Awareness and Prevalence of Electronic Cigarettes Among Adults in Pakistan: An Appraisal

INTRODUCTION:

The tobacco pandemic has stood as a formidable challenge to global public health and classifies as one of the most significant threats encountered by humanity1 . Not only is it the leading cause of preventable deaths2 , but it is responsible for causing more deaths than HIV, and illegal drug and alcohol use combined.3 Tobacco can be smoked (cigarettes, bidis), chewed (snuff, dip), and sniffed. Recently, battery-operated devices known as electronic cigarettes, also known as Electronic Nicotinic Delivery Systems (ENDS) or E-cigarettes, have entered the market and deliver nicotine along with flavorings and other compounds to the lungs in vapor form rather than smoke.4 Because they don’t burn tobacco, e-cigarette firms frequently promote them as being safer than traditional cigarettes. However, since these devices contain nicotine which comes from tobacco, they are still classified as tobacco products according to the Food and Drug Administration in the United States.4

There has been a slow but steady rise in the use of electronic -cigarettes among the public with different justifications for their motivation, such as in aiding smoking cessation efforts and providing a means to consume nicotine in smoke-free environments.5,6

Currently, the prevalence of tobacco uses among the youth (ages 13-15 years) in Pakistan is estimated to be 10.7% use any form of tobacco (boys 13.3% girls 6.6%).25 Tobacco control policies in the country at present, Smoking is prohibited in all places of public work or use, and on all public transport. Ban on advertising and promotional activities from tobacco manufacturers and retailers, however, a breeches in the law permits advertising activities to consenting adults. In addition, except in designated smoking areas (hotel guest rooms), all forms of smoking are prohibited in indoor public places and outdoor social venues, buses, trains and restaurants. Similarly, young Taiwanese men exhibited an upward trend in current e-cigarette use, with rates climbing from 2.5% in 2014 to 6.4% in 2017.8 European countries also displayed varying levels of ever e-cigarette use, ranging from 17% to 62%.9 This is somewhat alarming as recent studies have shown the adverse effects of e-cigarette use on human health which are known to cause respiratory and cardiovascular disease.10

Examining the frequency of e-cigarette utilization will help in understanding the track of this matter while recognizing the association to e-cigarette use will facilitate for aiming the high utilization of e-cigarette. Therefore, his paper will aim to systematically analyze and present the levels of perceptions and knowledge of e-cigarettes with subjects of multiple age groups and professions in order to understand the different levels of beliefs at each level.

PREVALENCE AND ASSOCIATED FACTORS:

Studies in Pakistan revealed that most of the people were have less information of what E- cigarettes are there was no proper knowledge along with negative feedback towards e-cigarette use in Pakistan due to cultural and social disgraces and lack of publicity. Males and females had significant differences in their views regarding e-cigarette use due to such social practices being measured offensive by females and males having greater freedom due to familial and cultural systems.25 Several studies have examined the frequency of vape and electronic cigarette in Saudi university use among diverse people. In a Saudi Arabian university, a study conducted among medical students revealed a more frequency of electronic cigarette and vape use at 12.2%.11 This study also found that males were more likely to engage in vaping compared to females.12 It is value observing that maximum partakers in this research not agree with belief that electronic nicotine are not so much hazardous than traditional cigarettes or effective in helping in quitting smoking.11,12 In Malaysia, the overall frequency of electronic cigarette practice was reported to be 3.2%.13 A research conducted Malaysia emphasized that prevailing electronic nicotine smokers were more likely to be youth and teenager, male, of higher education which concluded that elements and demographic factors strongly involved to the likelihood of e-cigarette use.

KNOWLEDGE AND PERCEPTIONS:

Numerous studies have highlighted on the facts and figures of electronic cigarette among different people. In Jazan University, Saudi Arabia, it has been discovered through research that students unsuccessful to identify the hazards associated with e-cigarettes.14 This finding advocates a lack of awareness regarding the problems of e-cigarette use among this target population. Therefore, there is an essential need for targeted strategies to improve students’ knowledge of Pros and cons of using e-cigarettes.14

In China, the utilization of vape and electronic smoking device among young adult was not so much in trend knowledge of harms of these devices was more prevalent.15 Furthermore, this study exposed a positive association between awareness of e-cigarettes and aim to use tobacco. These facts and figures emphasis the importance of lighting the awareness and notion of e-cigarettes as part of complete tobacco control policies. Amongst allied health students, research emphasized disparities of information regarding e- cigarettes.16 This suggests the need of academic drive to train healthcare professionals with correct and latest knowledge about e-cigarettes.

REASONS FOR USE AND PERCEPTIONS:

Considering the reason about use of vape and the observations enclosed is critical for scheming active public health involvements. Studies have recognized common causes reveals by individuals for using e-cigarettes, including variable taste essence, quitting tobacco, and relaxation in public smoking rules and regulations.11,13,14 Which reveals for the trend of electronic smoking device as a substitute to traditional smoking and as a possible to stop smoking cessation However, conflicting perceptions exist regarding the comparative adverse effect of e- cigarettes and traditional cigarettes and their effectiveness for smoking cessation. A study conducted in Northern England aimed to explore adults’ perceptions of e-cigarettes.17 These perceptions effect individuals’ behavior towards e-cigarettes and may affect their choice to use or not to use these tools.16

DISCUSSION:

The findings of this literature review show that although students were knowledgeable about the existence of electronic cigarettes, their utilization was not as widespread among the surveyed groups. It has been discovered that there were some restriction regarding using e-cigarettes smokers in Pakistan Although the strength of females participating in the study in Pakistan was less, possibly due to cultural biases leading to women refusing to participate or resulting in lesser number of women smoking, the ratio of male-to-female smokers was in accordance with the general trend observed in Pakistan.23 another study among dental undergraduate students in Jazan, Saudi Arabia showed an awareness of 91.9%14 whereas other similar studies also showed a similar high awareness score of 99.5% and 99.2% respectively.12,16 However, not many students reported the use of e-cigarettes. This could be attributed to the level of education. A study revealed that there was a negative correlation between e-cigarette use and educational attainment among young adults. In other words, higher levels of education appeared to act as a protective factor against e-cigarette use, even after considering other influencing factors.18

A study among medical students at Alfaisal University in Riyadh, Saudi Arabia showed a prevalence of 12.2% and another one showed a prevalence of 21.2% among healthcare students in the US.11,12 Furthermore, there was a slight discrepancy in determining whether e-cigarette users were mostly tobacco users. In contrast to the findings of Cataldo et al.19 and Lotrean20, which indicated that electronic cigarette users were primarily tobacco smokers, one study revealed that nearly 50% of students who experimented with electronic cigarettes were non-smokers.12 Hence, while a prior smoking history may contribute to the utilization of e-cigarettes, it is not a definitive factor that solely determines an individual’s decision to use these devices or not E-cigarettes have been heavily marketed as devices that can aid in smoking cessation. There was no clear consensus on whether students believed vaping can help in smoking cessation as studies showed a variable response of 46.9%,13.9% 41.6%.11,12,21 This variation in results indicates that there is a pressing need for not just medical students but those of all disciplines to receive education regarding vaping patterns and their association with tobacco smoking cessation. It is important to note that the FDA has not approved these devices for the purpose of quitting smoking.14

Participants from the other than allied health sciences exhibited significantly have more clear concept than the allied health programs.16 However, the average scores within each of these groups were less than 75%, exhibiting significant gaps in knowledge regarding e-cigarettes even among the higher level of knowledge participants.17 Similarly, in another study done in Nigeria focusing on young adults, varying levels of knowledge between 57% to 79% were reported.22,23,24,25 Thus, it is essential to develop and implement additional educational opportunities within all forms of the professional curriculum. The poor knowledge among the study population from certain programs may be accredited, in part, to the various choice of degree programs offered within a college.

CONCLUSION:

This literature review has provided insights into the prevalence, associated factors, knowledge, and concept of electronic smoking device in teenager and youth among different countries the evidences help to emphasize the need for targeted educational interventions to improve knowledge and awareness, particularly among healthcare students and the general population. Addressing misconceptions about the relative harm and effectiveness of e-cigarettes for smoking cessation are essential. Continued research and tracking of electronic device utilization evaluating the effectiveness of interventions which are essential to overcome possible public health risks related to e-cigarette use among these susceptible individuals.

CONFLICT OF INTEREST:

None declared

REFERENCES:

1. Ranabhat CL, Kim CB, Park MB, Jakovljevic MM. Situation, Impacts, and Future Challenges of Tobacco Control Policies for Youth: An Explorative Systematic Policy Review. Front Pharmacol. 2019;10:981. https://doi.org/10.3389/fphar.2019.00981
2. National Center for Chronic Disease P, Health Promotion Office on S, Health. Reports of the Surgeon General. The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2014.
3. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. J Am Med Assoc. 2004;291:1238- 45. https://doi.org/10.1001/jama.291.10.1238
4. Niaura R. E-Cigarette Science and Its Relevance for Regulatory Actions and Policy. Nicotine Tob Res. 2018;20:911. https://doi.org/10.1093/ntr/nty091
5. Pepper JK, Ribisl KM, Emery SL, Brewer NT. Reasons for starting and stopping electronic cigarette use. Int J Environ Res Public Health. 2014;11:10345-61. https://doi.org/10.3390/ijerph111010345
6. Brown J, West R, Beard E, Michie S, Shahab L, McNeill A. Prevalence and characteristics of e-cigarette users in Great Britain: Findings from a general population survey of smokers. Addict Behav. 2014;39:1120-5. https://doi.org/10.1016/j.addbeh.2014.03.009
7. Khan JA, Amir Humza Sohail AM, Arif Maan MA. Tobacco control laws in Pakistan and their implementation: A pilot study in Karachi. J Pak Med Assoc. 2016;66:875.
8. Wayne G, Mattia S, Enkhzaya C, Min-Kuang T, David TL, Chi Pang W. Are e-cigarettes reviving the popularity of conventional smoking among Taiwanese male adolescents? A time-trend populationbased analysis for 2004-2017. Tob Control. 2021;30:132. https://doi.org/10.1136/tobaccocontrol-2019-055310
9. Goniewicz ML, Zielinska-Danch W. Electronic cigarette use among teenagers and young adults in Poland. Pediatrics. 2012;130:e879-85. https://doi.org/10.1542/peds.2011-3448
10. Gotts JE, Jordt SE, McConnell R, Tarran R. What are the respiratory effects of e-cigarettes? BMJ (Clin Res ed). 2019;366:l5275. https://doi.org/10.1136/bmj.l5275
11. Habib E, Helaly M, Elshaer A, Sriwi D, Ahmad MS, Mohamed MI, et al. Prevalence and perceptions of e-cigarette use among medical students in a Saudi University. J Fam Medi Primary Care. 2020;9:3070- 5. https://doi.org/10.4103/jfmpc.jfmpc_235_20
12. Alanazi AMM, editor The Prevalence of Use, Awareness and Beliefs of Electronic Cigarettes Among College-Based Health Care Students At A Southeastern Urban University 2016.
13. Ab Rahman J, Mohd Yusoff MF, Nik Mohamed MH, Mahadir Naidu B, Lim KH, Tee GH, et al. The Prevalence of E-Cigarette Use Among Adults in Malaysia. Asia Pacific J Public Health. 2019;31(7_suppl):9S-21S. https://doi.org/10.1177/1010539519834735
14. Aqeeli AA, Makeen AM, Al Bahhawi T, Ryani MA, Bahri AA, Alqassim AY, et al. Awareness, knowledge and perception of electronic cigarettes among undergraduate students in Jazan Region, Saudi Arabia. Health Soc Care Community. 2022;30:706-13. https://doi.org/10.1111/hsc.13184
15. . Xiao L, Parascandola M, Wang C, Jiang Y. Perception and Current Use of E-cigarettes Among Youth in China. Nicotine & Tobacco Research : Official J Soc Res Nicotine Tob. 2019;21:1401-7. https://doi.org/10.1093/ntr/nty145
16. Franks AM, Hawes WA, McCain KR, Payakachat N. Electronic cigarette use, knowledge, and perceptions among health professional students. Currents in pharmacy teaching & learning. 2017;9:1003-9. https://doi.org/10.1016/j.cptl.2017.07.023
17. Arshad H, Jackson SE, Kock L, Ide-Walters C, Tattan-Birch H. What drives public perceptions of e-cigarettes? A mixed-methods study exploring reasons behind adults’ perceptions of e-cigarettes in Northern England. Drug and Alcohol Dependence. 2023;245:109806. https://doi.org/10.1016/j.drugalcdep.2023.109806
18. Cheekati A. The prevalence of e-cigarette use according to educational attainment among young adults in the population Assessment of Tobacco and Health (PATH) Study.
19. Cataldo JK, Petersen AB, Hunter MM, Wang JB, Sheon NM. Ecigarette marketing and older smokers: road to renormalization. Am J Health Behav. 2015;39 3:361-71. https://doi.org/10.5993/AJHB.39.3.9
20. Morrell HE, Cohen LM, Dempsey JP. Smoking prevalence and awareness among undergraduate and health care students. Am J Addicti. 2008;17:181-6. https://doi.org/10.1080/10550490802019899
21. Abo-Elkheir OI, Sobh E. Knowledge about electronic cigarettes and its perception: a community survey, Egypt. Respira Res. 2016;17:58. https://doi.org/10.1186/s12931-016-0365-0
22. Erinoso O, Oyapero A, Amure M, Osoba M, Osibogun O, Wright K, et al. Electronic cigarette use among adolescents and young adults in Nigeria: Prevalence, associated factors and patterns of use. PloS one. 2021;16:e0258850. https://doi.org/10.1371/journal.pone.0258850
23. . Saima Asim MHSNAAPSMN. Evaluating The Prevalence Of Vaping (E-Cigarettes) And Associated Factors Among Private / Public College Students Of Karachi. J Pharmaceu Neg Resul. 2023:415-22.
24. Sarfraz M, Rahim Khan HA, Urooba A, Manan Z, Irfan O, Nadeem R, et al. Awareness, use and perceptions about E-cigarettes among adult smokers in Karachi, Pakistan. J Pak Med Assoc. 2018;68:147- 53.
25. Shaikh A, Ansari HT, Ahmad Z, Shaikh MY, Khalid I, Jahangir M, et al. Knowledge and Attitude of Teenagers Towards Electronic Cigarettes in Karachi, Pakistan. Cureus. 2017;9:e1468. https://doi.org/10.7759/cureus.1468