Roengrudee Patanavanich, her Thai colleagues, and I just published “Patterns of e-cigarette use by sex and age in Thailand: The National Health Examination Survey 2024–2025” that provides detailed statistics on cigarette and e-cigarette use in Thailand, a country that does not allow import and sale of e-cigarettes. We found current e-cigarette use among 5.3% of youth (age 10-19), 8.3% of young adults (20-29) and 1.0% among adults (30+).
As elsewhere, most e-cigarettes people used were flavored (73.3% fruit, 30.0% menthol/mint, 9.5% candy/desert, and only 2.2% tobacco/other). Not surprisingly given the ban on import and sales, the most common source was online (41.0%).
The Thai youth (10-19 years old) prevalence had increased to 5.3% in 2024-5. While this was similar to the 5.2% level among US middle and high school youth in 2025, it actually shows that the Thai ban has helped keep youth e-cigarette use down. For comparison, US youth current e-cigarette use peaked in 2019 at 20.0%; it took years hard work, policy changes and money to get it down to 5.2%.
The Thai data also shows high levels of dual use of e-cigarettes and cigarettes — 38.1% among youth, 44.2% among young adults, and 50.0% among older adults. This is particularly concerning because dual use is more dangerous than just smoking.
The Thai data also shows that e-cigarettes are not being used as a (phyrric) effort to stop smoking. As we noted,
Only 15.1% (95% CI: 11.9–18.3) of people (and only 5.9% [95% CI: 2.5–9.3] of those aged 10–19 years), used e-cigarettes to stop smoking (Table 2); they started using them when friends suggested them, liked their flavors, and used them to relieve stress, particularly among young females. … This finding also contradicts the claims made by the tobacco industry and e-cigarette advocates that e-cigarettes are essential as a cessation strategy for people who currently smoke; this finding is consistent with several studies showing that young people use e-cigarettes out of curiosity rather than to quit smoking. In addition, in the US, youths who use e-cigarettes specifically to quit smoking were associated with significantly lower odds of having stopped smoking cigarettes. [citations omitted]
The paper concludes:
The high proportion of dual use and the high prevalence of e-cigarette use among people who never smoke, among people aged 10–19 years, suggest that e-cigarette use is not primarily motivated by cessation. Instead, social norms and curiosity are the most common reasons to initiate e-cigarette use. It is crucial for health initiatives, including those led by youth, to dispel prevalent misconceptions about the harm reduction claims of e-cigarettes and deformalize social norms that encourage their use.
Here is the abstract:
INTRODUCTION. Since their introduction in the early 2000s, the prevalence of e-cigarette use has increased globally. E-cigarette use among females, while usually lower than that of males, is rising and typically higher than cigarette use. This study describes the prevalence of e-cigarette use in Thailand stratified by age and sex,
including frequency of use, place obtained, preferred flavors, and reasons for use.
METHODS. This cross-sectional study used the seventh Thai National Health Examination Survey (NHES), conducted between 2024 and 2025. Weighted
percentages with 95% confidence intervals (CIs) were used to describe self reported e-cigarette use patterns across age groups and sex, accounting for survey weights and the complex survey design. We also used multivariable logistic regression models to examine the factors associated with e-cigarette use.
RESULTS. Current e-cigarette use was highest among males aged 20–29 years (13.4%; 95% CI 10.7–16.1). Among current e-cigarette users, dual use was higher among males than females (50.3%; 95% CI: 45.1–55.5 vs 18.8%; 95% CI: 11.7–26.0; p<0.01). Never smoking cigarettes among participants who currently use
e-cigarettes was higher among females <30 years than males (64.7%; 95% CI: 55.4–74.1 vs 22.5%; 95% CI: 17.4–27.6; p<0.001). Fruit flavors were the most preferred among e-cigarette users across age groups and sexes. Females were more likely to use e-cigarettes to relieve stress and generally initiated using e-cigarettes at a younger age than males. Multivariable logistic regression revealed that age and sex were significantly (p<0.001) associated with ever, current, and daily e-cigarette use.
CONCLUSIONS This study describes patterns of e-cigarette use in a country where e-cigarettes are prohibited. The high proportion of dual use and the high prevalence of e-cigarette use among younger adults who never smoked, suggest that e-cigarette use is not primarily motivated by cessation among younger users. Health initiatives should dispel e-cigarette harm reduction claims and denormalize social norms that encourage their use.
The full citation is: Patanavanich R., Aekplakorn W., Chariyalertsak S., Bumrerraj S., Vichitkunakorn P., Chuemchit M., Neelapaichit N., Glantz, S. A. (2026). Patterns of e-cigarette use by sex and age in Thailand: The National Health Examination Survey 2024–2025. Tobacco Induced Diseases, 24(July), 104. https://doi.org/10.18332/tid/218627It is available here.
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