Factors Associated with E-Cigarette Use Among Undergraduate Students in Surabaya, Indonesia

The use of electronic cigarettes (e-cigarettes) has increased among college students and is influenced by behavioral and environmental factors. This study aimed to analyze the association between secondhand vapor exposure, health risk perception, accessibility, and tobacco promotional media with e-cigarette use among undergraduate students. A quantitative study with a cross-sectional design was conducted among 131 undergraduate students selected using multistage random sampling from seven faculties at Universitas Airlangga. Data were collected using standardized questionnaires that had been tested for validity and reliability. Bivariable and multivariable logistic regression analyses were performed to assess the association between independent variables and e-cigarette use. The prevalence of e-cigarette use among students was 20.6%. Bivariable analysis showed significant associations between e-cigarette use and secondhand vapor exposure (p = 0.004), health risk perception (p = 0.001), accessibility (p = 0.003), and tobacco promotional media (p = 0.028). Students with high exposure to secondhand vapor were more likely to use e-cigarettes (PR = 2.50; 95% CI: 1.51–4.13). Multivariable analysis indicated that secondhand vapor exposure was the strongest factor associated with e-cigarette use (PR = 3.61; p = 0.003), followed by accessibility (PR = 2.98; p = 0.006), while good health risk perception acted as a protective factor (PR = 0.15; p = 0.004). Tobacco promotional media was not significantly associated with e-cigarette use in the multivariable model. This study found that secondhand vapor exposure, health risk perception, and accessibility were independently associated with e-cigarette use among undergraduate students at Universitas Airlangga. Exposure to secondhand vapor showed the strongest association, highlighting the importance of environmental influences in shaping e-cigarette use among young adults.