Abstract
The growing popularity of electronic cigarettes (e-cigarettes) among Indonesian youth presents a new public health challenge in a country with one of the highest tobacco burdens globally. While tobacco control regulations have been implemented, e-cigarettes remain largely unregulated, raising concerns about their health impacts and youth appeal. This study explores the prevalence, determinants and perceptions of e-cigarette use among high school and university students in Indonesia, providing critical insights to inform effective policymaking. A cross-sectional online-based survey was conducted in 2019 among 158 students aged 15-30 years across 17 provinces in Indonesia. Data on tobacco use behaviours, socioeconomic background, social influences and health perceptions were collected. Descriptive and inferential statistical analyses identified key determinants of e-cigarette use. Among the participants, 36.2% reported ever smoking, and 65.2% of these had tried e-cigarettes. Key determinants of e-cigarette use included male gender, urban residency, peer smoking and social acceptance of smoking (all p < 0.05). Notably, participants commonly perceived e-cigarettes as less harmful than combustible cigarettes and helpful for smoking cessation, despite conflicting scientific evidence. Overall, e-cigarette use is prevalent among Indonesian youth, driven by social and environmental factors, as well as misconceptions about safety. Strengthened regulations and targeted public health campaigns are essential to mitigate the health risks posed by e-cigarettes and enhance tobacco control efforts.