Perceptions and psychosocial correlates of e-cigarette use among Hong Kong university students: A mixed-methods study
Abstract
INTRODUCTION E-cigarette use among young adults is a concern in Hong Kong, where alternative smoking products have been prohibited since 2022, with public possession banned from 2026. Evidence among undergraduates is limited. This study examined e-cigarette use and associated psychosocial factors among Hong Kong undergraduates.
Methods
A sequential explanatory mixed-methods study was conducted at a Hong Kong university. Phase 1 was a cross-sectional survey (n=267) of full-time undergraduates aged ≥18 years, using convenience sampling. Measures, guided by an extended Theory of Planned Behavior framework, included peer influence, acceptability of public use, and perceived surveillance (1–5 scales). Outcomes were ever e-cigarette use during ages 13–19 years and current (past-30-day) use, analyzed by multivariable logistic regression (AOR, 95% CI). Phase 2 comprised 21 interviews, analyzed inductively.
Results
Mean age was 20.8 years (SD=2.0); 55.4% were female. Ever use during ages 13–19 years was 12.4% (33/266) and current use 8.6% (23/266); 86.8% of ever e-cigarette users had also smoked. Peer influence was associated with ever use (AOR=3.34; 95% CI: 1.95–5.73; p<0.001) and current use (AOR=3.20; 95% CI: 1.86–5.49; p<0.001); female sex was inversely associated with ever use (AOR=0.25; 95% CI: 0.09–0.65; p=0.005). Current use was also associated with acceptability of public use (AOR=1.97; 95% CI: 1.08–3.61; p=0.028) and inversely with surveillance (AOR=0.63; 95% CI: 0.41–0.97; p=0.034). Stress relief and peer influence were the most reported reasons for use (43.4% each), and friends the most common source (67.9%). Regulatory deterrence did not differ between users and non-users (p=0.683) despite high policy awareness (89.9%). Interviews described initiation through friends, use under stress, and acquisition through friends and cross-border sourcing.
Conclusions
Peer influence was most strongly associated with e-cigarette use; perceived legal deterrence was not. Because this cross-sectional design cannot establish temporal order, further studies are needed to determine causality and characterize informal supply channels among university students.