[01] Kleesha Perera, Faculty of Medicine, Melaka-Manipal Medical College, Manipal Academic of Higher Education (MAHE), Melaka, Malaysia. [02] Siew Yuen Kay, Faculty of Medicine, Melaka-Manipal Medical College, Manipal Academic of Higher Education (MAHE), Melaka, Malaysia. [03] Hanusha Rajenthiran, Faculty of Medicine, Melaka-Manipal Medical College, Manipal Academic of Higher Education (MAHE), Melaka, Malaysia. [04] Nurulnagihah Ibrahim, Faculty of Medicine, Melaka-Manipal Medical College, Manipal Academic of Higher Education (MAHE), Melaka, Malaysia. [05] Lim Ze Ming, Faculty of Medicine, Melaka-Manipal Medical College, Manipal Academic of Higher Education (MAHE), Melaka, Malaysia.

It known that 13.8% undergraduate students in Malaysia are using E-cigarettes and they have different views and perceptions regarding this issue. Our objective is to determine the knowledge, awareness, beliefs and prevalence of the use of Electronic cigarettes among undergraduate students in Malaysia and to determine the factors associated with knowledge, awareness, beliefs and prevalence of the use of Electronic cigarettes among undergraduate students in Malaysia. A cross-sectional study was conducted from September 2019 to October 2019 in Melaka-Manipal Medical College (MMMC). Data were collected using self-administered questionnaire and online questionnaires designed in English. Chi square test and logistic regression analysis were used. Level of significance was set at P < 0.05 and Odds ratio (OR) was calculated. 8.46% of undergraduate students practice smoking E-cigarettes. In multiple logistic regression analysis, knowledge was the only significant association with the practice of E-cigarettes (OR: 0.96; 95%CI 0.94-0.99; p-value 0.003). Younger aged students had a significant association with knowledge on E-cigarettes compared to older aged students (OR: 0.05; 95%CI 0.01-0.47; p-value 0.024). There was a significant association between students living in hostels and their belief towards E-cigarettes and students living outside hostels (OR: 0.47; 95% CI 0.23-0.97; x²: 4.25; p-value 0.039). Foundation in Science students were significantly aware of E-cigarettes (OR: 0.45; 95%CI 0.21-0.96; x²: 4.45; p-value 0.035). There was a significant association between male gender and E-cigarette smoking compared to females (OR: 7.29; 95% CI: 2.00-26.47, p value: <0.001). Based on our study, knowledge, male gender, family members who smoke and friends who smoke has an impact on E-cigarette smoking among undergraduate students.

E-cigarettes, Medical Students, Knowledge, Attitude, Beliefs, Prevalence, Cross-sectional

[01] NIDA. (2019, September 23). Electronic Cigarettes (E-cigarettes). Available from: https://www.drugabuse.gov/publications/drugfacts/electronic-cigarettes-e-cigarettes on 2019, September 25. [02] Mohamed M, Rahman A, Jamshed S, Mahmood S. Effectiveness and safety of electronic cigarettes among sole and dual user vapers in Kuantan and Pekan, Malaysia: a six-month observational study. BMC Public Health. 2018; 18 (1). [03] Grana RA, Ling PM. Smoking revolution? A content analysis of electronic cigarette retail websites. Am J Prev Med. 2014; 46: 395–403. [04] Schoenborn CA, Gindi RM. Electronic cigarette use among adults: United States, 2014. London: NCHS Data Brief; 2015. p. 1. [05] Centres for Disease Control and Prevention. (CDC). Notes from the field: electronic cigarette use among middle and high school students-United States, 2011–2012. MMWR. 2013; 62: 729–30. [06] Sutfin EL, McCoy TP, Morrell HE, Hoeppner BB, Wolfson M. Electronic cigarette use by college students. Drug Alcohol Depend. 2013; 131: 214–21. [07] Lee YO, Kim AE. ‘Vape shops’ and ‘E-cigarette lounges’ open across the USA to promote ENDS. Tob Control 2015; 24: 410–2. [08] Perikleous EP, Steiropoulos P, Paraskakis E, Constantinidis TC, Nena E. E-cigarette use among adolescents: An overview of the literature and future perspectives. Front Public Health 2018; 6: 86. [09] Rohde JA, Noar SM, Horvitz C, Lazard AJ, Cornacchione Ross J, Sutfin EL, et al. The role of knowledge and risk beliefs in adolescent E-cigarette use: A pilot study. Int J Environ Res Public Health 2018; 15: E830. [10] Mullin, Gemma (18 September 2019). "CRACKDOWN India BANS e-cigarettes after 7 vaping deaths as global backlash gathers pace". The Sun. [11] Beard, Emma; Shahab, Lion; Cummings, Damian M.; Michie, Susan; West, Robert (2016). "New Pharmacological Agents to Aid Smoking Cessation and Tobacco Harm Reduction: What Has Been Investigated, and What Is in the Pipeline?" (PDF). CNS Drugs. 30 (10): 951–83. doi: 10.1007/s40263-016-0362-3. ISSN 1172-7047. PMID 27421270. [12] Breland, A.; Spindle, T.; Weaver, M.; Eissenberg, T. Science and Electronic Cigarettes: Current Data, Future Needs. J. Addict. Med. 2014, 8, 223–233. [CrossRef] [PubMed]. [13] Carlos W, Crotty Alexander L, Gross J, Dela Cruz C, Keller J, Pasnick S et al. Vaping Associated Pulmonary Illness (VAPI). American Journal of Respiratory and Critical Care Medicine [Internet]. 2019; Available from: https://www.atsjournals.org/doi/pdf/10.1164/rccm.2007P13 [14] Caporale A, Langham M, Guo W, Johncola A, Chatterjee S, Wehrli F. Acute Effects of Electronic Cigarette Aerosol Inhalation on Vascular Function Detected at Quantitative MRI. Radiology [Internet]. 2019; 293 (1): 97-106. Available from: https://pubs.rsna.org/doi/abs/10.1148/radiol.2019190562 [15] Gravely S, Fong GT, Cummings KM, et al. 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. Int. J. Environ. Res. Public Health. 2015; 12 (5): 4631-4637. doi: 10.3390/ijerph120504631. [16] Malaysia's Fatwa Council declares electronic cigarettes as 'haram' or forbidden [Internet]. The Straits Times. 2019 [cited 10 October 2019]. Available from: https://www.straitstimes.com/asia/se-asia/malaysias-fatwa-council-declares-electronic-cigarettes-as-haram-or-forbidden [17] Ministry of Health Malaysia. 2015. KawalanpenjualandanpenggunaanrokokelektronikdanvapeolehKementerianKesihatan Malaysia. https://kpkesihatan.com/2015/11/09/kenyataanakhbar-kpk-9-nov-2015-kawalan-penjualandan-penggunaan-rokok-elektronik-vape-olehkkm/ [March 2018]. [18] Mohamad Sapiee N. E-Cigarette Use, Its Impact on Tobacco Smoking and the Intention to Quit. Medicine & Health. 2019; 14 (1): 78-90. [19] Wan Puteh S. E., Abdul Manap R., Hassan T. M., Ahmad I. S., Idris I. B., Md Sham F. et al. The use of e-cigarettes among university students in Malaysia. Tobacco Induced Diseases. 2018; 16 (December): 57. doi: 10.18332/tid/99539. [20] Goh Y, Dujaili J, Blebil A, Ahmed S. Awareness and use of electronic cigarettes: Perceptions of health science programme students in Malaysia. Health Education Journal [Internet]. 2017; 76 (8): 1000-1008. Available from: https://journals.sagepub.com/doi/abs/10.1177/0017896917732363?journalCode=heja [21] Canzan F, Finocchio E, Moretti F, Vincenzi S, Tchepnou-Kouaya A, Marognolli O et al. Knowledge and use of e-cigarettes among nursing students: results from a cross-sectional survey in north-eastern Italy. BMC Public Health [Internet]. 2019; 19 (1). Available from: https://static-content.springer.com/esm/art%3A10.1186%2Fs12889-019-7250-y/MediaObjects/12889_2019_7250_MOESM1_ESM.pdf [22] Moysidou A, Farsalinos K, Voudris V, Merakou K, Kourea K, Barbouni A. Knowledge and Perceptions about Nicotine, Nicotine Replacement Therapies and Electronic Cigarettes among Healthcare Professionals in Greece. International Journal of Environmental Research and Public Health [Internet]. 2016; 13 (5): 514. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4881139/ [23] Ferrara P, Shantikumar S, Cabral Veríssimo V, Ruiz-Montero R, Masuet-Aumatell C, Ramon-Torrell J. Knowledge about E-Cigarettes and Tobacco Harm Reduction among Public Health Residents in Europe. International Journal of Environmental Research and Public Health [Internet]. 2019; 16 (12): 2071. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6617304/ [24] Lee H, Wilson S, Partos T, McNeill A, Brose L. Awareness of Changes in E-cigarette Regulations and Behavior Before and After Implementation: A Longitudinal Survey of Smokers, Ex-smokers, and Vapers in the United Kingdom. Nicotine & Tobacco Research [Internet]. 2019;. Available from: https://academic.oup.com/ntr/advance-article/doi/10.1093/ntr/ntz008/5301505 [25] Alanazi, Abdullah Mayof, "The Prevalence of Use, Awareness and Beliefs of Electronic Cigarettes Among College-Based Health Care Students At A Southeastern Urban University." Thesis, Georgia State University, 2016. http://scholarworks.gsu.edu/rt_theses/33 [26] Hinderaker K, Power D, Allen S, Parker E, Okuyemi K. What do medical students know about e-cigarettes? A cross-sectional survey from one U.S. medical school. BMC Medical Education [Internet]. 2018; 18 (1). Available from: https://www.ncbi.nlm.nih.gov/pubmed/29499682 [27] Pepper JK, McRee AL & Gilkey MB et al (2014, June). Healthcare providers' beliefs and attitudes about electronic cigarettes and preventive counseling for adolescent patients. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4111908/. [28] Hafiz A, Rahman M, Jantan Z. Factors associated with knowledge, attitude and practice of e-cigarette among adult population in KOSPEN areas of Kuching district, Sarawak, Malaysia. International Journal Of Community Medicine And Public Health. 2019; 6 (6): 2300. [29] Iqbal, Nousheen & Khan, Zain & Anwar, Syed & Irfan, Omar & Irfan, Babar & Hussain, Ammar & Bibi, Maria & Siddiqui, Faraz & Khan, Javaid et al (2017). Prevalence and knowledge of electronic cigarettes amongst medical students, A cross sectional survey from Karachi, Pakistan. PA4487. 10.1183/1393003.congress-2017.PA4487. Available from: https://www.researchgate.net/publication/321931616_Prevalence_and_knowledge_of_electronic_cigarettes_amongst_medical_students_A_cross_sectional_survey_from_Karachi_Pakistan [30] Nalan. O, Ayse Baha, OnurCoskun, E. EylemAkpinar (2019). Use of and Awareness about Electronic Cigarette among Medical School Students. Available from: https://www.ejmo.org/pdf/Use%20of%20and%20Awareness%20about%20Electronic%20Cigarette%20among%20Medical%20School%20Students-0059.pdf [31] Goniewicz M. L, Lingas E. O, & Hajek P. (2013, March). Patterns of electronic cigarette use and user beliefs about their safety and benefits: an internet survey. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3530631/ [32] Perialathan K, Rahman A, Lim K, Adon Y, Ahmad A, Juatan N et al. Prevalence and associated factors of ever use of electroniccigarettes: Findings from a hospitals and health clinics study based in Malaysia. Tobacco Induced Diseases [Internet]. 2018; 16 (November). Available from: http://www.tobaccoinduceddiseases.org/Prevalence-and-associated-factors-of-ever-use-of-electronic-ncigarettes-Findings,99258,0,2.html