Students enrolled in healthcare-related programmes consistently reported the lowest rates of e-cigarette use and the highest levels of health knowledge.
Citing a systematic review published in the Malaysian Journal of Medical Sciences, Monash University Malaysia Assoc Prof Dr Anne Yee said those in non-healthcare or vocational programmes showed the reverse.
The most plausible explanation, she opined, is that healthcare students are better informed.
“When health literacy is genuinely embedded in a curriculum, it shapes behaviour in ways that awareness campaigns alone do not,” she said.
Referring to the “Vaping among Malaysian students 2022–2024: A systematic review of prevalence, awareness and influencing factors” journal paper, she said the prevalence of vaping ranged from 2.9% among medical and dental students at Universiti Teknologi MARA (UiTM) to 32% among students at Universiti Kuala Lumpur Royal College of Medicine Perak.
The paper, Dr Yee added, identified peer pressure as the main driver of vaping initiation. Social trends, media exposure, and academic stress followed closely. Among medical students, stress relief was a specific motivator.
“In a cohort with higher-than-average health literacy, the ordinary pressures of student life are still potent enough to override what they know.
“The pathway into vaping is social before it is pharmacological. Young people are not primarily choosing to vape through a rational assessment of nicotine delivery options.
“They vape because their friends do, because platforms make it look aspirational, and because the digital spaces they occupy are saturated with influencer-driven promotion and flavoured device advertising that targets their age group with precision,” she said.
And while awareness of e-cigarettes is high across Malaysian campuses, Prof Yee stressed that knowing and understanding are not synonymous.
In a study of medical and dental students at UiTM, 62.1% demonstrated poor knowledge of the actual risks of vaping, she said, adding that this is surprising for a group that should be better-informed.
“More concerning is the misconception by more than half of the students at Universiti Malaysia Sabah that e-cigarettes are less harmful than conventional cigarettes.
“Repackaging nicotine addiction in fruit flavours, sleek devices, and lifestyle marketing does not make it less addictive.
“Labelling vaping as harm reduction does not automatically make it harmless either,” she said.
While the e-cigarette’s nicotine delivery method without tar and combustion carries a lower burden of disease than a cigarette, she warned that it is not the complete picture.
“The gap between partial truth and full understanding is where addiction takes hold,” she said, explaining that combustion-free nicotine delivery devices carry a different risk from cigarettes.
According to the paper, 38.9% of University of Cyberjaya students reported using e-cigarettes as a smoking cessation tool yet only 14% of students who attempted to quit sought professional support, Dr Yee noted.
“Most quit attempts fail without structured help. In the absence of that support, vaping does not become a bridge away from addiction. It becomes the addiction itself. E-cigarettes still deliver nicotine, the substance that drives dependence.
“Even more concerning, vape liquids are increasingly being mixed with synthetic substances and illegal drugs, meaning that a product marketed as a health-conscious alternative is, in some cases, an unregulated chemical mixture with no reliable content disclosure,” she concluded.
