Breaking the Cycle: Physical Activity, Nicotine Dependence, and Psychological Well-Being Among University E-Cigarette Users

Abstract INTRODUCTION Electronic cigarette (EC) use is rising among Malaysian university students, a population navigating the stresses of emerging adulthood. While ECs are promoted as “safer” alternative, accumulating evidence links nicotine exposure with adverse mental health. Understanding behavioural (physical activity, quit motivation) and contextual (nicotine content and dependence, dual use, sociodemographic) correlates of psychological well-being can inform tailored cessation strategies.METHODS Cross-sectional online survey across six universities. Eligible participants were EC users aged 18–25. Measures included sociodemographic, EC patterns (frequency, nicotine content, dual use); nicotine dependence (e-FTND); quit motivation (stages); physical activity (IPAQ); and psychological well-being (PWB, Ryff, 18-item). Analyses used Chi-square tests and crude/adjusted odds ratios (cOR/aOR), α = 0.05.RESULTS Of 660 respondents, 601 met criteria (mean age 22.3; 79.4% male). Daily EC use was 74.5%; 63.0% of nicotine users reporting < 20mg nicotine content. PWB distribution: 70.0% moderate, 30.0% low. Ethnicity and income related to PWB (Chinese cOR = 3.886; Indian cOR = 4.849 vs Malay; higher income cOR = 1.905). Lower nicotine content was associated with higher odds of PWB (cOR = 1.920, 95% CI: 1.206–3.056). Dual use was linked to poorer PWB; exclusive EC users had higher odds better PWB (cOR = 1.710, 95% CI: 1.196–2.420).DISCUSSION Higher nicotine dependence showed consistent negative patterns across PWB domains (e.g. greater stagnation, poorer relations, lower mastery and self-acceptance). Higher quit motivation (preparation) aligned with better PWB, whereas lower motivation (precontemplation/contemplation) aligned with poorer PWB. Physical activity related positively to PWB, especially Personal Growth and Self-Acceptance, and to fewer negative endorsement (e.g. disappointment in achievements, difficulties in trusting others). In adjusted models, significant predictors of PWB were ethnicity (Chinese/Indian), nicotine dependence (moderate/high), quit motivation (contemplation/preparation), and being physically active.CONCLUSIONS Among young EC users, psychological well-being reflects a balance of risk and protection: higher nicotine dependence and dual-use undermine PWB, whereas lower nicotine content, stronger quit motivation, and physical activity are protective. Culturally sensitive interventions that integrate dependence reduction, motivational enhancement, and physical activity, while accounting for nicotine strength and sociodemographic context, may yield synergistic gains in both cessation and mental health.ImplicationsThis study underscores the potential of physical activity as a protective factor against nicotine dependence and poor psychological well-being among university EC users. Positioning physical activity as both a health behaviour and therapeutic tool enables universities and policymakers to integrate it with motivational enhancement and dependence reduction strategies. Tailored interventions are for dual users, high-nicotine consumers, and those with low quit motivation, while ensuring inclusivity across socioeconomic and cultural contexts. Embedding physical activity into student health services, digital platforms, and peer initiatives could reduce relapse, strengthen resilience, and improve well-being.