon or Mindanao had higher odds of current e-cigarette use compared to girls and youth in Visayas. Findings indicated that one in four Philippine students aged 13-15 years ever used e-cigarettes and one in seven currently use e-cigarettes. This study highlights the importance of implementing evidence-based strategies, including relevant tobacco control policies.

Acute Pericarditis After Use of Electronic Cigarettes: A Case Report

Acute pericarditis is the most common pericardial disease in clinical practice and frequently in young and middle-aged people. The past decade has dramatically increased electronic cigarettes or vapes in developing countries. However, there are no case reports describing vaping-induced acute pericarditis. This report describes a case of a 27-year-old male who presented with acute onset chest pain after using an electronic cigarette. His ECG showed typical pericarditis with diffuse ST-segment elevation and downsloping TP segment. The patient responded to the medical therapies of non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine, but serum troponin T went up. In this case report, the authors have shared their opinions on how to handle this situation.

Dental Hygienists Knowledge, Beliefs, and Intentions Regarding Asking Adolescents About Electronic Nicotine Delivery Systems Use

PURPOSE

The purpose was to assess clinical dental hygienists' knowledge, beliefs, and intentions regarding asking adolescents about electronic nicotine delivery systems (ENDS) use.

METHODS

Cross-sectional survey research was conducted with a convenience sample of dental hygienists using a validated instrument developed based on the theory of planned behavior (TPB) that contained the following sections: demographics, knowledge, behavioral belief (BB), normative beliefs, control beliefs, and behavioral intention. Outcomes were analyzed using descriptive statistics, correlations, and multivariate regression analysis.

RESULTS

Of the 360 participants who opened the survey, 257 completed it for a completion rate of 71.4%. The knowledge score mean was 72%. BBs suggested that a majority (83%) of participants were likely to ask adolescent patient about ENDS use, however, normative beliefs showed that only about half had the support of their dentist/supervisor, and one-third (33%) felt they had sufficient tobacco/nicotine use and dependency guideline resources. This resulted in only half having the behavioral intention to ask adolescents about ENDS use. Demographic variables were not significantly correlated with the TPB subscales or intention. In the regression model all three TPB subscales predicted intention (F3, 251) = 46.1; p < .001). The coefficient of determination (R2 = 0.35) suggested 35% of the variation in the intention to ask about ENDS use can be explained by the model.

DISCUSSION

Most participants had favorable BBs toward asking about ENDS use among adolescents. However, adequate support from dentists/supervisors and training on guidelines for prevention and cessation of ENDS is needed to encourage dental hygienists to ask adolescents about ENDS use.

Implications of nicotine vaping products for tobacco control in ASEAN low-income and middle-income countries: in-depth interviews with experts from the region

OBJECTIVES

The use of nicotine vaping products (NVPs) has increased in low-income and middle-income countries (LMICs) in the Association of Southeast Asian Nations (ASEAN) region; however, it is uncertain what implications the presence and use of NVPs have for tobacco control.

DESIGN

In-depth interviews were conducted to explore ASEAN tobacco control experts' (n=11) views on the rise of NVP use in ASEAN LMICs, current NVP policies, the potential harm reduction and smoking cessation utilities of these devices, and what implications they may have for tobacco control. Data were analysed using inductive, reflexive thematic analysis.

RESULTS

Five themes emerged: (1) NVPs threaten tobacco control in ASEAN LMICs; (2) commercial factors influence youth appeal and access: product attributes, marketing, supply chains; (3) opposition to the smoking cessation and harm reduction utilities of NVPs; (4) policies are inconsistent and fragmented in the region; and (5) tobacco industry power and tactics have been used to capture NVP markets.

CONCLUSIONS

ASEAN tobacco control experts believe that NVPs pose a threat to youth and non-smokers in LMICs in the region, largely because of tobacco industry NVP marketing activities. They do not support the use of NVPs for smoking cessation or harm reduction and call for more restrictions and consistent policy enforcement across the region to protect young people, while also cautiously recognising that use of NVPs may have some benefits for smokers.

Vaping Among Adolescents: An Overview of E-Cigarette Use in Middle and High School Students in India

E-cigarette use among middle and high school students has become a growing public health concern in recent years. The prevalence of e-cigarette use among adolescents has increased dramatically, and there are serious health risks associated with this behavior. This review article provides an overview of e-cigarette use in middle and high school students, including the prevalence of use, contributing factors, health effects, policies and regulations surrounding e-cigarette use in schools, and interventions for preventing e-cigarette use in adolescents. The article highlights the need for effective prevention and cessation programs, increased public awareness about the risks of e-cigarette use, and stronger regulations on e-cigarette products. Addressing e-cigarette use among youth is critical for protecting the health and well-being of future generations, and it is important for parents, educators, healthcare providers, and policymakers to work together to prevent and reduce e-cigarette use among adolescents and promote healthy behaviors.