Awareness, Perception and Behaviors Related to Electronic Cigarettes in Lebanon: A Survey Study

doi:10.38179/ijcr.v3i1.93

DOI:

https://doi.org/10.38179/ijcr.v3i1.93

Keywords:

Electronic Cigarettes, Tobacco Smoking, Smoking cessation , Youth, Lebanon

Abstract

Background: Electronic cigarettes (E-cigarettes) are gaining momentum worldwide. They are looked at as an effective way to cease smoking with reduced harm. Since Lebanon is a country with a high smoking prevalence, it is of interest then to analyze the current and expanding role of E-cigarettes among the Lebanese population.

Aim: The objective of our study was to evaluate the awareness, perception, and behaviors related to E-cigarettes in Lebanon.

Methods: A cross-sectional survey of Lebanese pedestrians chosen from random sectors of Beirut was recruited in our sample study. A self-administered questionnaire was distributed to examine their awareness, perception, and behaviors related to E-cigarettes. SPSS was used for analysis. The main outcome was to assess the awareness of E-cigarettes in the Lebanese population and evaluate their perception as an effective smoking cessation tool.

Results: Of the 364 respondents, 53% were males, 84% were aware of E-cigarettes, and 16% never-tried them. E-cigarettes helped 56% of users to cut down on tobacco smoking, and among all respondents, 60% believed that it is less harmful than tobacco cigarettes. Moreover, 30% perceived it as an effective way to quit smoking. The majority of participants (61%) who tried it were between 18 and 25 years of age, and 36% of them were nonsmokers.

Conclusion: Our study is the first in Lebanon to assess the awareness, perception, and behaviors related to E-cigarettes. The majority of our population was aware of E-cigarettes, and some perceived them as a less harmful replacement compared to tobacco smoking. Additionally, non-smokers may be attracted to E-cigarette smoking which may lead to developing a new attraction and gateway for smoking. Therefore, awareness about E-cigarette's correct use, benefits, and harms need to be highlighted among the public, particularly the young generation in Lebanon.

References

WHO. Tobacco. 2020; https://www.who.int/news-room/fact-sheets/detail/tobacco

National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. 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.

Office of the Surgeon General (US); Office on Smoking and Health (US). The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2004. PMID: 20669512.

Grana R, Benowitz N, Glantz SA. E-cigarettes: a scientific review. Circulation. 2014;129(19):1972-1986. PMID: 24821826. https://doi.org/10.1161/CIRCULATIONAHA.114.007667

Vardavas CI, Anagnostopoulos N, Kougias M, Evangelopoulou V, Connolly GN, Behrakis PK. Short-term pulmonary effects of using an electronic cigarette: impact on respiratory flow resistance, impedance, and exhaled nitric oxide. Chest. 2012;141(6):1400-1406. PMID: 22194587. https://doi.org/10.1378/chest.11-2443

Food and Drug Administration, HHS. Deeming Tobacco Products To Be Subject to the Federal Food, Drug, and Cosmetic Act, as Amended by the Family Smoking Prevention and Tobacco Control Act; Restrictions on the Sale and Distribution of Tobacco Products and Required Warning Statements for Tobacco Products. Final rule. Fed Regist. 2016;81(90):28973-29106.

Marques P, Piqueras L, Sanz MJ. An updated overview of e-cigarette impact on human health. Respir Res. 2021;22(1):151. PMID: 34006276. https://doi.org/10.1186/s12931-021-01737-5

London RCoPo. Nicotine without smoke Tobacco harm reduction. Royal College of Physicians of London; 2016.

Margham J, McAdam K, Forster M, et al. Chemical Composition of Aerosol from an E-Cigarette: A Quantitative Comparison with Cigarette Smoke. Chem Res Toxicol. 2016;29(10):1662-1678. PMID: 27641760. https://doi.org/10.1021/acs.chemrestox.6b00188

CDC. Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products. 2020; https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html

Association L. What It Means to Be "Nic-Sick". 2019; https://www.lung.org/blog/nic-sick.

National Academies of Sciences E, Medicine. Public health consequences of e-cigarettes. 2018. PMID: 29894118. https://doi.org/10.17226/24952

Hammond D, Reid JL, Cole AG, Leatherdale ST. Electronic cigarette use and smoking initiation among youth: a longitudinal cohort study. CMAJ. 2017;189(43):E1328-E1336. PMID: 29084759. https://doi.org/10.1503/cmaj.161002

Berry KM, Fetterman JL, Benjamin EJ, et al. Association of Electronic Cigarette Use With Subsequent Initiation of Tobacco Cigarettes in US Youths. JAMA Netw Open. 2019;2(2):e187794. PMID: 30707232. https://doi.org/10.1001/jamanetworkopen.2018.7794

Spindle TR, Hiler MM, Cooke ME, et al. Electronic cigarette use and uptake of cigarette smoking: a longitudinal examination of US college students. Addictive behaviors. 2017;67:66-72. PMID: 28038364. https://doi.org/10.1016/j.addbeh.2016.12.009

Barrington-Trimis JL, Kong G, Leventhal AM, et al. E-cigarette use and subsequent smoking frequency among adolescents. Pediatrics. 2018;142(6). PMID: 30397165. https://doi.org/10.1542/peds.2018-0486

Hartmann-Boyce J, McRobbie H, Bullen C, Begh R, Stead LF, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev. 2016;9(9):CD010216. PMID: 27622384 https://doi.org/10.1002/14651858.CD010216.pub3

Pearson JL, Richardson A, Niaura RS, Vallone DM, Abrams DB. e-Cigarette awareness, use, and harm perceptions in US adults. Am J Public Health. 2012;102(9):1758-1766. PMID: 22813087. https://doi.org/10.2105/AJPH.2011.300526

Padon AA, Lochbuehler K, Maloney EK, Cappella JN. A Randomized Trial of the Effect of Youth Appealing E-Cigarette Advertising on Susceptibility to Use E-Cigarettes Among Youth. Nicotine Tob Res. 2018. PMID: 29106669. https://doi.org/10.1093/ntr/ntx155

Organization WH. WHO report on the global tobacco epidemic, Lebanon 2019; https://www.who.int/tobacco/surveillance/policy/country_profile/lbn.pdf. Accessed 6/6, 2020.

Wang MP, Li WH, Jiang N, et al. E-Cigarette Awareness, Perceptions and Use among Community-Recruited Smokers in Hong Kong. PLoS One. 2015;10(10):e0141683. 2015. PMID: 26348280. https://doi.org/10.1371/journal.pone.0141683

Jiang N, Chen J, Wang MP, et al. Electronic cigarette awareness and use among adults in Hong Kong. Addict Behav. 2016;52:34-38.

Gallus S, Lugo A, Pacifici R, et al. E-cigarette awareness, use, and harm perceptions in Italy: a national representative survey. Nicotine Tob Res. 2014;16(12):1541-1548. PMID: 25082832. https://doi.org/10.1093/ntr/ntu124

Szklo A, Perez C, Cavalcante T, et al. Increase of electronic cigarette use and awareness in Brazil: findings from a country that has strict regulatory requirements for electronic cigarette sales, import, and advertising. https://doi.org/10.18332/tid/83860

King BA, Alam S, Promoff G, Arrazola R, Dube SR. Awareness and ever-use of electronic cigarettes among U.S. adults, 2010-2011. Nicotine Tob Res. 2013;15(9):1623-1627. PMID: 23449421. https://doi.org/10.1093/ntr/ntt013

Schoenborn CA, Gindi RM. Electronic Cigarette Use Among Adults: United States, 2014. NCHS Data Brief. 2015;(217):1-8.PMID: 26555932.

Merry S, Bullen CR. E-cigarette use in New Zealand-a systematic review and narrative synthesis. N Z Med J. 2018;131(1470):37-50. Published 2018 Feb 23. PMID: 29470471.

Daniluk A, Gawlikowska-Sroka A, Stępien-Słodkowska M, Dzięciołowska-Baran E, Michnik K. Electronic Cigarettes and Awareness of Their Health Effects. Adv Exp Med Biol. 2018;1039:1-8. PMID: 28801792 https://doi.org/10.1007/5584_2017_83

Franks AM, Hawes WA, McCain KR, Payakachat N. Electronic cigarette use, knowledge, and perceptions among health professional students. Curr Pharm Teach Learn. 2017;9(6):1003-1009. doi:10.1016/j.cptl.2017.07.023. PMID: 29233367. https://doi.org/10.1016/j.cptl.2017.07.023

McNeill A, Brose L, Calder R, Hitchman S, Hajek P, McRobbie H. E-cigarettes: an evidence update. Public Health England. 2015;3.

Venkatesan P. E-cigarette use in young people in the UK. The Lancet Oncology. 2017;18(10):e571. PMID: 28890297. https://doi.org/10.1016/s1470-2045(17)30674-5

Primack BA, Soneji S, Stoolmiller M, Fine MJ, Sargent JD. Progression to Traditional Cigarette Smoking After Electronic Cigarette Use Among US Adolescents and Young Adults. JAMA Pediatr. 2015;169(11):1018-1023. PMID: 26348249. https://doi.org/10.1001/jamapediatrics.2015.1742

Wackowski OA, Delnevo CD. Smokers' attitudes and support for e-cigarette policies and regulation in the USA. Tob Control. 2015;24(6):543-546. doi:10.1136/tobaccocontrol-2014-051953 PMID: 25564281. https://doi.org/10.1136/tobaccocontrol-2014-051953

Staff S. FDA takes significant steps to protect Americans from dangers of tobacco through new regulation. 2016.