Theoretical Framework

This study on students’ perspectives regarding the risks of electronic cigarettes (e-cigarettes) and
traditional cigarettes is grounded in three key theoretical models: Nola Pender’s Health
Promotion Model (HPM), the Theory of Planned Behavior (TPB), and Social Cognitive
Theory (SCT). These frameworks provide a comprehensive understanding of the psychological,
social, and behavioral factors that influence students' decisions to smoke or vape. By integrating
these theories, this study seeks to explore the factors that shape students' perceptions of e-cigarettes
and traditional cigarettes, including health risks, social influences, and behavioral intentions.

Pender’s Health Promotion Model (HPM) (Pender, 1982, 1996) explains health-related behaviors
by emphasizing perceived benefits, perceived barriers, self-efficacy, and environmental influences.
According to this model, individuals are more likely to engage in behaviors they perceive as
beneficial while avoiding those they see as harmful. In the context of this study, students may
perceive e-cigarettes as a less harmful alternative to traditional cigarettes, influencing their decision
to vape instead of smoke. Conversely, perceived barriers—such as health risks, financial costs, and
institutional regulations—may deter them from using either product. For example, many students
may avoid traditional cigarettes due to their well-established health risks, including lung disease
and cardiovascular problems. However, the perception that e-cigarettes pose fewer health risks may
encourage some students to vape, despite the presence of nicotine and other harmful chemicals.

Additionally, self-efficacy plays a crucial role in shaping smoking behaviors. Students who believe
they can control their smoking habits or quit altogether are more likely to engage in
health-promoting behaviors (Pender, 1996). However, if they lack confidence in their ability to quit,
they may continue smoking or vaping despite knowing the risks. Environmental factors, such as
anti-smoking campaigns, policies restricting cigarette and e-cigarette use on campus, and
healthcare interventions, may also influence students' smoking behaviors. Therefore, the HPM
helps explain how individual perceptions, social norms, and institutional policies interact to shape
students' decisions regarding e-cigarettes and traditional cigarettes.

The Theory of Planned Behavior (TPB) (Ajzen, 1991) further explains smoking behavior by
emphasizing three key components: attitude toward the behavior, subjective norms, and perceived
behavioral control. Attitude refers to students ’ personal beliefs about smoking and vaping —
whether they perceive e-cigarettes as safer or more socially acceptable than traditional cigarettes.
For example, students who believe that vaping is a healthier alternative to smoking may be more
inclined to use e-cigarettes. On the other hand, students who view all nicotine products as harmful
may be more likely to avoid both vaping and smoking.

Subjective norms highlight the influence of peers, family, and societal expectations, which can
shape students' smoking decisions. If e-cigarette use is widely accepted among their peers, students
may be more inclined to try vaping. Studies have shown that peer pressure significantly influences
young adults' decisions to smoke or vape, particularly in social settings where e-cigarette use is
normalized (David et al., 2015). This aligns with the findings of McLeish et al. (2022), who
observed that many college students lack accurate knowledge about the dangers of vaping but
continue to use e-cigarettes due to social acceptance and perceived reduced harm.

Lastly, perceived behavioral control refers to students' belief in their ability to regulate their
smoking habits. If they feel that quitting is difficult due to nicotine addiction, they may be more
likely to continue using e-cigarettes or traditional cigarettes. Conversely, if they believe they have
control over their smoking habits, they may be more likely to quit. TPB suggests that individuals
who perceive smoking as a controllable behavior are more likely to engage in cessation efforts,
while those who feel powerless against nicotine addiction may struggle to quit (Ajzen, 1991).

In addition to HPM and TPB, Social Cognitive Theory (SCT) (Bandura, 1986) provides valuable
insight into the role of observational learning, social influence, and self-efficacy in shaping
smoking behavior. SCT posits that students may adopt smoking or vaping behaviors by observing
peers, social media, or advertisements that portray e-cigarettes as trendy and socially acceptable.
For example, the widespread marketing of flavored e-cigarettes has contributed to their appeal
among young adults, reinforcing the idea that vaping is a desirable and low-risk activity (Garcia et
al., 2020).

The concept of reinforcement also plays a role, as students who perceive vaping as a stress reliever
or a social activity may be more inclined to engage in it. Many young adults turn to e-cigarettes to
cope with stress, anxiety, or academic pressure, reinforcing the habit through repeated use
(Leventhal et al., 2023). Reciprocal determinism, a key SCT concept, highlights the interaction
between personal beliefs, environmental factors, and behavior. For instance, a student’s decision to
vape may be influenced by marketing strategies, peer acceptance, and their own perception of harm
reduction compared to traditional cigarettes. This aligns with findings from Resano et al. (2022),
who reported that stress and social influences are significant factors contributing to e-cigarette use
among nursing students in Manila.

By integrating these three theories, this study provides a structured approach to understanding why
students may choose e-cigarettes over traditional cigarettes and how their perceptions influence
their smoking behaviors. The Health Promotion Model explains how students weigh the benefits
and risks of smoking and vaping, the Theory of Planned Behavior provides insight into their
attitudes and social influences, and the Social Cognitive Theory highlights the role of peer
influence and media exposure. Together, these frameworks contribute to a deeper understanding of
smoking and vaping behavior among college students, which can inform future health interventions
and smoking cessation programs.

Moreover, several studies align with this theoretical framework. McLeish et al. (2022) found that
while many college students recognize the health risks of e-cigarettes, they often lack knowledge
about the specific dangers associated with vaping. This aligns with HPM’s concept of perceived
benefits and barriers in decision-making. Leventhal et al. (2023) identified a link between
e-cigarette use and increased depressive symptoms, emphasizing the social and psychological
influences on smoking behavior, which supports SCT’s emphasis on environmental and personal
interactions. David et al. (2015) found that peer influence significantly affects Filipino students ’
experimentation with e-cigarettes, supporting TPB ’ s concept of subjective norms. Furthermore,
Resano et al. (2022) highlighted stress as a major factor influencing smoking and vaping behavior
among nursing students in Manila, reinforcing the role of perceived behavioral control in TPB.

References

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Bandura, A. (1986). Social foundations of thought and action: A social cognitive

David, V. C. B., Lozano, P. N. M. G., Sabino, A. S., & Salvedia, K. J. A. (2015). Awareness,
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undergraduate students of the University of the Philippines Manila.

Garcia, M., Lee, H., & Patel, R. (2020). Flavored e-cigarettes and youth appeal: A review of usage
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https://doi.org/10.1016/j.jadohealth.2020.03.012

Leventhal, A. M., Strong, D. R., Kirkpatrick, M. G., Unger, J. B., Sussman, S., Riggs, N. R., ... &
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https://doi.org/10.1001/jamanetworkopen.2023.2001

McLeish, C., Hart, J. L., & Walker, K. (2022). College student e-cigarette users’ knowledge about
e-cigarettes: Ingredients, health risks, device modifications, and information sources. International
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Pender, N. J. (1982). Health promotion in nursing practice. Appleton-Century-Crofts.

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Resano, J. E. P., et al. (2022). The Philippine Journal of Science, 151(1), 411–423.