BACKGROUND: E-cigarette use among early adolescents in Thailand is rising. Despite efforts by tobacco control agencies, preventing e-cigarette use among at-risk youth remains a challenge. This study aimed to explore stakeholder perspectives on preventing e-cigarette use among at-risk youth, applying the Health Literacy (HL) framework.
METHODS: This descriptive qualitative study was conducted through in-depth interviews and focus groups with youth at risk (n=9), parents (n=9), and teachers involved in tobacco control (n=8). The research took place in a northern province of Thailand from September to November 2024. Purposive sampling was employed until data saturation was achieved. Interview questions, grounded in the HL framework, were validated for content. Data were transcribed verbatim and analyzed thematically, with investigator triangulation to enhance reliability.
RESULTS: Six main themes with 20 subthemes emerged, most of which were consistent across participant groups. Stakeholders' perspectives on e-cigarette prevention were categorized into three levels of HL. At the functional literacy level, participants understood the health risks of e-cigarettes but lacked detailed knowledge about the substances in e-cigarettes and their specific health consequences. In terms of communication literacy, parents and teachers acknowledged the significant influence of online advertising on youth e-cigarette use, and vulnerable adolescents struggled to resist peer pressure. At the critical literacy level, stakeholders suggested that prevention could be achieved by helping youth evaluate the consequences of e-cigarette use and encouraging the setting of personal life goals through contemporary, accessible methods.
CONCLUSIONS: Stakeholders recognize the health risks of e-cigarettes but feel less confident in effectively communicating these risks to others. Online e-cigarette advertising plays a significant role in shaping youth behavior. Enhancing health literacy, decision-making skills, and self-management among at-risk youth—using modern tools such as mobile apps and online platforms—could help prevent e-cigarette use. Additionally, stricter regulations on online e-cigarette advertising are essential.