Use of e-cigarettes among public health students in Thailand: Embedded mixed-methods design

E-cigarettes are new tobacco products widely used among adolescents. Public health students are not only susceptible to e-cigarette use, but they should also serve as non-smoking role models. The study aimed to investigate the current situation of e-cigarette use and the factors associated with its use among public health students.

In this embedded mixed-methods design, the primary approach was a cross-sectional online survey. The samples were 2302 third-year public health students from 37 public health education institutes across Thailand. Stratified two-stage cluster random sampling was employed to select the subjects. Data were collected using self-administered questionnaires from January to March 2021. A checklist form was employed to collect qualitative data about teaching and learning activities related to tobacco control in June 2021. Descriptive statistics were used for data analysis, including inferential statistics regarding logistic regression.

Overall, 3.9% (95% CI: 3.1-4.6) of the students currently used e-cigarettes in the past 30 days. The significant factors that could explain 43.4% of e-cigarette use were predisposing factors: being male (adjusted odds ratio, AOR=1.8; 95% CI: 1.0-3.3), having a neutral attitude toward e-cigarette use (AOR=2.2; 95% CI: 1.1-4.5), and not believing that public health professionals should serve as non-smoking role models for clients and the general public (AOR=2.3; 95% CI: 1.2-4.0). The enabling factor was having tried tobacco products (AOR=40.7; 95% CI: 19.1-87.1), and the reinforcing factor was having three or more close friends who smoke cigarettes (AOR=3.2; 95% CI: 1.8-5.8).

Students' behaviors should be modified through curriculum-based teaching and learning activities to develop negative attitudes toward e-cigarette smoking, increase students' awareness as non-smoking role models, and establish smoke-free environments.