Trends in e-cigarette use among adolescents in Malaysia, 2016–2022: A secondary dataset analysis of national surveys

INTRODUCTION: E-cigarette use among adolescents has increased in recent years, including in Malaysia. Monitoring changes in use is important to inform the prevention of nicotine addiction. This study examines changes in adolescent e-cigarette use in Malaysia and associated sociodemographic factors from 2016 to 2022. METHODS: This study was a secondary analysis of data from three national school-based health surveys in Malaysia: Tobacco and E-Cigarette Survey among Malaysian Adolescents (TECMA) 2016, and National Health and Morbidity Survey (NHMS) 2017 and 2022. The analysis included school-going adolescents aged 13-17 years. Complex sample analysis was used to estimate prevalence, and multivariable logistic regression using NHMS 2017 and NHMS 2022 examined associated factors. All surveys used a two-stage stratified cluster sampling design and a questionnaire adapted from the Global Youth Tobacco Survey. RESULTS: A total of 13162, 27497, and 33523 respondents participated in TECMA 2016, NHMS 2017, and NHMS 2022. The prevalence of current e-cigarette use among adolescents aged 13-17 years was 12.0% (95% CI: 10.1-14.3), 9.8% (95% CI: 9.0-10.8), and 14.9% (95% CI: 13.7-16.1) in 2016, 2017, and 2022, respectively. Multivariable logistic regression showed that the adjusted odds ratio (AOR) of e-cigarette use increased from 2017 to 2022 among adolescents who smoke from 15.25 (95% CI: 12.62-18.43) to 56.29 (95% CI: 46.76-67.77), among Malays from 1.78 (95% CI: 1.28-2.48) to 3.71 (95% CI: 3.02-4.57), and among students whose parents smoke from 1.0 (95% CI: 0.85-1.19) to 1.32 (95% CI: 1.16-1.49). The association with parental e-cigarette use decreased from 3.78 (95% CI: 3.00-4.77) to 1.64 (95% CI : 1.42-1.89). CONCLUSIONS: E-cigarette use among adolescents has increased in Malaysia. While associated factors remain generally consistent, their strength has changed across survey waves. These findings highlight the need for continued public health efforts and appropriate regulatory strategies to address e-cigarette use among adolescents in Malaysia.