Exploring promoting and preventing factors of e-cigarette initiation: a mixed-methods study in Thai non-user college students with interest in e-cigarette use

As the popularity of e-cigarettes has grown in the last decade, the marketing of e-cigarettes has also expanded. College students represent a target group for tobacco industry marketing. However, little is known about the protective and promoting factors influencing e-cigarette initiation among this group. This study aims to explore factors promoting and preventing e-cigarette initiation among Thai college students. We used a mixed-methods approach, combining survey and in-depth interviews. Quantitative analysis included multivariate logistic regressions for the e-cigarette use (ever vs. never) and for interest in trying e-cigarettes among non-users, and thematic analysis for qualitative study among non-users who showed some interest in trying e-cigarettes. A survey of 614 students found that 137 (22.3%) reported using e-cigarettes, and 39 non-users showed some interest in trying them. We identified factors associated with higher odds for e-cigarette use, including older age, income > 10,000 Baht (vs. <5,000), living in a condominium (vs. living with family), and having any friend who uses e-cigarettes (vs. none). For interest in trying e-cigarettes among 475 non-users, only having any friend who uses e-cigarettes is associated with higher odds. Interviews with 15 non-users who showed some interest in trying e-cigarettes revealed factors influencing interest (curiosity, stress, socialization) and deterrents (cost, health, mannerisms, parental influence). Some factors (image, odor, peer) can both promote and prevent use. Identifying these factors can inform targeted prevention campaigns. This study ascertains the reasons behind the potential interest of college students in initiating e-cigarettes. The findings of this study will inform the design of a prevention program for e-cigarette use among young people who do not currently use them.