Psychosocial Correlates of Adolescent E-Cigarette Preventive Behavior Among Thai Secondary School Students: A
Jun Norkaew1, Rattanathorn Intarak2, Ranee Wongkongdech3
1Faculty of Public Health, Lampang Campus, Thammasat University, Lampang 52000, Thailand.
Abstract:
Background: The increasing use of e-cigarettes among adolescents is a growing public health concern in Thailand, where they are prohibited but remain accessible. This study aimed to examine the psychosocial correlates of preventive behaviors regarding e-cigarettes among adolescents in central Thailand. Methods: A cross-sectional correlational study was conducted with 383 secondary school students (Grades 7-12) selected through proportionate stratified random sampling from two government schools in Ongkharak District, Thailand. Data were collected using a validated self-administered online questionnaire assessing attitudes toward e-cigarettes, peer influence, family attachment, and preventive behaviors. Item analysis, confirmatory factor analysis (CFA), and factor-score regression with bootstrapped indirect-association analysis (k = 5000) were performed to examine direct and indirect associations. Results: The four-factor measurement model demonstrated acceptable absolute fit (SRMR = 0.069) but weaker incremental fit (CFI = 0.70), expected given the large number of ordinal indicators estimated via maximum likelihood, with standardized factor loadings ranging from 0.621 to 0.926 (p < 0.001). The structural model explained 44.2% of the variance in preventive behaviors (R2 = 0.442). Family attachment showed the strongest total association (β = 0.456), including both direct and indirect associations through attitudes (β = 0.116) and peer influence (β = 0.162), consistent with a pattern of statistically significant indirect associations. Conclusions: Family attachment was associated with self-reported e-cigarette preventive behavior, with statistically significant indirect associations through attitudes and peer influence. Given the cross-sectional design, these findings should be interpreted as model-consistent associations rather than causal mediation, and may inform future family- and peer-oriented prevention research in comparable settings.
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