Prevalence and predictors of e-cigarette use among adolescents in a tertiary pediatric clinic: insights from the new ECABA Scale

Abstract

Background. Electronic cigarettes (e-cigarettes) are rapidly infiltrating youth culture under the guise of safety and social acceptance. Despite their prohibition in Türkiye, anecdotal reports suggest widespread access and experimentation among adolescents. This study aimed to determine the prevalence and predictors of e-cigarette use among adolescents attending a tertiary pediatric clinic, using the validated E-Cigarette Attitudes and Beliefs in Adolescents (ECABA) Scale to explore how beliefs shape behavior. Methods. A cross-sectional design with consecutive sampling was employed. A total of 547 adolescents aged 14–18 years without psychological or organic illness participated. Data were collected using the 18-item ECABA Scale, along with demographic, cigarette, and e-cigarette use information. Logistic regression models were used to identify independent predictors of ever and current e-cigarette use. Results. E-cigarette use was alarmingly common: 18.5% had ever tried, and 9.2% were current users. Males and those with peers who smoked or vaped were significantly more likely to use e-cigarettes (p<0.001). Higher ECABA total scores, reflecting more favorable attitudes, independently predicted both ever and current use (odds ratios 1.054 and 1.048 per unit increase, respectively). Subscales related to perceived physical harmlessness and social acceptance also emerged as significant predictors. Conclusions. Adolescents who view e-cigarettes as harmless or socially acceptable are substantially more likely to use them, despite national restrictions. These findings expose a critical gap in prevention efforts and call for urgent school-based interventions to challenge the illusion of “safe vaping.” The ECABA Scale may serve as an effective early warning tool to identify at-risk youth before nicotine dependence takes hold.