Attitude and Environmental Factors Associated With Successful E-Cigarette Quitting Among Secondary School Students: A Cross-Sectional Observational Study

INTRODUCTION: E-cigarette use has become increasingly prevalent among adolescents and young adults. OBJECTIVE: This study aimed to identify determinants associated with successful e-cigarette cessation among secondary school students. SETTING: Study was conducted at the secondary schools in northern Thailand. METHODS: A cross-sectional study was conducted among 277 secondary school students in Thailand, aged 12 to 25 years. Participants completed a self-administered electronic questionnaire assessing sociodemographic characteristics, academic performance, age of initiation, exposure to e-cigarette use in the environment (defined as having 1 or more e-cigarette users among family, relatives, or friends), perceived risks, and attitudes toward e-cigarettes (the higher score indicates risky attitudes toward e-cigarettes). The outcome was successful cessation, defined as being a former e-cigarette user (no use in the past 12 months among ever-users). Multiple logistic regression analyses were used to explore the factors associated with successful e-cigarette quitting. The gender subgroup analysis was performed. RESULTS: < .001) were independently associated with cessation. Subgroup analysis confirmed the importance of attitudes for both males and females, while environmental exposure was significant among females. CONCLUSION: Successful cessation among secondary school students was strongly associated with less risky attitudes toward e-cigarettes and the absence of e-cigarette users in the peer and family environment. Interventions should target both individual attitude and environmental factors to improve quit rates. Therefore, interventions should focus on correcting attitudes regarding the social image, stress relief, and socialization aspects of e-cigarettes, while simultaneously engaging families and peers to create a vape-free environment.