Knowledge about electronic cigarettes and its perception: a community survey, Egypt

Abo-Elkheir and Sobh Respiratory Research (2016) 17:58 DOI 10.1186/s12931-016-0365-0 RESEARCH Open Access Knowledge about electronic cigarettes and its perception: a community survey, Egypt Omaima I. Abo-Elkheir1 and Eman Sobh2,3* Abstract Background: Electronic cigarettes are promoted as safer products than traditional cigarettes and as smoking cessation devices. Awareness and perception are key elements for the adoption of new habits. Little is known about electronic cigarettes and public opinions towards it. This study aims to identify the prevalence of knowledge about electronic cigarettes, its perception, and use among Egyptian population. Methods: An observational cross-sectional study using self-administered questionnaire in Arabic language was conducted between March and April 2015 among a sample of Egyptian population aged 15–75 years (N = 1239). We compared between respondent’s who know e-cigarettes and those who do not know it. Results: More than half (57.5 %) of the respondents had heard about e-cigarettes, 51.8 % were non-smokers and nobody of them reported use of e-cigarettes. There were statistically significant differences between those who know and those who do not know e-cigarettes regarding age, educational levels and history of smoking. Among those who know e-cigarettes, 41.6 % believed that e-cigarettes help smoking cessation and 31.9 % believed it is less harmful than traditional cigarettes. Conclusions: A considerable level of knowledge about e-cigarettes is found among young people aged 15–39 years. E-cigarettes were perceived as less harmful than traditional cigarettes or a smoking cessation aid. None of the respondents reported use of e-cigarettes. Keywords: Electronic cigarettes, Knowledge, Smoking, Perception, Community survey Background The use of different forms of tobacco inflicts a huge and growing burden on public health globally. Electronic cigarettes or e-cigarettes (ECs) were invented in China in 2003 [1], these are battery-operated vaporizing devices look like a cigarette and used to deliver nicotine vapor to users [2]. A wide variety of ECs are available in the market; the main ingredients of e-cigarettes liquid other than nicotine are propylene glycol, glycerol and several flavorings [3]. E-cigarettes use and promotion appears in news stories and entertainment media particularly the internet as safer products than regular cigarettes or as medical products and smoking-cessation aids [4]. The extent to which e-cigarettes use will result in nicotine * Correspondence: 2 Pulmonary Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt 3 Pulmonary Medicine Department, Al-Zahraa University Hospital, 11517 Al-Abbassia, Cairo, Egypt Full list of author information is available at the end of the article dependence and subsequent use of other tobacco products as well as the effect of these products on public health is unknown [5]. Concerns have been raised about the rising popularity and availability of e-cigarettes together with its unique nature and flavorings that may attract youth to try it [5]. A controversy was generated around e-cigarettes within the tobacco control field; some recommend using e-cigarettes as a smoking cessation aid while others debate that e-cigarettes should be banned due to lack of safety and efficacy data [6]. Furthermore, e-cigarettes are not currently approved by the Food and Drug Administration (FDA) for smoking cessation [7]. Also, the Forum of International Respiratory Societies (FIRS) recommended restriction or banning of e-cigarettes until availability of more information about their safety [8]. E-cigarettes attract smokers by providing sensation and appearance mimicking cigarettes; they are socially acceptable by enabling users to retain their smoker © 2016 Abo-Elkheir and Sobh. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Abo-Elkheir and Sobh Respiratory Research (2016) 17:58 identity without the risk of smoke [9]. Worldwide awareness and use of e-cigarettes have dramatically increased in recent years [10] especially among youth [5]. More educated people have a higher awareness of e- cigarettes than those with lower education [4, 6]. Egypt has the highest number of tobacco users in the Arab region [11]. WHO reported 22 % of Egypt’s populations are current or former smokers, of which 43 % men and about 1 % women [12]. Also; a significant number of youth and adolescents consume tobacco products [11]. According to the Global Youth Tobacco Survey (GYTS); 13.6 % of Egyptian youth (18.1 % of boys and 8.2 % of girls) reported current use of any tobacco products [13]. Egypt has made important strides in efforts to control tobacco use and reduce its adverse health effects. Laws and regulations have been enacted to ban indoor smoking in public places and taxes on cigarette sales were imposed [14, 15], Moreover; selling tobacco products is banned by law to those less than 18 years old. Tobacco advertising, promotion, and sponsorship are also banned in Egypt by law No. 52 for 1981 [16]. However; some forms of tobacco marketing including internet advertising and product placement in movies and television programs are generally allowed [11, 17]. The recognition of tobacco use as an addiction and cause of cancer, along with concerns about the ill-effects of breathing secondhand smoke led to declining social acceptance of smoking [18], besides the advent of legal restrictions on smoking [16] make e-cigarettes an attractive alternative to traditional cigarettes in Egypt. However, up to our knowledge, there is no data available about awareness of e-cigarettes and its use in Egypt. Therefore, assessment of the level of awareness and utilization of e-cigarettes among the population is needed. This study will be partially helpful in the analysis and evaluation of the situation in Egypt related to e-cigarettes. Objective To identify the prevalence of knowledge about electronic cigarettes, its perception, and use among Egyptian population. Page 2 of 7 study representing urban governorates, Upper Egypt, Lower Egypt and Frontier governorates. Among the 1294 persons who received the questionnaires; 1239 accepted to participate in this study and returned a completely filled questionnaire (response rate was 88.9 %). Data was collected by trained fourth-year medical students. Study tool A questionnaire was designed in Arabic language to attain the predetermined obje (...truncated)