A Comparison of Knowledge and Attitudes Toward E-Cigarette Use Among Lower Secondary School Students in Dusit District, Bangkok

Abstract

Aim/Purpose: This research aimed to compare knowledge and attitudes toward e-cigarette use among students by gender, Grade Point Average (GPA), daily income, having friends who use e-cigarettes, and having family members who use e-cigarettes.

Introduction/Background: E-cigarette use among adolescents remains a significant public health concern in Thailand and worldwide. As a relatively new form of tobacco product, e-cigarettes often contain higher levels of nicotine than conventional cigarettes, leading to potential adverse effects on physical health, mental well-being, the economy, and the environment. Recent evidence indicates a rapid increase in new e-cigarette users among adolescents aged 13–15 years, affecting both males and females. However, research examining e-cigarette use in Thailand among adolescents in this age group remains limited.

Methodology: This research employed a comparative research design. The sample comprised 288 lower secondary school students in Grades 7–9, selected via cluster sampling. The research instruments included: (a) a demographic information questionnaire of five items, (b) a questionnaire assessing lower secondary students’ knowledge of e-cigarettes of 19 items, and (c) a questionnaire measuring lower secondary students’ attitudes toward e-cigarette use of 25 items. Content validity was evaluated by three experts. The Index of Item-Objective Congruence (IOC) for the e-cigarette knowledge questionnaire ranged from .67 to 1.00, while the IOC for the attitude questionnaire was 1.00. The reliability of the e-cigarette knowledge questionnaire was assessed using the Kuder–Richardson Formula 20 (KR-20), yielding a coefficient of .81. The reliability of the attitude questionnaire was evaluated using Cronbach’s alpha coefficient, which was .89. Data were analyzed using Descriptive Statistics, Independent t-Tests, One-Way Analysis of Variance, and pairwise comparisons using the Bonferroni Method.

Findings: The data analysis revealed several important findings regarding students’ knowledge and attitudes toward e-cigarette use. First, when comparing male and female students, no statistically significant differences were observed in either their level of knowledge or their attitudes toward e-cigarette use. Second, peer influence emerged as a noteworthy factor. Students who reported having friends who used e-cigarettes demonstrated significantly higher levels of knowledge about e-cigarettes compared to those whose friends did not use them (t = 2.206, p = .028). However, there was no significant variation in attitudes between the two groups. Third, knowledge scores did not differ significantly between students who had family members who used e-cigarettes and those who did not. Nevertheless, students whose family members did not use e-cigarettes exhibited more appropriate and health-conscious attitudes toward e-cigarette use compared to those with family members who did use them (t = −3.308, p = .001). Fourth, knowledge scores regarding e-cigarette use did not differ significantly across students with varying GPAs. However, students with GPAs ranging from 3.50 to 4.00 demonstrated more appropriate attitudes toward e-cigarette use than those with GPAs of 3.00 or lower (F₃,₂₈₄ = 4.721, p = .003). Finally, students’ daily income levels did not show any significant differences in either knowledge or attitudes toward e-cigarette use.

Contribution/Impact on Society: The findings of this study indicated that students with friends who use e-cigarettes demonstrated higher levels of knowledge compared to those whose friends did not use e-cigarettes. In addition, students without family members who use e-cigarettes and those with GPAs of 3.50 or above exhibited more appropriate attitudes than other groups. These results suggest that certain groups of students may be at greater risk of initiating e-cigarette use. Educational administrators can utilize these findings to design targeted measures and prevention campaigns focusing on at-risk students, while also promoting positive peer networks to prevent e-cigarette use. Furthermore, policymakers and public health personnel may apply this information to strengthen family-based strategies for e-cigarette prevention.

Recommendations: This study’s significant findings provide important implications for adolescents, parents, school counselors, school administrators, public health practitioners, and policymakers in developing effective strategies to prevent e-cigarette use among adolescents. Schools should implement continuous educational programs that provide accurate information about e-cigarettes and relevant legal regulations. Such programs should also strengthen students’ critical thinking, decision-making, and refusal skills related to e-cigarette use, particularly among students with lower academic achievement. In addition, prevention efforts should emphasize the roles of peers, parents, and family members by promoting participatory activities that actively engage these groups in reducing e-cigarette use among adolescents.

Research Limitations: The data for this study was collected from a single school; therefore, the findings may not be generalizable to students in other contexts that differ in terms of environmental conditions, school policies, resources, or social backgrounds. In addition, the results of this study may not be generalized to lower secondary school students at the national level, nor to students in private schools or schools located in rural areas.

Future Research: Future research should include a larger sample size and be conducted in private schools or schools in rural areas. In addition, technology should be utilized to develop innovative e-cigarette prevention interventions that are appropriate for lower secondary school students.