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Introduction Electronic cigarettes (e-cigarettes) are new smoking devices that have gained popularity recently. However, there is limited evidence on e-cigarette consumption in Malaysia. This study aims to determine the prevalence, risk factors and perception associated with e-cigarette use among those attending government hospitals and health clinics in Malaysia. Methods A cross-sectional hospital-based study was conducted in seven public hospitals and health clinics in Malaysia, which were selected through a twostage cluster sampling. A validated questionnaire was used to obtain data from the selected participants. Multivariable logistic regression was employed to determine the association between sociodemographics and perceptions of e-cigarette use. Results Almost three-quarters (73.6%; n=923/1254) of participants were aware of e-cigarettes and 13.2% (n=122/923) reported having ever used e-cigarettes. The prevalence was significantly higher among males (18.1%), smokers (21.4%), and younger age group 18–34 years (30.2%). Ever users showed favourable perceptions towards e-cigarettes compared to non-users (23.3% vs 30.14%, p