Electronic Cigarette Usage and Psychological Distress: Insights from University Students amid the Armed Conflict in Southern Thailand

Background/Objectives: Electronic cigarettes (e-cigarettes) are a significant public health concern, particularly among young individuals. This study aimed to assess the attitudes and factors, including mental distress, that influence e-cigarette uses among university students in Southern Thailand, including in armed conflict areas. Methods: A cross-sectional survey was conducted at the Prince of Songkla University across two campuses: Hatyai and Patani. Data on demographics, attitudes towards e-cigarettes, usage patterns, and mental health (using the 21-item Depression, Anxiety, and Stress Scale) were collected and analysed using R software. Results: Among 901 participants (236 men and 665 women), the prevalence of e-cigarette use was 6.9%. Furthermore, male students (odds ratio [OR] = 2.65; 95% confidence interval [CI] = [1.28, 5.46]), tobacco users (OR = 97.56; 95% CI = [26.77, 355.66]), and those living alone (OR = 13.48; 95% CI = [1.21, 150.47]) were more likely to engage in e-cigarette use. Additionally, Islamic students reported lower usage rates than their Buddhist counterparts (OR = 0.32; 95% CI = [0.11, 0.9]). Conclusions: E-cigarette users exhibited higher scores on the depression, anxiety, and stress subscales than non-users. Smokers perceived e-cigarettes as a means of reducing tobacco consumption, alleviating stress, and enhancing their image. Moreover, non-smokers considered e-cigarettes should be “illegal” in Thailand.