Study seeks ban on promoting e-cigarettes as a safe alternative

Updated 05 Apr 2018


THE study suggests e-cigarettes may serve as a gateway to nicotine addiction.
THE study suggests e-cigarettes may serve as a gateway to nicotine addiction.

KARACHI: A recent study conducted at five medical institutions highlights how vulnerable students are to the new global epidemic of electronic cigarettes, which they consider relatively safe, though data is emerging on the negative effects of these devices.

It found that conventional cigarettes were still popular among medical students, some of whom were taking up e-cigarettes with other tobacco products, suggesting a ban on promoting and marketing e-cigarettes as a safe alternative till definitive scientific evidence demonstrating its benefits emerges.

Titled ‘Electronic cigarettes use and perception amongst medical students: a cross-sectional survey from Sindh, Pakistan’, the study was recently published in the BMC Research Notes, an online journal.

A total of 500 students, 58 per cent of them female students, were interviewed during the study conducted at the Aga Khan University, Jinnah Sindh Medical and Dental College, Jinnah Sindh Medical University, Dow University of Health Sciences and Liaquat University of Medical and Health Sciences in 2016.

According to the study, while the epidemic of e-cigarettes is rising globally with insufficient data on its health safety, there is little or no data available on the knowledge and use of e-cigarettes from developing regions, which are still struggling to contain the use of conventional tobacco products.

Survey of five medical institutions depicts how vulnerable students are to using the electronic device

“This highlights a key knowledge gap that still remains to be addressed. In general, medical students are considered to have better levels of knowledge as they are expected to interact with patients in their training years, so it is important to know regarding their perspectives on e-cigarettes,” it says.

The study aims to explore the existing levels of knowledge, attitude and perception as well as usage of e-cigarettes among medical students.


Although the study did not find e-cigarettes widely popular on medical campuses, its users and non-users both considered these devices less harmful. It found use of e-cigarettes significantly higher among male smokers, which was consistent with data on cigarette smoking in Pakistan.

It also found that those who were using e-cigarettes were using other tobacco products concomitantly more often than non-users. Use of conventional cigarette was 80.6pc, smokeless tobacco use was 38.7pc and shisha use was 83.9pc among e-cigarette users compared to 13.4, 2.3 and 31.6pc of non e-cigarette users, respectively.

“Over 65pc students were aware of e-cigarettes, 6.2pc reported having used e-cigarettes, of whom 1.2pc self-reported daily use. Users of conventional tobacco products were significantly more likely to have heard of e-cigarettes (87.6pc) and having used them (13.9pc),” it says.

For nearly half of the respondents, the major source of information was mass media/internet, followed by friends or acquaintances, while other sources of information were also suggested by 11.6pc.

Compared to e-cigarette users, the majority of non-users said they believed it was not harmful at all (71pc).

“It is of great concern as noted previously that newer users have often tried it as an experiment, especially in teenagers and young populations, and can hence serve as a gateway to nicotine addiction in these groups,” it says.

Among those who reported smoking, 43 (8.6pc) labelled themselves as current cigarette smokers (who smoked at least once in last month), 8.2pc as occasional smokers (who smoked less than once a month) and 0.8pc were ex-smokers. Respondents who used conventional tobacco products were significantly more likely to be males (63pc) and enrolled in public sector institutes.

More than 50pc of these tobacco users belonged to 4th and 5th year of medical colleges.

By comparison, it was found that conventional tobacco users were significantly more likely to have heard of e-cigarettes and having used them.

Tobacco non-users were significantly more likely to have heard of e-cigarettes through mass media (46.2pc) while users heard through friends/acquaintances (32.9pc).

Compared to e-cigarette users a majority of non-users perceived that the use of e-cigarettes was associated with respiratory diseases like chronic obstructive pulmonary disease (COPD), asthma and lung cancer (45.2pc), associated with addiction and dependency (29pc) and is harmful for pregnant women (45.2pc).

“However, there was no significant difference of opinion found among users and non-users when they were asked whether e-cigarette help in quitting, [was] less harmful than conventional cigarette, more harmful than conventional cigarette and equally harmful to conventional cigarette,” it says.

Only 27.4pc of respondents thought e-cigarettes help in quitting.

Insufficient data

The study also provides information about e-cigarettes’ history and the data so far available on its health safety.

Also known as electronic nicotine delivery systems, an e-cigarette, it says, is a handheld electronic device first introduced in the early 2000s. It has a basic design with engineering variations and user modifications which results in difference in nicotine delivery.

“It is currently actively marketed with healthy claims, as a better alternative to conventional cigarette smoking and as smoking cessation aid, often endorsed by celebrities and doctors,” it says.

However, it points out, that sufficient evidence is not available in support of e-cigarettes’ efficacy in smoking cessation nor its health safety.

“Alternatively, use of e-cigarettes can also have negative health consequences; a cross-sectional survey of students from 24 colleges and universities in Texas found e-cigarette use to be associated with depressive symptoms. Until long-term observational data of e-cigarette users is available, possibility of adverse health effects cannot be ruled out,” the study says.

Published in Dawn, April 5th, 2018