Characterizing reasons for e-cigarette use among Filipino adults who smoke: A cross-sectional study

Introduction:
There is a potential risk of increased dual use of e-cigarettes and cigarettes among people who currently smoke and use e-cigarettes. Limited data are available on why people who smoke in the Philippines use e-cigarettes, including reasons that relate to smoking cessation. The current study addresses this gap to inform e-cigarette regulatory strategy.

Methods:
Data were collected via an online self-administered cross-sectional survey in November 2023 from 611 Filipino adults who smoke and reported current e-cigarette use (i.e. dual users). Participants selected their primary reason for e-cigarette use from a pre-populated list of 15 reasons. We conducted separate logistic regression models of each top reason for e-cigarette use, controlling for demographic and tobacco-use variables.

Results:
The top primary reasons for e-cigarette use were to cut down smoking (26%), to help quit smoking (24%), to use when not allowed to smoke cigarettes (11.6%), vaping is less harmful than smoking to others around me (11.6%), and ‘I enjoy the flavor’ (8.5%). Men were more likely than women to select to help quit (adjusted odds ratio, AOR=1.84; p=0.003, 95% CI: 1.22–2.77). Those intending to quit smoking within the year were more likely to select to help quit (AOR=5.22; p<0.001, 95% CI: 2.30–11.9) and to cut down (AOR=2.84, p<0.001, 95% CI: 1.36–5.95), and less likely to select to use when not allowed to smoke (AOR=0.25, p<0.001, 95% CI: 0.13–0.50) and because ‘I enjoy the flavor’ (AOR=0.24, p<0.001, 95% CI: 0.12–0.49).

Conclusions:
Some people who smoke in the Philippines use e-cigarettes in order to support smoking cessation; however, there is a risk of prolonged dual use if strong regulations are not implemented to promote complete cessation. Further research should investigate causal factors for e-cigarette use to identify policy pathways for reducing dual use and supporting cessation efforts.

ACKNOWLEDGEMENTS

We would like to acknowledge the contributions of study participants and the expert data collection team at GoodThinking Inc. We also thank Dr. Tuo-Yen Tseng at the Johns Hopkins Bloomberg School of Public Health Institute for Global Tobacco Control and our partners at Campaign for Tobacco-Free Kids and Vital Strategies for their feedback and review of study findings.

CONFLICTS OF INTEREST

The authors have each completed and submitted an ICMJE form for disclosure of potential conflicts of interest. The authors declare that they have no competing interests, financial or otherwise, related to the current work. J. Cohen reports that since the initial planning of the work, received support from the Bloomberg Philanthropies’ Bloomberg Initiative to Reduce Tobacco Use – Grant No. 47580 (to her institution) and that in the past 36 months, received payment for expert testimony from Grant & Eisenhofer P.A. (payment to her for preparing an abatement plan report in litigation against a tobacco company), received support for attending meetings and/or travel from Bloomberg Philanthropies’ (payment made on her behalf and payment reimbursed directly to her for travel expenses for in-country partner meetings and conference attendance), and had a leadership/fiduciary role as a board member of the Society for Research on Nicotine and Tobacco, completed 3-year term (no payment). K. Welding reports that since the initial planning of the work received support from the Bloomberg Philanthropies’ Bloomberg Initiative to Reduce Tobacco Use (Funding number 110801, paid to institution, and that in the past 36 months, received grants or contracts from NIH/NIDA, the World Health Organization, the FDA Center for Tobacco Products, the Pan American Health Organization and the University of Augusta (all paid to institution), received payment or honoraria from Bath University (paid to individual) and had a leadership/fiduciary role at the Institute for Health Metrics and Evaluation (University of Washington) – Tobacco Metrics Advisory Group (unpaid). L. Czaplicki, F.T. Dayagbil, E.U. Dorotheo, A. Mayor, M. Valera, R. Zaman and E. Crespi report that since the initial planning of the work, received support from the Bloomberg Philanthropies’ Bloomberg Initiative to Reduce Tobacco Use (payments made to their institution).L. Czaplicki reports that in the past 36 months received a grant from the National Institutes of Health (payments made to her institution), received payment or honoraria from the University of California Office of the President (payment made to her for grant review activities), and received support for attending meetings and/or travel from Bloomberg Philanthropies (payment made on her behalf and payment reimbursed directly to her for travel expenses for in-country partner meetings and conference attendance) and from the National Institutes of Health (payment made on her behalf for conference fee). F.T. Dayagbil reports that in the past 36 months received support for attending meetings and/or travel from Cebu Normal University, Commission on Higher Education and had a leadership/fiduciary role at the Philippine Association for Teachers and Educators. E.U. Dorotheo reports that in the past 36 months received a grant from the Gates Foundation (Grant payment to his organization, Southeast Asia Tobacco Control Alliance) and received support for attending meetings and/or travel from the International Union for Cancer Control (travel support for World Cancer Congress 2024). A.M.F.G. Mayor reports that in the past 36 months received consulting fees from the Bloomberg Philanthropies’ Bloomberg Initiative to Reduce Tobacco Use (payments made to institution). M. Valera reports that in the past 36 months received support for attending meetings and/or travel from Vital Strategies.

FUNDING

This research was funded by the Bloomberg Philanthropies’ Bloomberg Initiative to Reduce Tobacco Use.

ETHICAL APPROVAL AND INFORMED CONSENT

Ethical approval was obtained from the Johns Hopkins Bloomberg School of Public Health Institutional Review Board (Approval number: 00024497; Date: 17 October 2023) and the Philippine Social Science Council-Social Science Ethics Review Board (Approval number: CF-23-24; Date: 5 October 2023). Participants provided informed consent.

DATA AVAILABILITY

The data supporting this research are available from the authors on reasonable request.

AUTHORS' CONTRIBUTIONS

RZ, LC, EC, and KW: research concept and design. RZ, LC, EC, AM and KW: collection and assembly of the data. RZ and LC: data analysis and interpretation. RZ and LC: writing of the original draft. All authors: reviewing and editing of the manuscript. All authors read and approved the final version of the manuscript.

ADDITIONAL INFORMATION

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PROVENANCE AND PEER REVIEW

Not commissioned; externally peer-reviewed.

DISCLAIMER

Edgardo Ulysses Dorotheo reports that he is an Editorial Board Member Editor of the journal and that he had no involvement in the peer-review or acceptance of this article and had no access to information regarding its peer-review. Full responsibility for the editorial process for this article was delegated to a handling editor of the journal.

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Philippines Statistics Authority. 2021 Philippines Global Adult Tobacco Survey. https://drupal.gtssacademy.org.... Published December, 2023. Accessed October 23, 2025.