Attitudinal and social factors associated with e-cigarette use among students in formal and non-formal educational settings in Chiang Mai, Thailand

Background E-cigarette use has increased globally and raises concerns about its potential health impacts, particularly among young people, in whom prevalence continues to rise. Objective To identify factors associated with its use among students enrolled in formal and non-formal educational institutions in Chiang Mai, Thailand. Methods This is a cross-sectional observational study in students, aged 12–25 years old. Data were collected using a structured questionnaire covering sociodemographic characteristics, e-cigarette use behaviors, perceived risk/benefit of e-cigarette use, attitudes toward e-cigarettes, and legal awareness regarding e-cigarettes. Data were analyzed using descriptive statistics and multivariable logistic regression adjusting for age, sex, and school type. Results Of the 900 participants, 30.8% had used e-cigarettes and 18.1% reported past-3-month e-cigarette use. Factors significantly associated with past-3-month e-cigarette use included having close contacts who use e-cigarettes (aOR 5.42, 95% CI 3.54–8.30), and favorable attitudes toward e-cigarettes (aOR 7.88 per interquartile-range increase [score 0 to 5], 95% CI 3.97–15.64; overall p < 0.001). In contrast, higher perceived risk/benefit of e-cigarette use (aOR 0.53 per interquartile-range increase [score 13 to 18], 95% CI 0.35–0.80; overall p = 0.011), and greater legal awareness regarding e-cigarettes (aOR 0.41 per interquartile-range increase [score 10 to 16], 95% CI 0.24–0.71; overall p < 0.001) were associated with reduced odds of e-cigarette use. Conclusion Social environmental factors, attitudes toward e-cigarettes, perceived risk/benefit of e-cigarettes, and legal awareness were associated with e-cigarette use among young people. These findings may inform evidence-based public health policies and comprehensive prevention strategies aimed at improving risk perception, modifying attitudes toward e-cigarettes, and enhancing knowledge of regulatory frameworks. Future longitudinal intervention studies are needed to evaluate the strategies’ effectiveness.