earticle

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Objectives: This study aimed to identify factors associated with smoking and e-cigarette use among men and women, adopting a socio-ecological model. Methods: Data from the Community Health Survey were merged with regional-level databases covering 255 health center units, yielding 230,777 individuals. Explanatory variables were selected through stepwise, and multilevel logistic regression were conducted with smoking and e-cigarette use as dependent variables. Analyses were stratified by gender. Results: Among 105,226 men, 33.9% were smokers, 80.4% smoked traditional cigarettes, and 19.6% used e-cigarettes. Among 125,551 women, 3.8% were smokers, 75.1% smoked traditional cigarettes, and 24.9% used e-cigarettes. Common individual factors associated with smoking included living alone, sales/service jobs, high school education, middle income, poor oral health, lack of physical activity or health check-ups, binge drinking, high stress, neighborhood dissatisfaction, and low social participation. E-cigarette users were more likely to have higher socioeconomic status. Regionally, higher neighborhood trust reduced smoking for both genders. Among men, smoking was more likely in areas with higher cerebrovascular disease mortality and divorce rates, while a higher financial independence rate increased e-cigarette use. Among women, regions with larger elderly populations had lower smoking rates. Conclusion: Smoking and e-cigarette prevention and cessation programs need to consider both individual and regional factors.