Abstract: Excise tax policies are increasingly used to regulate e-cigarette consumption, but their impact on consumer behavior remains complex. Understanding how these policies influence attitudes and purchasing decisions is essential for effective regulation and public health strategies. While prior studies have examined taxation effects, fewer have explored the roles of consumer awareness, fairness perceptions, affordability concerns, and government intent in shaping attitudes and repurchase intentions. This study analyzes how excise tax implementation affects consumer perceptions and behavior regarding e-cigarettes. Using a quantitative research design, data were collected and examined through regression analysis and correlation matrices to assess relationships between key factors. Consumer awareness emerged as the most significant influence on attitudes toward e-cigarette consumption, with fairness and affordability playing lesser roles. The government’s intent was found to have the weakest impact. Additionally, attitude was the strongest predictor of repurchase intention, with fairness and awareness also affecting purchasing behavior indirectly. Findings suggest that taxation alone may not effectively influence consumer behavior. A combination of fair tax policies, affordability considerations, and, most critically, awareness campaigns can improve consumer perceptions and promote responsible purchasing decisions. Policymakers should prioritize educational initiatives to inform consumers about the rationale and benefits of excise tax policies, ensuring that such measures are viewed as fair and justifiable. Integrating taxation with consumer education can create informed and responsible consumption patterns.