E-cigarette use, perceived risks, attitudes, opinions of e-cigarette policies, and associated factors among Thai university students.

Introduction: Although many countries, including Thailand, currently ban the sale of e-cigarettes, their use continues to rise, especially among young adults. Since the study of e-cigarette use among university students is limited, this study aimed to determine factors associated with e-cigarette use and explore university students' attitudes toward e-cigarettes, perceived risk, and opinion of e-cigarette policies.

Methods: This cross-sectional study was conducted among undergraduate students using convenience sampling in a university, in central Thailand from November 2022 to February 2023. A self-administered online questionnaire was distributed to 19 faculties representing health sciences, science and technology, social and arts faculties, and the International College.

Results: A total of 548 students completed the online questionnaire, and 20.4% reported ever using e-cigarettes, while 40% of e-cigarette users were unsure about the nicotine content. About 28% agreed, and 22% were unsure whether e-cigarettes could help quit smoking. Most students perceived that e-cigarettes are addictive and harmful, while about half of the participants agreed with the policy related to e-cigarettes in Thailand. Students with positive attitudes towards e-cigarettes were more likely to use e-cigarettes (AOR=1.15; 95% CI: 1.08-1.22), and those with lower perceived risk (AOR=0.89; 95% CI: 0.82-0.96) and who disagreed with e-cigarettes policy (AOR=0.93; 95% CI: 0.89-0.97) were more likely to use e-cigarettes. Personal income and having friends who use e-cigarettes were the significant predictors for e-cigarette use, while studying in the faculty of science and technology was a predictor of using e-cigarettes last month.

Conclusions: Although the perceived risk was high, about half of the students thought that e-cigarettes could help them quit smoking and were unsure or disagreed with e-cigarette banning policies. Attitude, perceived risk, policy opinions, personal income, and having friends who used e-cigarettes, were associated with e-cigarette use. Thus, correcting misunderstandings and increasing risk perceptions about e-cigarettes must be advocated among university students.