E-cigarette use among female Chinese Indonesian college students in China: A qualitative interpretive phenomenological analysis from an acculturation perspective

INTRODUCTION: International students navigate health behaviors across different cultural and regulatory environments, yet their e-cigarette use remains understudied. This qualitative study explores e-cigarette use among female Chinese Indonesian college students in China, examining how acculturation experiences and gendered social norms shape vaping behaviors. METHODS: This qualitative study was conducted at a university in Fujian Province, China, in October 2024, employing Interpretive Phenomenological Analysis (IPA). Three female Chinese Indonesian college students (aged 18-21 years) were purposively selected from a larger survey (n=45) based on Indonesian nationality with Chinese ancestry, female gender, current e-cigarette use, and willingness to participate. Semi-structured interviews were supplemented by questionnaire data assessing acculturation difficulties, psychological well-being (CES-D-10), and social support. Analysis followed Smith's IPA procedures with Berry's acculturation framework as an interpretive lens. RESULTS: Four main themes emerged: 1) Social initiation and peer-embedded use - initiated through peer influence in Indonesian high schools and maintained within co-national networks in China; 2) Acculturation stressors without stress-coping use - participants described e-cigarette use as unrelated to academic pressure, language barriers, and loneliness; 3) Navigating gendered social norms - China was perceived as more permissive, with use concealed from families; and 4) Habituated practice and flavor preferences - use was framed as habit, with fruit flavor preferences driving cross-border sourcing. CONCLUSIONS: E-cigarette use among these students appears to be shaped by peer socialization and habit formation rather than acculturative stress; future longitudinal, multi-site studies with larger samples are needed to examine these patterns among broader international student populations.