Tobacco smoking remains a leading cause of preventable morbidity and mortality worldwide. It is a major risk factor for cardiovascular and cerebrovascular diseases, chronic obstructive pulmonary disease, lower respiratory infections, tuberculosis, and multiple cancers [1]. Despite continuing tobacco-control efforts, tobacco use remains an important public-health concern in Korea. According to the 2022 Korea National Health and Nutrition Examination Survey, the current smoking rate among Korean adults was 17.7%, with a marked sex disparity (males, 30.0%; females, 5.0%) [2]. Alternative nicotine products have also become increasingly visible. National data reported that liquid-type e-cigarette use among adults increased from 1.1% in 2013 to 4.5% in 2023, whereas heated tobacco products (HTPs) use changed from 6.2% in 2019 to 6.1% in 2023, indicating a slight decrease or relative stability rather than an increase [3]. E-cigarette aerosols and emissions contain toxicants associated with airway inflammation and cardiovascular risks [4,5], and dual use with conventional cigarettes further complicates cessation [6,7].

Despite growing attention to novel tobacco products, evidence regarding e-cigarette use specifically among employed female workers remains limited. Female workers represent a distinct demographic whose health behaviors are uniquely shaped by workplace environments, occupational stress, and socio-behavioral dynamics [8-12]. Furthermore, female smoking in Korea is frequently underreported due to social stigma, masking the true burden of nicotine reliance in this population [2]. A recent study using the same 2023 Community Health Survey (CHS) examined e-cigarette use among females of childbearing age, identifying employment as a significant risk factor [13]. However, that study encompassed a broad population including non-female workers, limiting specific insights into the working population [13]. By focusing exclusively on economically active females, the present study builds upon these findings to isolate population-specific determinants within the female workforce. Therefore, this study aimed to identify the sociodemographic, psychological, and health-related behavioral factors associated with current e-cigarette use among Korean female workers using representative data from the 2023 CHS.

Among the 70,552 female workers, 1,108 participants were classified as current e-cigarette users and 69,444 as non-users. The weighted prevalence of current e-cigarette use was 2.5% (Table 1). Table 2 presents the differences in current e-cigarette use according to participants’ characteristics. Current e-cigarette use was significantly associated with age and marital status, but not with educational attainment. Younger participants were more likely to use e-cigarettes: among current e-cigarette users, 46.7% were aged 19–29 years, 28.1% were aged 30–39 years, and 26.2% were aged 40 years or older (P<0.001). Single females accounted for 69.3% of current e-cigarette users, compared with 30.7% who were married (P<0.001).

Among the health-related characteristics, subjective health status was significantly associated with current e-cigarette use (P=0.008). Among current e-cigarette users, 40.6% rated their health as good, 49.5% as moderate, and 9.8% as poor. Stress was reported by 91.4% of current e-cigarette users, compared with 84.4% of non-users (P<0.001). Depressive symptoms were reported by 19.9% of current e-cigarette users and 8.0% of non-users (P<0.001). Breakfast consumption was also significantly associated with current e-cigarette use. Among current e-cigarette users, 70.2% reported eating breakfast fewer than <3 times/wk, whereas 29.8% reported eating breakfast three or more times per week (P<0.001). Current drinking was reported by 76.6% of current e-cigarette users, compared with 50.2% of non-users (P<0.001). Awareness of smoke-free areas was lower among current e-cigarette users than among non-users: 49.5% of users were aware of smoke-free areas, compared with 60.7% of non-users (P<0.001).

Table 3 presents the results of the complex-sample logistic regression analysis examining factors associated with current e-cigarette use among female workers. The final model was statistically significant (Wald F=101.680, P<0.001) and yielded a Nagelkerke pseudo-R² of 0.172. After adjustment for the covariates, marital status, educational attainment, subjective health status, stress, depressive symptoms, breakfast consumption, current drinking, awareness of smoke-free areas, and age group were significantly associated with current e-cigarette use. Age was significantly associated with e-cigarette use. Compared with females aged 40 years or older, females aged 19–29 years (OR=5.58, 95% CI=4.42–7.03) and those aged 30–39 years (OR=4.28, 95% CI=3.46–5.30) had higher odds of e-cigarette use (overall P<0.001). Compared with married females, single females had higher odds of current e-cigarette use (OR=2.07, 95% CI = 1.73–2.48, P<0.001). Females with a high school education or less had higher odds of e-cigarette use than those with a college education or higher (OR=2.62, 95% CI=2.20–3.12, P<0.001). Compared with females who reported good subjective health, those reporting poor health (OR=1.87, 95% CI=1.44–2.45) or moderate health (OR=1.57, 95% CI=1.35–1.82) had higher odds of e-cigarette use; the overall effect of subjective health status was statistically significant (P<0.001). Females who experienced stress had higher odds of e-cigarette use than those who did not (OR=1.42, 95% CI=1.12–1.78, P=0.003). Participants who reported depressive symptoms also had higher odds of e-cigarette use (OR=2.26, 95% CI=1.88–2.71, P<0.001). Females who ate breakfast two times or fewer per week had higher odds of e-cigarette use than those who ate breakfast three or more times per week (OR=2.18, 95% CI=1.85–2.56, P<0.001). Current drinkers had higher odds of e-cigarette use than non-drinkers (OR=2.29, 95% CI=1.94–2.71, P<0.001). Compared with females who were unaware of smoke-free areas, those who were aware had lower odds of current e-cigarette use (OR=0.58, 95% CI=0.49–0.65, P<0.001). Overall, current e-cigarette use was associated with younger age, single marital status, lower educational attainment, poorer subjective health, stress, depressive symptoms, infrequent breakfast consumption, and current alcohol use.

The present study investigated factors associated with current e-cigarette use among Korean female workers using data from the 2023 CHS. Younger age, marital status, educational attainment, subjective health status, psychological distress, breakfast frequency, current alcohol use, and awareness of smoke-free areas were significantly associated with e-cigarette use. Our findings both align with and meaningfully extend recent research on tobacco use among Korean females [13]. Whereas the previous study focused on females of childbearing age, the present study specifically examined economically active females and identified population-specific sociodemographic, psychological, and health-related behavioral correlates of e-cigarette use among female workers.

Younger age and single marital status showed strong positive associations with e-cigarette use, consistent with prior evidence highlighting young adults’ exposure to social media marketing and social support dynamics [15-20]. Notably, an important methodological finding emerged regarding educational attainment. While bivariate analysis indicated a higher proportion of e-cigarette users among college graduates, multivariate analysis revealed that lower educational attainment (high school or less) was independently associated with substantially higher odds of e-cigarette use. This reversal reflects a suppression effect caused by age and socio-behavioral covariates. In Korea, higher educational attainment is concentrated among younger demographics who also exhibit higher vaping rates. Once age and lifestyle factors were controlled for, lower educational attainment emerged as a true socioeconomic risk factor, aligning with literature on health literacy and resource inequalities [14].

Health status and psychological distress—including self-rated health, stress, and depression—were consistently associated with elevated odds of vaping [21,22]. Female workers facing occupational strain and gendered workplace pressures may utilize e-cigarettes as a coping mechanism. Similarly, health-risk behaviors such as breakfast skipping and current alcohol use were linked to e-cigarette use, underscoring behavioral clustering [22-24]. Conversely, awareness of smoke-free policies served as a protective factor, supporting the rigorous enforcement of workplace tobacco-free policies [1,25].

Study limitations include its cross-sectional design, reliance on self-reports susceptible to social desirability bias [2], and the lack of unmeasured workplace characteristics (e.g., job strain, working hours, shift work). Nevertheless, these findings highlight the need for comprehensive, gender-responsive, and workplace-based interventions targeting vulnerable female workers.