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  1. Fulltext Awareness, trial, and current use of electronic cigarettes in 10 countries: Findings from the ITC project
    Gravely S, Fong GT, Cummings KM, Yan M, Quah AC, Borland R, et al.
    Int J Environ Res Public Health, 2014 Nov 13;11(11):11691-704.
    PMID: 25421063 DOI: 10.3390/ijerph111111691
    BACKGROUND: In recent years, electronic cigarettes (e-cigarettes) have generated considerable interest and debate on the implications for tobacco control and public health. Although the rapid growth of e-cigarettes is global, at present, little is known about awareness and use. This paper presents self-reported awareness, trial and current use of e-cigarettes in 10 countries surveyed between 2009 and 2013; for six of these countries, we present the first data on e-cigarettes from probability samples of adult smokers.

    METHODS: A cross-sectional analysis of probability samples of adult (≥ 18 years) current and former smokers participating in the International Tobacco Control (ITC) surveys from 10 countries. Surveys were administered either via phone, face-to-face interviews, or the web. Survey questions included sociodemographic and smoking-related variables, and questions about e-cigarette awareness, trial and current use.

    RESULTS: There was considerable cross-country variation by year of data collection and for awareness of e-cigarettes (Netherlands (2013: 88%), Republic of Korea (2010: 79%), United States (2010: 73%), Australia (2013: 66%), Malaysia (2011: 62%), United Kingdom (2010: 54%), Canada (2010: 40%), Brazil (2013: 37%), Mexico (2012: 34%), and China (2009: 31%)), in self-reports of ever having tried e-cigarettes (Australia, (20%), Malaysia (19%), Netherlands (18%), United States (15%), Republic of Korea (11%), United Kingdom (10%), Brazil (8%), Mexico (4%), Canada (4%), and China (2%)), and in current use (Malaysia (14%), Republic of Korea (7%), Australia (7%), United States (6%), United Kingdom (4%), Netherlands (3%), Canada (1%), and China (0.05%)) [corrected].

    CONCLUSIONS: The cross-country variability in awareness, trial, and current use of e-cigarettes is likely due to a confluence of country-specific market factors, tobacco control policies and regulations (e.g., the legal status of e-cigarettes and nicotine), and the survey timing along the trajectory of e-cigarette awareness and trial/use in each country. These ITC results constitute an important snapshot of an early stage of what appears to be a rapid progression of global e-cigarette use.
    Matched MeSH terms: Electronic Cigarettes*; Electronic Cigarettes/psychology*; Electronic Cigarettes/utilization*
  2. Fulltext Correction: Gravely, S., et al. Awareness, Trial, and Current Use of Electronic Cigarettes in 10 Countries: Findings from the ITC Project. Int. J. Environ. Res. Public Health 2014, 11, 11691-11704
    Gravely S, Fong GT, Cummings KM, Yan M, Quah AC, Borland R, et al.
    Int J Environ Res Public Health, 2015 May;12(5):4631-7.
    PMID: 25922990 DOI: 10.3390/ijerph120504631
    The authors wish to make the following amendments to their paper published in International Journal of Environmental Research and Public Health.
    Matched MeSH terms: Electronic Cigarettes*
  3. Fulltext E-cigarettes: facts and legal status
    Sinniah D, Khoo EJ
    International e-Journal of Science, Medicine & Education, 2015;9(3):10-19.
    MyJurnal
    The sale of tobacco-based cigarettes has declined in western countries, and ‘Big Tobacco’ is trying to make up the deficit in profits from the developing world. The recent introduction of e-cigarette, in which they have invested both their hopes and their finances, has been a boon to them as it serves to confuse smokers and non-smokers about the real issues relating to the toxicity, dangers, and the promotion of nicotine addiction especially among youths who have not previously smoked cigarettes. E-cigarettes cause inflammation and damage to epithelial cells in human airways and increased risk of infection. E-cigarette vapour contains more carcinogens like formaldehyde and acetaldehyde compared to a regular cigarette. Longterm vaping is associated with an incremental lifetime cancer risk. E-cigarettes are neither safe nor effective in helping smokers quit; there is enough evidence to caution children, adolescents, pregnant women, and women of reproductive age about e-cigarette’s potential for long term consequences to foetal and adolescent brain development that sub-serve emotional and cognitive functions. The nicotine effects that cause modification of late CNS development constitute a hazard of adolescent nicotine use. The American Heart Association (AHA), Food and Drug Administration (FDA), World Health Organisation (WHO) and two-thirds of the major nations in the world discourage the promotion of e-cigarettes as an alternative to proven nicotine-addiction treatments. Doctors, health care workers, and medical students should be armed with the facts about e-cigarettes, its dangers, and the legal status concerning its use, in order to be able to offer proper counselling to patients and adolescents, in particular, with special reference to the Malaysian context.
    Matched MeSH terms: Electronic Cigarettes*
  4. Fulltext Awareness and current use of electronic cigarettes in Indonesia, Malaysia, Qatar, and Greece: Findings From 2011-2013 Global Adult Tobacco Surveys
    Palipudi KM, Mbulo L, Morton J, Mbulo L, Bunnell R, Blutcher-Nelson G, et al.
    Nicotine Tob Res, 2016 Apr;18(4):501-7.
    PMID: 25895951 DOI: 10.1093/ntr/ntv081
    INTRODUCTION: Increases in electronic cigarette (e-cigarette) awareness and current use have been documented in high income countries but less is known about middle and low income countries.
    METHODS: Nationally representative household survey data from the first four Global Adult Tobacco Surveys to assess e-cigarettes were analyzed, including Indonesia (2011), Malaysia (2011), Qatar (2013), and Greece (2013). Correlates of e-cigarette awareness and current use were calculated. Sample sizes for Greece and Qatar allowed for further analysis of e-cigarette users.
    RESULTS: Awareness of e-cigarettes was 10.9% in Indonesia, 21.0% in Malaysia, 49.0% in Qatar, and 88.5% in Greece. In all four countries, awareness was higher among male, younger, more educated, and wealthier respondents. Current e-cigarette use among those aware of e-cigarettes was 3.9% in Malaysia, 2.5% in Indonesia, 2.2% in Greece and 1.8% in Qatar. Across these four countries, an estimated 818 500 people are currently using e-cigarettes. Among current e-cigarette users, 64.4% in Greece and 84.1% in Qatar also smoked cigarettes, and, 10.6% in Greece and 6.0% in Qatar were never-smokers.
    CONCLUSIONS: E-cigarette awareness and use was evident in all four countries. Ongoing surveillance and monitoring of awareness and use of e-cigarettes in these and other countries could help inform tobacco control policies and public health interventions. Future surveillance should monitor use of e-cigarettes among current smokers and uptake among never-smokers and relapsing former smokers.
    Study name: Global Adults Tobacco Survey (GATS-2011)
    Matched MeSH terms: Electronic Cigarettes*; Electronic Cigarettes/trends*; Electronic Cigarettes/utilization
  5. Fulltext Front to back ocular injury from a vaping-related explosion
    Khairudin MN, Mohd Zahidin AZ, Bastion ML
    BMJ Case Rep, 2016 Apr 05;2016.
    PMID: 27048399 DOI: 10.1136/bcr-2016-214964
    We describe a case of extensive ocular injury secondary to an electronic cigarette (e-cigarette)-related explosion. The explosion was the result of modifications made to a heating element of the e-cigarette device by a non-professional. Extensive ocular injuries that result from an explosion of an e-cigarette device can potentially cause significant and permanent visual impairment.
    Matched MeSH terms: Electronic Cigarettes/adverse effects*
  6. Clearing the clouds-Malaysia's vape epidemic
    Ganasegeran K, Rashid A
    Lancet Respir Med, 2016 11;4(11):854-856.
    PMID: 27743870 DOI: 10.1016/S2213-2600(16)30314-9
    Matched MeSH terms: Electronic Cigarettes/statistics & numerical data*
  7. Reasons for using electronic cigarettes and intentions to quit among electronic cigarette users in Malaysia
    Wong LP, Mohamad Shakir SM, Alias H, Aghamohammadi N, Hoe VC
    J Community Health, 2016 Dec;41(6):1101-1109.
    PMID: 27147418 DOI: 10.1007/s10900-016-0196-4
    The rapidly increasing uptake of e-cigarettes in Malaysia as of late demands a study to identify factors leading to its increased popularity and user intentions to quit smoking e-cigarettes. A convenience sample of e-cigarette smokers visiting e-cigarette retail shops in Selangor and Kuala Lumpur was recruited. The majority of e-cigarette smokers were youth in colleges or universities (39 %), and young professionals and managers (36 %). The main reasons for using e-cigarettes were to help the user quit tobacco cigarettes (88 %), the perception that e-cigarettes are not as intrusive as tobacco cigarettes (85 %) and can be used in public areas (70 %), the perception that e-cigarettes are healthier than tobacco cigarettes (85 %), and its relatively lower cost compared to tobacco cigarettes (65 %). A total of 65.3 % of respondents expressed intentions to quit e-cigarettes. In a multivariate analysis, the respondents who earned monthly income of RM1000 or less were significantly more likely to intend to quit smoking e-cigarettes [OR 1.551; 95 % CI 1.022-2.355; p = 0.015] compared to the respondents who earned a monthly income of more than RM2000. The respondents who disagreed with the statement 'Smoking e-cigs is relatively cheaper compared to tobacco cigarettes' were significantly more likely to intend to quit smoking e-cigarettes [OR 1.548; 95 % CI 1.045-2.293; p = 0.027] compared to respondents who did not agree. e-cigarette preventive interventions should target areas related to the identified main reasons for using e-cigarettes, namely as an aid for quitting tobacco cigarettes, the perception that e-cigarettes are not as intrusive as tobacco cigarettes and can be used in public areas, the idea that e-cigarettes are healthier than tobacco cigarettes, and its relatively lower cost compared to tobacco cigarettes.
    Matched MeSH terms: Electronic Cigarettes; Electronic Cigarettes*
  8. Fulltext Familiarity, perception, and reasons for electronic-cigarette experimentation among the general public in Malaysia: Preliminary insight
    Elkalmi RM, Bhagavathul AS, Ya'u A, Al-Dubai SA, Elsayed TM, Ahmad A, et al.
    J Pharm Bioallied Sci, 2016 Jul-Sep;8(3):240-7.
    PMID: 27413354 DOI: 10.4103/0975-7406.180768
    OBJECTIVES: The objectives of this study were to assess the general public views and familiarity toward electronic cigarette (e-cigarette) in Kuantan, Malaysia.
    METHODOLOGY: A total of 277 Kuantan people were involved in this study. The questionnaire was distributed at random in shops, businesses, and public places in Kuantan. Statistical analysis was performed using SPSS (version 17.0).
    RESULTS: From 400 participants, a total number of 277 (160, 57.7% men and 117, 42.4% women) respondents completed the questionnaire. The mean age was 26.89 ± 9.8 years old. The majority of the study participants were male (57.7%), Malay (83.8%), Muslims (83.8%), singles (69%), and employed (75.8%), with about 83 (29.9%) of the respondents were smokers. The prevalence of e-cigarettes smokers was found to be only 1.4% (n = 4). About one-third of the respondents (n = 72, 26%) have tried e-cigarette before. Job status was significantly associated with smoking e-cigarette among the population (P = 0.02). Main factors for a person to start e-cigarette smoking were curiosity (37.5%) and cheaper price (40.8%). Majority of respondents agreed that e-cigarette would not affect health as normal cigarette, and that variety of flavors contribute to better enjoyment (51.6% and 66.7%, respectively).
    CONCLUSION: The results of the current study demonstrate that the prevalence of e-cigarettes smoking and its popularity, familiarity, and knowledge are still insufficient among Kuantan population. Further studies should be done to tackle this problem before it getting worse.
    KEYWORDS: Electronic-cigarette; Malaysia; experimentation; perception; prevalence
    Comment in: Farsalinos KE, Le Houezec J. Electronic cigarette experimentation in the Malaysian city of Kuantan: Was there an association with the smoking status? J Pharm Bioallied Sci. 2016 Oct-Dec;8(4):347-348
    Matched MeSH terms: Electronic Cigarettes*
  9. Fulltext Electronic cigarette experimentation in the Malaysian city of Kuantan: Was there an association with the smoking status?
    Farsalinos KE, Le Houezec J
    J Pharm Bioallied Sci, 2016;8(4):347-348.
    PMID: 28216962 DOI: 10.4103/0975-7406.199341
    Comment on: Elkalmi RM, Bhagavathul AS, Ya’u A, Al-Dubai SA, Elsayed TM, Ahmad A, et al. Familiarity, perception, and reasons for electronic-cigarette experimentation among the general public in Malaysia: Preliminary insight. J Pharm Bioallied Sci. 2016;8:240–7
    Matched MeSH terms: Electronic Cigarettes*
  10. Fulltext Tobacco & E-cigarette Survey Among Malaysian Adolescent (TECMA) 2016
    Aris T, Abd Ghani AA, Mohd Yusoff MF, Robert TG, Tee GH, Mohd Hasri NH, et al.
    ISBN: 978-983-2387-30-5
    Citation: Aris T, Abd Ghani AA, Mohd Yusoff MF, Robert TG, Tee GH, Mohd Hasri NH, et al. Tobacco & E-cigarette Survey Among Malaysian Adolescent (TECMA) 2016. Kuala Lumpur: Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia; 2016
    Matched MeSH terms: Electronic Cigarettes*
  11. E-cigarette users' attitudes on the banning of sales of nicotine e-liquid, its implication on e-cigarette use behaviours and alternative sources of nicotine e-liquid
    Wong LP, Alias H, Agha Mohammadi N, Ghadimi A, Hoe VCW
    J Community Health, 2017 Dec;42(6):1225-1232.
    PMID: 28589268 DOI: 10.1007/s10900-017-0374-z
    The banning of sales of nicotine e-liquid in e-cigarette shops has been implemented in several states in Malaysia. The distribution of nicotine e-liquid can only be allowed by licensed pharmacies or registered medical practitioners. This study aimed to evaluate e-cigarette users' responses to the control policy in a cross-sectional survey of 851 e-cigarette users by utilizing a self-report questionnaire that assessed (1) attitudes on regulation policy of e-cigarette banning; (2) e-cigarette use behaviors; and (3) sources of e-liquid after the regulation policy has been implemented. Participants from the state of Selangor where the banning policy was implemented were surveyed. The majority (95.8%) opposed the banning and believed e-cigarettes should be sold to anyone aged 18 years or above as with tobacco cigarettes, only a minority believed that nicotine e-liquid should only be available for sale over the counter in pharmacy stores (14.6%) and in clinics with a doctor's prescription (11.8%). The majority (44.2%) reported that they would continue their e-cigarette use as before the banning policy, while 20% plan to completely stop e-cigarette usage without replacing it with any alternatives. The vast majority (87.9%) was still able to obtained nicotine e-liquid from e-cigarette shops in spite of the ban and the second most common source was from online purchase (63.1%). The sales of nicotine e-liquid from black-market were evidenced as many reported obtaining zero nicotine e-liquid from the black market (54.4%). Self- or home-made (30.8%) nicotine e-liquid was also reported. Majority of respondents that self-made e-liquid were from the average monthly income group (below MYR3000). Obtaining nicotine from the pharmacy was least preferred (21.4%). Provision of professional advice to nicotine e-liquid users along with the ban may lessen the likelihood of users switching to tobacco cigarettes or other nicotine alternatives. Banning of sales of nicotine e-liquid in e-cigarette shops resulted in a boom in the black market supplying nicotine e-liquid and, self- or home-made nicotine e-liquid. Enforcing regulations and monitoring black market sales is warranted. Efforts to educate e-cigarette users of the danger of sourcing nicotine e-liquid from the black market and self- or home-made nicotine e-liquid are essential.
    Matched MeSH terms: Electronic Cigarettes*
  12. Knowledge, attitude and willingness to counsel patients regarding e-cigarettes among academic health professionals in Malaysia
    Yaldrum A, Ramachandra SS, Arora S, Gujjar KR, Dicksit DD, Squier CA
    Tob Prev Cessat, 2017;3:6.
    PMID: 32432181 DOI: 10.18332/tpc/68748
    Matched MeSH terms: Electronic Cigarettes*
  13. Fulltext Vaping topography and reasons of use among adults in Klang Valley, Malaysia
    Zainol Abidin N, Abidin EZ, Zulkifli A, Syed Ismail SN, Karuppiah K, Amer Nordin AS, et al.
    Asian Pac J Cancer Prev, 2018 Feb 26;19(2):457-462.
    PMID: 29480664
    Background: Consistency and accuracy of results in assessing health risks due to vaping or e-cigarette use are difficult to achieve without established consumption data. The present report covers baseline data on vaping topography and reasons for use among local users in Klang Valley, Malaysia.
    Methods: An 80-item survey regarding socio-demographic characteristics, smoking topography and reasons for e-cigarette use was employed to assess e-cigarette users recruited from several public universities and private organisations. The survey questionnaire was self-administered. Data were analysed using statistical software.
    Results: Eighty-six current e-cigarette users participated with more than half (51.2%) of them aged ≥ 25 years old. Significant proportions of the sample were single (51.2%), had a tertiary education level (63.5%) and a household income of less than USD1000 per month (65.2%). Median duration of e-cigarette use was less than a year; users drew approximately 50 puffs per day and refilled twice a day. The majority (74%) used e-liquids containing nicotine with a concentration of 6 μg/mL. Daily users spent USD18-23 per month. Reasons for using the e-cigarette included enjoyment of the products (85.9%), perception of lower toxicity than tobacco (87%), and the fact that it was a cheaper smoking alternative (61%).
    Conclusion: The data on e-cigarette smoking topography obtained in this study are novel. The reasons of usage were mainly users’ enjoyment of e-cigarettes, preparation for quitting smoking, perception of low toxicity and a healthier smoking substitute and cheapness in the long run. The results establish basic knowledge for the local vaping topography and reference material for future e-cigarette-related research.
    Matched MeSH terms: Electronic Cigarettes/statistics & numerical data
  14. Children and e-cigarettes: a new threat to health
    Binns C, Lee MK, Low WY
    Asia Pac J Public Health, 2018 05;30(4):315-320.
    PMID: 29978722 DOI: 10.1177/1010539518783808
    The widespread availability and use of e-cigarettes in many countries has established the need for an assessment of their effect on children. By the end of 2017 the number published annually on e-cigarettes had increased to 2976 and included 171 papers on e-cigarettes and children. The objective of this commentary is to provide a review and public health perspective on the effects of e-cigarettes on children. There are four public health questions to be answered: 1. Are e-cigarettes and replenishing fluids toxic on accidental ingestion? 2. If children smoke e-cigarettes is this harmful? 3. Does exposure to second hand vapour from e-cigarettes cause harm to children? 4. Are children (adolescents) who use e-cigarettes more likely to begin smoking conventional cigarettes? There were 2229 reported exposures to e-cigarette fluids and liquid nicotine in the USA in 2017 causing cardiovascular symptoms of varying severity. No deaths were reported although the potential is always there. Exposure to e-cigarette vapor is less dangerous than cigarette smoke. However it does damage pulmonary endothelium in experimental models. No long term studies are yet available on chronic diseases although vapor does contain carcinogens. Adolescents who use e-cigarettes are more likely to become tobacco smokers. Because of the accumulating evidence of harm to children great caution should be exercised in widening the public promotion and usage of e-cigarettes. Children should avoid any contact with E-cigarettes or their vapour.
    Matched MeSH terms: Electronic Cigarettes*
  15. Fulltext Effectiveness and safety of electronic cigarettes among sole and dual user vapers in Kuantan and Pekan, Malaysia: a six-month observational study
    Mohamed MHN, Rahman A, Jamshed S, Mahmood S
    BMC Public Health, 2018 Aug 20;18(1):1028.
    PMID: 30126382 DOI: 10.1186/s12889-018-5951-2
    BACKGROUND: Current studies on electronic cigarettes (ECs) have assessed the smoking cessation effectiveness and safety of EC among sole EC users. However, in Malaysia and elsewhere, most EC users also smoke conventional cigarettes (CCs). We aimed to investigate nicotine cessation for both ECs and CCs. Additionally, safety issues among sole EC and dual (EC and CC) users over a six-month period were reported.

    METHODS: We observed 218 sole Malaysian EC and dual users over 6 months from June 2015 to November 2015. Both groups underwent exhaled breath carbon monoxide and saliva cotinine analyses to verify their nicotine cessation from both EC and CC use. Adverse events and withdrawal symptoms were assessed based on self-reports.

    RESULTS: Only 3.3% of observed users quit both ECs and CCs, whereas 20.5% quit smoking CCs. Quitting ECs and CCs was significantly higher among sole EC users (5 vs 2, respectively; OR: 5.62; P = 0.036) than it was among dual users, a result that was similar for CCs smoking (29 vs. 15; OR: 6.33; P ≤ 0.001). No severe health issues were reported over the entire study period.

    CONCLUSION: The rates of quitting CCs and ECs were higher in sole EC users than those in dual users. No serious health effects were reported over 6 months in either group. ECs may serve as a smoking cessation aid in Malaysia, but appropriate regulations are necessary to encourage sole EC use to ensure product quality. Large randomised clinical trials (RCTs) with a longer follow-up are required to better measure the effectiveness and safety of ECs use alone and in combination with CCs.
    Matched MeSH terms: Electronic Cigarettes*
  16. Fulltext Source of cigarettes among youth smokers in Malaysia: Findings from the tobacco and e-cigarette survey among Malaysian school adolescents (TECMA)
    Lim KH, Teh CH, Heng PP, Pan S, Ling MY, Yusoff MFM, et al.
    Tob Induc Dis, 2018;16:51.
    PMID: 31516448 DOI: 10.18332/tid/96297
    INTRODUCTION: Understanding how and where youth obtain tobacco products are major factors in the development of suitable intervention programs to reduce youth smoking. This study aimed to determine the source of cigarettes and the associated factors among Malaysian school adolescent smokers.

    METHODS: Our sample consisted of 1348 youth aged 10-17 years who were current smokers (having smoked at least once in the last 30 days). The source of cigarettes (commercial, over-the-counter purchases; or social, borrowing or obtaining from someone else) was the dependent variable, and multivariable logistic regression was employed to determine its association with independent variables (i.e. sociodemographics, smoking behavior, and knowledge of laws prohibiting sales of cigarettes to youth).

    RESULTS: Over half (54.3%) of current smokers obtained cigarettes from commercial sources, with a proportion nearly two times higher (84.2% vs 43.7%) among frequent smokers (i.e. those smoking more than 20 days per month) compared to less-frequent smokers, and among young males (56.5% vs 32.0%) compared young females. Multivariable logistic regression indicated that in urban areas, young females (AOR=12.5, 95% CI: 1.38-99.8) frequent smokers (AOR=4.41, 95% CI: 2.05-9.46), and those studying in lower (AOR=3.76, 95% CI: 1.41-10.02) and upper secondary (AOR=4.74, 95% CI: 1.72-13.06) school students were more likely to obtain cigarettes from a commercial source. On the other hand, in rural areas, only frequent smokers were more likely to get their cigarettes from commercial sources, whilst other variables were not significant.

    CONCLUSIONS: The proportion of youth smokers who obtained cigarettes from commercial sources appeared to be high, suggesting that law enforcement and health promotion activities should be enhanced to reduce the rate of smoking among Malaysian youth.
    Matched MeSH terms: Electronic Cigarettes*
  17. Fulltext The use of e-cigarettes among university students in Malaysia
    Wan Puteh SE, Manap RA, Hassan TM, Ahmad IS, Idris IB, Sham FM, et al.
    Tob Induc Dis, 2018;16:57.
    PMID: 31516454 DOI: 10.18332/tid/99539
    INTRODUCTION: E-cigarette use is an emerging phenomenon with increasing recognition and acceptance globally. This study aims to create a profile of e-cigarette users among university students in Malaysia.

    METHODS: The study was conducted using a cross-sectional research involving six universities in Malaysia. A semi-structured questionnaire was distributed to 1302 randomly selected students, who either smoked cigarettes and/or e-cigarettes. The 2011 version of Global Adult Tobacco Surveys (GATS) tool was used to record the respondents' sociodemographic data.

    RESULTS: The study revealed that 74.9% of the respondents smoked e-cigarettes; 40.3% used both cigarettes and e-cigarettes (dual users), and 34.5% were exclusive e-cigarette users. The exclusive use of e-cigarettes was related to gender (OR=0.18, 95% CI: 0.09-0.39). Also, male respondents were the majority users (95%). Of the respondents, 75.2 % were Malays, 98.0% single and most believed they have no health problems (92.1%). Further findings revealed the occurrence of adverse effects, dizziness 14.4%, cough 14.1%, and headaches 12.4%. Overall, 57.8% of the respondents used e-cigarettes as a smoking cessation tool, while others consider e-cigarettes a self-image enhancing tool or as part of social activities.

    CONCLUSIONS: Further research on the use of e-cigarettes should be conducted on a large number of respondents in other settings to augment the findings of this study, and also guide policy making on and prevention practice of e-cigarette use, among the general student population in Malaysia.
    Matched MeSH terms: Electronic Cigarettes*
  18. Fulltext Nicotine, propylene glycol and tobacco-specific nitrosamines content in selected e-liquids in Malaysia: the case support for initiation of standards or guidelines
    Aziemah Zulkifli, Emilia Zainal Abidin, Najihah Zainol Abidin, Hasanah Mohd Ghazali, Praveena, Sarva Mangala, Amer Siddiq Amer Nordin, et al.
    Malaysian Journal of Medicine and Health Sciences, 2018;14(102):1-9.
    MyJurnal
    Electronic Cigarette (EC) usage has been gaining acceptance in Malaysia despite its lack of analytical evidence on the chemical constituents of its liquid formulations. This study aims to evaluate the chemical concentrations of nicotine, propylene glycol (PG) and selected Tobacco-Specific Nitrosamines (TSNAs); 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) and N’-nitrosonornicotine (NNN) in e-liquids locally sourced from the Malaysian market. Methods: A total of 17 e-liquids from a variety of flavours and brands were purchased from local EC retailers in Klang Valley, Malaysia. Nicotine and PG concentrations were assessed using Gas Chromatography-Flame Ionization Detector (GC-FID) while NNK and NNN were quantified using Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS). The concentrations of nicotine and PG (mg/mL) were described in comparison with the levels indicated on the labels when present while levels of TSNAs were descriptively explained. Results: Nicotine was detected in all e-liquid samples, despite several samples being declared as nicotine-free. The average (standard deviation) level of nicotine, PG, NNN and NNK were 3.26 (1.04) mg/mL, 484.10 (98.24) mg/mL, 0.383(0.288) μg/L and 0.086 (0.057) μg/L, respectively. Labelling discrepancies (when indicated on the label) of nicotine and PG were between the range of 27%-73% and 3%-63%, respectively. Conclusion: The concentrations of nicotine and PG in local e-liquids were varied. There were evidences of labelling discrepancy in that local e-liquids. TSNAs were detected in all samples of e-liquids. This study brought forth strong evidence on the need for the implementation of regulation on e-liquid manufacturing and sales, particularly on the accuracy of labelling and licensing to protect the public health.
    Matched MeSH terms: Electronic Cigarettes*
  19. Fulltext Prevalence of awareness, ever-use and current use of nicotine vaping products (NVPs) among adult current smokers and ex-smokers in 14 countries with differing regulations on sales and marketing of NVPs: cross-sectional findings from the ITC Project
    Gravely S, Driezen P, Ouimet J, Quah ACK, Cummings KM, Thompson ME, et al.
    Addiction, 2019 06;114(6):1060-1073.
    PMID: 30681215 DOI: 10.1111/add.14558
    AIMS: This paper presents updated prevalence estimates of awareness, ever-use, and current use of nicotine vaping products (NVPs) from 14 International Tobacco Control Policy Evaluation Project (ITC Project) countries that have varying regulations governing NVP sales and marketing.

    DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: A cross-sectional analysis of adult (≥ 18 years) current smokers and ex-smokers from 14 countries participating in the ITC Project. Data from the most recent survey questionnaire for each country were included, which spanned the period 2013-17. Countries were categorized into four groups based on regulations governing NVP sales and marketing (allowable or not), and level of enforcement (strict or weak where NVPs are not permitted to be sold): (1) most restrictive policies (MRPs), not legal to be sold or marketed with strict enforcement: Australia, Brazil, Uruguay; (2) restrictive policies (RPs), not approved for sale or marketing with weak enforcement: Canada, Malaysia, Mexico, New Zealand; (3) less restrictive policies (LRPs), legal to be sold and marketed with regulations: England, the Netherlands, Republic of Korea, United States; and (4) no regulatory policies (NRPs), Bangladesh, China, Zambia. Countries were also grouped by World Bank Income Classifications. Country-specific weighted logistic regression models estimated adjusted NVP prevalence estimates for: awareness, ever/current use, and frequency of use (daily versus non-daily).

    FINDINGS: NVP awareness and use were lowest in NRP countries. Generally, ever- and current use of NVPs were lower in MRP countries (ever-use = 7.1-48.9%; current use = 0.3-3.5%) relative to LRP countries (ever-use = 38.9-66.6%; current use = 5.5-17.2%) and RP countries (ever-use = 10.0-62.4%; current use = 1.4-15.5%). NVP use was highest among high-income countries, followed by upper-middle-income countries, and then by lower-middle-income countries.

    CONCLUSIONS: With a few exceptions, awareness and use of nicotine vaping products varied by the strength of national regulations governing nicotine vaping product sales/marketing, and by country income. In countries with no regulatory policies, use rates were very low, suggesting that there was little availability, marketing and/or interest in nicotine vaping products in these countries where smoking populations are predominantly poorer. The higher awareness and use of nicotine vaping products in high income countries with moderately (e.g. Canada, New Zealand) and less (e.g. England, United States) restrictive policies, is likely due to the greater availability and affordability of nicotine vaping products.

    Matched MeSH terms: Electronic Cigarettes*
  20. Fulltext Factors associated with different smoking statuses among Malaysian adolescent smokers: a cross-sectional study
    Nur Atikah AH, Wee LH, Nur Zakiah MS, Chan CMH, Mohamed Haniki NM, Swinderjit JS, et al.
    BMC Public Health, 2019 Jun 13;19(Suppl 4):579.
    PMID: 31196055 DOI: 10.1186/s12889-019-6857-3
    BACKGROUND: This study focused on the associations between socioeconomic status (SES) and adolescent smoking among secondary school students (13 to 17 years) in the Federal Territory of Kuala Lumpur, Malaysia. Our objective was to evaluate the relationships between adolescent demographics, socioeconomic status and smoking status.

    METHODS: The survey data were based on baseline findings from a cross-sectional study (N = 422 adolescents). Chi-square test was used to assess the relationship between demographic characteristics, socioeconomic status (household monthly income and daily allowance) and adolescent smoking status. Exhaled carbon monoxide (CO) reading and the Hooked on Nicotine Checklist (HONC) were used to evaluate adolescent smoking status. A Multivariate Multinomial Logistic Regression (MMLR) was employed to test selected demographic and socioeconomic predictors of smoking status.

    RESULTS: Of the 422 adolescents (M age = 15.58, SD = 1.24), more than half of the participants initiated smoking between 13 to 17 years old (59.0%). A total of 308 (73.0%) were electronic cigarette users, with more than 50% comprising of single users. The mean CO reading was 2.14 ppm with 78.0% of adolescents scoring more than 0 on the Hooked on Nicotine Checklist (HONC). Males and participants aged 15 and 16 years were at increased risks of sole CC smoking. Meanwhile, males, those who are not hooked on smoking and with a non-smoker CO reading were at increased risks of sole EC smoking. Finally, Bumiputeras were at less risk of EC smoking.

    CONCLUSIONS: Demographic variables such as age, gender and ethnicity predicted smoking status predicted smoking risk, but not socioeconomic factors. The findings allow policy makers to target specific high-risk demographic groups when designing smoking cessation programs for adolescents.
    Matched MeSH terms: Electronic Cigarettes*; Electronic Cigarettes/statistics & numerical data
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