Factors Associated With E-Cigarette Usage and the Reasons for Initiation Among Malaysian Adolescents

Implications of nicotine vaping products for tobacco control in ASEAN low-income and middle-income countries: in-depth interviews with experts from the region

OBJECTIVES

The use of nicotine vaping products (NVPs) has increased in low-income and middle-income countries (LMICs) in the Association of Southeast Asian Nations (ASEAN) region; however, it is uncertain what implications the presence and use of NVPs have for tobacco control.

DESIGN

In-depth interviews were conducted to explore ASEAN tobacco control experts' (n=11) views on the rise of NVP use in ASEAN LMICs, current NVP policies, the potential harm reduction and smoking cessation utilities of these devices, and what implications they may have for tobacco control. Data were analysed using inductive, reflexive thematic analysis.

RESULTS

Five themes emerged: (1) NVPs threaten tobacco control in ASEAN LMICs; (2) commercial factors influence youth appeal and access: product attributes, marketing, supply chains; (3) opposition to the smoking cessation and harm reduction utilities of NVPs; (4) policies are inconsistent and fragmented in the region; and (5) tobacco industry power and tactics have been used to capture NVP markets.

CONCLUSIONS

ASEAN tobacco control experts believe that NVPs pose a threat to youth and non-smokers in LMICs in the region, largely because of tobacco industry NVP marketing activities. They do not support the use of NVPs for smoking cessation or harm reduction and call for more restrictions and consistent policy enforcement across the region to protect young people, while also cautiously recognising that use of NVPs may have some benefits for smokers.

Nicotine dependence and associated factors among persons who use electronic e-cigarettes in Malaysia - an online survey

BACKGROUND

Nicotine dependence, factors associated with dependence, and self-reported side effects among people who use e-cigarettes are scarce in developing countries.

METHODS

A sample of 302 persons who currently use e-cigarettes was recruited from discussion forums on Reddit, Facebook, and the forum 'lowyat'. The online Google form survey collected data on demographics, e-cigarette use, and the reasons, for cigarette smoking, Fagerstorm Test for Nicotine Dependence adapted for e-cigarettes (eFTND), and side effects experienced.

RESULTS

The mean age was 25.5 years (6.5), 60.6% were males and 86% had higher education. About 47% were using e-cigarettes only, 27.8% were currently using dual products (both electronic and conventional cigarettes), and 25.2% had also smoked cigarettes in the past. 'Less harmful than cigarettes' (56.3%), 'because I enjoy it' (46.7%), and 'it has a variety of flavors (40.4%) were the common reasons for e-cigarette use. The mean eFTND score was 3.9 (SD = 2.2), with a median of four side effects (IQR 3-6), sore or dry mouth/throat (41.4%), cough 33.4%, headache (20.5%), dizziness (16.2%) were commonly reported side effects. eFTND score and side effects were higher among persons using dual products. By multiple linear regression analysis, males (β = 0.56 95% CI 0.45, 1.05, p = 0.033), dual-use (β = 0.95 95% CI 0.34, 1.56, p < 0.003), and use of nicotine-containing e-cigarettes (β = 0.66 95% CI 0.07, 1.25 p = 0.024) had higher eFTND score.

CONCLUSION

Our findings of the study call for the placement of disclaimers about possible nicotine addiction and side effects of e-cigarette products.

Prevalence and Associated Factors of E-Cigarette Use among Adolescents in Southeast Asia: A Systematic Review

The use of e-cigarettes in adolescents remains a major public health concern. Like other tobacco products, e-cigarettes pose health risks to adolescents. Understanding the magnitude of this problem and identification of its associated factors will serve as a guide for development of preventive interventions. This systematic review aims to identify and discuss current epidemiological data on the prevalence and associated factors of e-cigarette use among adolescents in Southeast Asia. The reporting of this systematic review is in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. We carried out a literature search through three databases (Scopus, PubMed, Web of Science) and targeted original English-language articles published between 2012 and 2021. A total of 10 studies were included in this review. The prevalence of current e-cigarette uses ranges from 3.3% to 11.8%. Several associated factors of e-cigarette use were identified, including sociodemographic factors, traumatic childhood experience, peer and parental influence, knowledge and perception, substance use, and accessibility of e-cigarettes. These factors should be addressed though multifaceted interventions which simultaneously target multiple factors. Laws, policies, programs, and interventions must be strengthened and tailored to the needs of adolescents at risk of using e-cigarettes.

Electronic cigarette or vaping use among adolescents in the United States: A call for research and legislative action

Vaping among adolescents is increasingly common and may result in poor health outcomes; however, little research has been conducted evaluating the risks of vaping among adolescents and the knowledge and perceptions that drive use. We must gain a better understanding of vaping outcomes and adolescents' perceptions while identifying potential ways to lessen or eradicate the health burdens associated with vaping. This knowledge could then inform robust educational and public health programs to prevent and mitigate vaping among youths. Health education incorporating a target populations' world view, spheres of influence, readiness, motivation, intention, and determination promotes informed decision making. There are few resources currently being allocated to the problem even though legislators and enforcement agencies are aware. We cannot simply rely on existing laws to serve as a sufficient deterrent to prevent underaged usage. Further efforts are needed in the areas of behavioral science, health education, and public policy to tackle this urgent public health concern.

Global frequency and epidemiological profile of electronic cigarette users: a systematic review

OBJECTIVE

Electronic cigarette (e-cigarette) use is growing significantly worldwide, especially among young people. This product has been associated with renormalizing smoking and hindering quit attempts in smokers. Moreover, among nonsmokers, it can lead to subsequent cigarette smoking and nicotine dependence. The present study aimed to assess the epidemiological profile of e-cigarette users worldwide.

STUDY DESIGN

A systematic review was performed using 3 main electronic databases (Medline/PubMed, SCOPUS, and EMBASE). Studies were independently assessed by 2 reviewers based on established eligibility criteria. The risk of bias was assessed using the MAStARI critical appraisal instrument.

RESULTS

From 4,496 records, 43 were included. Among the 1,238,392 participants, 132,786 (10.72%) were e-cigarette users. The age range with the highest percentage of e-cigarette users was 18-24 years old, with 40,989 (30.86%) males, 34,875 (26.26%) females, and 33.6% being current cigarette smokers. The highest prevalence of users was 52.88% in Croatia and 49.62% in New Zealand. Other possible correlations were observed with e-cigarette use, such as a high level of education.

CONCLUSION

Overall, e-cigarette users tended to be male young adults with a higher level of education. The highest prevalence of use was found in Croatia. This systematic review provides valuable information to improve the development of appropriate intervention strategies targeting e-cigarette users for more accurate anti-smoking actions.

An International Systematic Review of Prevalence, Risk, and Protective Factors Associated with Young People's E-Cigarette Use

While the prevalence of young people's conventional cigarette use has decreased in many countries, the use of e-cigarettes has risen. To effectively counteract the growing popularity of e-cigarettes among young people internationally, researchers should know the exact prevalence as well as the protective and risk factors associated with vaping. Based on five eligibility criteria, 53 articles were chosen and analyzed by general characteristics, prevalence, sample characteristics, gender difference, protective factors, and risk factors. In this study, the international pooled prevalence of young people's lifetime e-cigarette use was 15.3%, the current use was 7.7%, and dual use was 4.0%. While the highest lifetime, current, and dual prevalence were found in Sweden, Canada, and the United Kingdom, respectively, the lowest prevalence was found in Germany, followed by South Korea and Sweden. Some protective and risk factors include perceived cost and danger of vaping, parental monitoring, internal developmental assets, cigarette use, family and peer smoking, exposure to online advertisements, and the presence of nearby retail stores. Based on this review, researchers and practitioners can develop different intervention programs and strategies for young smokers.

Personality Traits and Sociodemographic Factors Associated with the Use of E-Cigarettes, Waterpipe and Conventional Cigarettes among Medical University Students

This study aimed to investigate the prevalence and sociodemographic characteristics of smokers in a private medical university in Malaysia and to examine whether there is an association between personality traits and various smoking types. There were 468 participants in this study and the mean age was 20.97 years (±2.743). The prevalence of conventical cigarette users, e-cigarette users, and water pipe users was 4.7%, 6.4%, and 4.0%, respectively. Parents’ annual income (p = 0.001) and ethnicity (p < 0.001) were significantly associated with the current smoker group. Binary logistic regression modelling revealed that study participants with either Malay (OR 4.23, 95% CI 1.73, 10.34) or Chinese (OR 4.16, 95% CI 1.98, 8.73) ethnicity were approximately four times more likely to use tobacco products compared with study participants with Indian and Other ethnicities. Lower parents’ annual income was almost four times more likely to be associated with smoking behaviour (OR 3.82, 95% CI 1.58, 9.27). Significant differences in mean personality traits score of Openness (p = 0.018) and Extraversion (p = 0.004) were observed between never-smoker and current smoker study participants. In addition, cigarette users scored higher in Conscientiousness personality traits compared with non-cigarette whereas e-cigarette users and waterpipe users scored lower in Extraversion (p = 0.02). Post-hoc analysis revealed that the never-smoker group scored higher in Extraversion compared with the dual tobacco user group (p = 0.03). In addition, the single tobacco user group scored higher in Agreeableness personality trait compared with the never-smoker group (p = 0.01). Deeper understanding of the different cognitive dimensions, ethnicities, and educational backgrounds can potentially impact smoking prevention and cessation programs.

Correlates of dual/poly tobacco use among school-going adolescents in Malaysia: Findings from a nationwide school-based study

INTRODUCTION

Dual/poly tobacco use is common among youths globally. However, in Malaysia information on dual/poly tobacco use is scarce, thus the present study examines the prevalence and factors associated with dual/poly tobacco users among school-going adolescents in Malaysia.

METHODS

We derived data on tobacco and e-cigarette use among Malaysian adolescents from a nationwide school-based study conducted in 2016. A total of 13135 adolescents responded in the cross-sectional survey which used multi-stage sampling to select a representative sample of school-going adolescents aged 11–19 years. A standard validated questionnaire was used to obtain the data and multiple logistic regression was conducted to assess factors associated with dual/ poly tobacco use.

RESULTS

The prevalence of dual/poly tobacco use was 6.5%, more than half of which were both conventional and e-cigarette users. Multivariable logistic regression revealed that the likelihood of dual tobacco use was significantly higher among males (AOR=14.73; 95% CI: 9.11–23.81), secondary school students, those aged 16–19 years (AOR=5.99; 95% CI: 4.04–8.87), natives of Sabah (AOR=7.41; 95% CI: 3.48–15.79), and those never been taught on the health hazards of tobacco at school, exposed to secondhand smoke (SHS) at home, school or other public areas, and had a positive perception of e-cigarettes and lower perception of the harms of tobacco smoking.

CONCLUSIONS

Although the prevalence of dual/poly users was still low among Malaysian school-going adolescents, proactive measures should be taken to reduce dual tobacco use among youth in Malaysia with focus on the factors identified in this study.

Current e-cigarette use among in-school adolescents in West Malaysia: Examining the interactions between sociodemographic characteristics and lifestyle risk behaviours

Background

Adolescent e-cigarette use has increased dramatically. Most e-cigarette liquids contain nicotine, which can harm the developing adolescent brain. Local studies examining the risk factors of adolescent e-cigarette use and interactions between its risk factors are limited. This study was aimed at determining the prevalence of current e-cigarette use and its associated factors among in-school adolescents in West Malaysia. We also examined the possible sociodemographic characteristic, lifestyle risk behaviour and parental factor interactions that affect the probability of current e-cigarette use.

Methods

We conducted a cross-sectional study using data from the National Health and Morbidity Survey 2017. Respondents aged 13–18 years were included in the study. The data were analysed using STATA (v.15).

Results

The prevalence of current e-cigarette use was 9.1%. Male gender, older age, Malay ethnicity, schooling in urban area, current smoking, current alcohol use, current drug use, having parents that are not married and living together and parental tobacco product use were significantly associated with current e-cigarette use. There were significant interactions between: i) gender with age, ethnicity, current smoking, current alcohol use and current drug use, ii) ethnicity with current smoking and current alcohol use, iii) locality with ethnicity, current smoking and current alcohol use, iv) current drug use with age, ethnicity, current smoking and current alcohol use, v) parental marital status with gender, age and ethnicity, and vi) parental tobacco use with ethnicity and current smoking.

Conclusion

Our findings identify significant associations between sociodemographic characteristics, lifestyle risk behaviours and parental factors with current e-cigarette use. They also provide new insight into the interactions between these factors that affect the probability of current e-cigarette use among West Malaysian adolescents. Efforts to tackle e-cigarette use in Malaysian adolescents should target sociodemographic characteristics, lifestyle risk behaviours and parental factors such as smoking cessation intervention for parents.

Susceptibility to e-cigarette initiation among tobacco product naïve adolescents in Malaysia: Findings from the tobacco and e-cigarette survey among Malaysian adolescents (TECMA)

INTRODUCTION

Predicting susceptibility to e-cigarette (EC) initiation among adolescents is crucial to optimize preventive measures before the health risk behavior persists through adulthood. The identification of susceptible groups is needed in response to the surge of EC use. This study aimed to determine the prevalence and determinants associated with EC susceptibility among tobacco product naïve (never users of any single tobacco product) school-going adolescents in Malaysia.

METHODS

Data were derived from the Tobacco and EC Survey among Malaysians (TECMA), which recruited a total of 13162 school-going adolescents aged 10– 19 years from 138 randomly selected schools via a two-stage stratified cluster sampling design. A validated self-administered questionnaire adapted from the Global Youth Tobacco Survey was utilized as the study instrument. The data were analyzed using SPSS version 22.0 descriptively and with multivariable logistic regression to determine the associated factors of EC susceptibility.

RESULTS

About 15.7% of the tobacco naïve adolescents were susceptible to EC initiation, with the proportion of susceptibility significantly higher among males, mid-adolescents, rural adolescents, those reporting exposure to tobacco advertisement and those not taught in school about the danger of tobacco use. Multivariable logistic regression revealed that the male students (AOR=2.20; 95% CI: 1.86–2.59) from a rural locality (AOR=1.45; 95% CI: 1.23–1.71), those reporting no lessons on the danger of tobacco use at school (AOR=1.66; 95% CI: 1.39–1.99) and those exposed to tobacco advertisement (AOR=1.67; 95% CI: 1.07–2.61), were more susceptible to EC initiation, while no significant association was found between secondhand smoke exposure and EC susceptibility.

CONCLUSIONS

Comprehensive EC preventive strategies are critically needed together with the implementation of targeted, gender, and culturally impressionable interventions. In addition, future studies should focus on the evaluation of the impacts of the preventive and control efforts to ensure their effectiveness in preventing EC initiation among Malaysian adolescents.