Original article
peer-reviewed
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Published: July 13, 2017 (see history)
DOI: 10.7759/cureus.1468
Cite this article as: Shaikh A, Ansari H T, Ahmad Z, et al. (July 13, 2017) Knowledge and Attitude of Teenagers Towards Electronic Cigarettes in Karachi, Pakistan. Cureus 9(7): e1468. doi:10.7759/cureus.1468
Abstract
Introduction
Studies have shown that electronic cigarettes have gained immense popularity and their use has increased dramatically all over the world. However, little is known about the knowledge and attitudes towards e-cigarettes in third world countries such as Pakistan. The aim of this study was to determine the perceptions of teenagers in Karachi regarding e-cigarettes and whether the differences in said perceptions were affected by gender and level of education.
Methods
We conducted a cross-sectional study in January 2017 using convenience sampling and interviewed 441 young individuals, aged 13 to 19 years, to determine their knowledge, attitudes, and practices regarding e-cigarettes. The participants were questioned about their knowledge and its source. Attitudes were judged using four and five-point Likert scales while questions regarding practices focused on single and current use. Chi-square and Mann-Whitney tests were applied to compare the knowledge, attitudes, and practices of teenagers with gender and level of schooling.
Results
The majority of participants knew what e-cigarettes were (n=277, 68.7%) but did not know about their contents (n=225, 55.8%) and had learned about them from either friends or the internet (n=245, 60.%). Almost half of them (n=190, 47.2%) believed that the reason for e-cigarette use was either peer pressure or to quit smoking conventional cigarettes. An overwhelming majority also stated that; it was either easy or very easy to obtain e-cigarettes (n=277, 68.7%), they would not try smoking e-cigarettes even if a good friend of theirs recommended them (n=287, 71.2%), they were not current e-cigarette smokers (n=370, 91.8%) and they would never promote e-cigarette use (n=371, 92.1%). Statistically significant differences were found with males knowing more about e-cigarettes (p=0.006) and being more common to either have smoked (p <0.001) or be current e-cigarette smokers (p <0.001). Furthermore, middle school students were more likely to have negative attitudes towards e-cigarettes believing they were more harmful (p=0.003) and more addictive (p <0.001) than conventional cigarettes.
Conclusion
Many people were aware of what electronic cigarettes are but still, it was evident that there was the lack of proper knowledge along with negative attitudes towards e-cigarette use among teenagers in Pakistan due to cultural and social stigmas and lack of advertising. Males and females had considerable differences in their opinions regarding e-cigarette use owing to such social practices being considered taboo by females and males having greater freedom due to patriarchal, familial and cultural systems.
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Original article
peer-reviewed
Knowledge and Attitude of Teenagers Towards Electronic Cigarettes in Karachi, Pakistan
Asim Shaikh , Hamza T. Ansari , Zeerak Ahmad , Mahnoor Y. Shaikh , Ilma Khalid , Maha Jahangir , Amna Majeed , Nimra Shakeel , Arsalan Ahmed , Roha Saeed Memon , Eleze Tariq , Rafia Irfan , Dania Madni
Author Information
Asim Shaikh
Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
Hamza T. Ansari Corresponding Author
Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
Zeerak Ahmad
Ziauddin Medical College, Ziauddin University
Mahnoor Y. Shaikh
Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
Ilma Khalid
Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
Maha Jahangir
Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
Amna Majeed
Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
Nimra Shakeel
Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
Arsalan Ahmed
Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
Roha Saeed Memon
Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
Eleze Tariq
Aga Khan University, The Aga Khan University
Rafia Irfan
Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
Dania Madni
Ziauddin University
Ethics Statement and Conflict of Interest Disclosures
Human subjects: Consent was obtained by all participants in this study. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.
Article Information
DOI
10.7759/cureus.1468
Cite this article as:
Shaikh A, Ansari H T, Ahmad Z, et al. (July 13, 2017) Knowledge and Attitude of Teenagers Towards Electronic Cigarettes in Karachi, Pakistan. Cureus 9(7): e1468. doi:10.7759/cureus.1468
Publication history
Received by Cureus: May 06, 2017
Peer review began: May 15, 2017
Peer review concluded: July 04, 2017
Published: July 13, 2017
Copyright
© Copyright 2017
Shaikh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
License
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Original article
peer-reviewed
Knowledge and Attitude of Teenagers Towards Electronic Cigarettes in Karachi, Pakistan
Asim Shaikh , Hamza T. Ansari , Zeerak Ahmad , Mahnoor Y. Shaikh , Ilma Khalid , Maha Jahangir , Amna Majeed , Nimra Shakeel , Arsalan Ahmed , Roha Saeed Memon , Eleze Tariq , Rafia Irfan , Dania Madni
Figures etc.
| Gender | P-Values | |||
| Male Female | ||||
| Do you know what e-cigarettes are? | Yes | 122(30.3%) | 25(6.2%) | <0.001* |
| No | 155(38.5%) | 101(25.1%) | ||
| If yes, then how did you learn about them? | Internet | 41(10.2%) | 2(0.5%) | <0.001* |
| Friends | 60(14.9%) | 5(1.2%) | ||
| Television | 70(17.4%) | 1(0.2%) | ||
| Magazines | 74(18.4%) | 5(1.2%) | ||
| Newspapers | 8(2%) | 25(6.2%) | ||
| Did not know about e-cigarettes | 11(2.7%) | 101(25.1%) | ||
| Are you aware of the various ingredients and chemicals in e-cigarette smoke? | Yes | 78(19.4%) | 100(24.8%) | 0.006* |
| No | 69(17.1%) | 156(38.7%) | ||
| Do you know about the different levels of nicotine in e-cigarettes? | Yes | 36(8.9%) | 111(27.5%) | 0.002* |
| No | 32(7.9%) | 224(55.6%) | ||
| What do you think makes people start smoking e-cigarettes? | Stress | 19(4.7%) | 5(1.2%) | <0.001* |
| Depression | 33(8.2%) | 11(2.7%) | ||
| Peer pressure | 10(2.5%) | 35(8.7%) | ||
| Acceptability in family | 58(14.4%) | 42(10.4%) | ||
| Recreational use | 24(6%) | 54(13.4%) | ||
| To quit smoking regular cigarettes | 69(17.1%) | 43(10.7%) | ||
| How effective do you think e-cigarettes are in helping people quit smoking regular cigarettes? | Extremely effective | 20(5%) | 32(7.9%) | 0.062 |
| Slightly effective | 42(10.4%) | 61(15.1%) | ||
| No idea | 62(15.4%) | 141(35%) | ||
| Slightly ineffective | 7(1.7%) | 10(2.5%) | ||
| Extremely ineffective | 16(4%) | 12(3%) | ||
| What do you think about the statement “people harm themselves when smoking e-cigarettes”? | Strongly agree | 43(10.7%) | 90(22.3%) | 0.456 |
| Agree | 50(12.4%) | 78(19.4%) | ||
| Undecided | 34(8.4%) | 51(12.7%) | ||
| Disagree | 12(3%) | 13(3.2%) | ||
| Strongly disagree | 8(2%) | 24(6%) | ||
| When comparing harmful effects of e-cigarettes to regular cigarettes, how harmful do you think they are? | Much more harmful | 27(6.7%) | 45(11.2%) | <0.001* |
| Slightly more harmful | 12(3%) | 30(7.4%) | ||
| Equally harmful | 31(7.7%) | 109(27%) | ||
| Slightly less harmful | 46(11.4%) | 54(13.41%) | ||
| Much less harmful | 31(7.7%) | 18(4.5%) | ||
| When comparing the addiction of e-cigarettes to regular cigarettes, how addictive do you think they are? | Much more addictive | 30(7.4%) | 74(18.4%) | 0.061 |
| Slightly more addictive | 17(4.2%) | 23(5.7%) | ||
| Equally addictive | 46(11.4%) | 83(20.6%) | ||
| Slightly less addictive | 33(8.2%) | 52(12.9%) | ||
| Much less addictive | 21(5.2%) | 24(6%) | ||
| What do you think about the statement “all tobacco products are dangerous”? | Strongly agree | 74(18.4%) | 162(40.2%) | 0.028* |
| Agree | 52(12.9%) | 62(15.4%) | ||
| Undecided | 12(3%) | 13(3.2%) | ||
| Disagree | 7(1.7%) | 10(2.5%) | ||
| Strongly disagree | 2(0.5%) | 9(2.2%) | ||
| Do you think smoking e-cigarettes makes people young people “fit in”, feel “cool” and become socially more acceptable? | Yes | 57(14.1%) | 108(26.8%) | 0.503 |
| No | 90(22.3%) | 148(36.7%) | ||
| How easy do you think it is to buy e-cigarettes for young people of your age? | Very easy | 60(14.9%) | 69(17.1%) | 0.004* |
| Easy | 53(13.2%) | 95(23.6%) | ||
| Difficult | 21(5.2%) | 76(18.9%) | ||
| Very difficult | 13(3.2%) | 16(4%) | ||
| If a good friend of yours wanted you to try e-cigarettes, would you try them? | Definitely will | 27(6.7%) | 18(4.5%) | <0.001* |
| Probably will | 37(9.2%) | 34(8.4%) | ||
| Probably will not | 22(5.5%) | 26(6.5%) | ||
| Definitely will not | 61(15.1%) | 178(44.2%) | ||
| If you ever try smoking e-cigarettes, do you think you would do it with your guardian’s permission? | Yes | 40(9.9%) | 107(26.6%) | 0.137 |
| No | 40(9.9%) | 88(21.8%) | ||
| Are you surrounded by, or live with people who use and promote the use of e-cigarettes? | Yes | 50(12.4%) | 72(17.9%) | 0.216 |
| No | 97(24.1%) | 184(45.7%) | ||
| Do you, or have you ever smoked e-cigarettes? (Even one or two puffs.) | Yes | 60(14.9%) | 36(8.9%) | <0.001* |
| No | 87(21.6%) | 220(54.6%) | ||
| Are you a current e-cigarette smoker? (Smoked in the past 30 days.) | Yes | 22(5.5%) | 11(2.7%) | <0.001* |
| No | 125(31%) | 245(60.8%) | ||
| Would you ever promote or recommend the use of e-cigarettes to other people if you got the chance to? | Yes | 20(5%) | 12(3%) | 0.001 |
| No | 127(31.5%) | 244(60.5%) | ||
Table 1: Table representing the knowledge, attitudes and practices compared with gender
| Gender | P-Values | |||
| Male Female | ||||
| Do you know what e-cigarettes are? | Yes | 122(30.3%) | 25(6.2%) | <0.001* |
| No | 155(38.5%) | 101(25.1%) | ||
| If yes, then how did you learn about them? | Internet | 41(10.2%) | 2(0.5%) | <0.001* |
| Friends | 60(14.9%) | 5(1.2%) | ||
| Television | 70(17.4%) | 1(0.2%) | ||
| Magazines | 74(18.4%) | 5(1.2%) | ||
| Newspapers | 8(2%) | 25(6.2%) | ||
| Did not know about e-cigarettes | 11(2.7%) | 101(25.1%) | ||
| Are you aware of the various ingredients and chemicals in e-cigarette smoke? | Yes | 78(19.4%) | 100(24.8%) | 0.006* |
| No | 69(17.1%) | 156(38.7%) | ||
| Do you know about the different levels of nicotine in e-cigarettes? | Yes | 36(8.9%) | 111(27.5%) | 0.002* |
| No | 32(7.9%) | 224(55.6%) | ||
| What do you think makes people start smoking e-cigarettes? | Stress | 19(4.7%) | 5(1.2%) | <0.001* |
| Depression | 33(8.2%) | 11(2.7%) | ||
| Peer pressure | 10(2.5%) | 35(8.7%) | ||
| Acceptability in family | 58(14.4%) | 42(10.4%) | ||
| Recreational use | 24(6%) | 54(13.4%) | ||
| To quit smoking regular cigarettes | 69(17.1%) | 43(10.7%) | ||
| How effective do you think e-cigarettes are in helping people quit smoking regular cigarettes? | Extremely effective | 20(5%) | 32(7.9%) | 0.062 |
| Slightly effective | 42(10.4%) | 61(15.1%) | ||
| No idea | 62(15.4%) | 141(35%) | ||
| Slightly ineffective | 7(1.7%) | 10(2.5%) | ||
| Extremely ineffective | 16(4%) | 12(3%) | ||
| What do you think about the statement “people harm themselves when smoking e-cigarettes”? | Strongly agree | 43(10.7%) | 90(22.3%) | 0.456 |
| Agree | 50(12.4%) | 78(19.4%) | ||
| Undecided | 34(8.4%) | 51(12.7%) | ||
| Disagree | 12(3%) | 13(3.2%) | ||
| Strongly disagree | 8(2%) | 24(6%) | ||
| When comparing harmful effects of e-cigarettes to regular cigarettes, how harmful do you think they are? | Much more harmful | 27(6.7%) | 45(11.2%) | <0.001* |
| Slightly more harmful | 12(3%) | 30(7.4%) | ||
| Equally harmful | 31(7.7%) | 109(27%) | ||
| Slightly less harmful | 46(11.4%) | 54(13.41%) | ||
| Much less harmful | 31(7.7%) | 18(4.5%) | ||
| When comparing the addiction of e-cigarettes to regular cigarettes, how addictive do you think they are? | Much more addictive | 30(7.4%) | 74(18.4%) | 0.061 |
| Slightly more addictive | 17(4.2%) | 23(5.7%) | ||
| Equally addictive | 46(11.4%) | 83(20.6%) | ||
| Slightly less addictive | 33(8.2%) | 52(12.9%) | ||
| Much less addictive | 21(5.2%) | 24(6%) | ||
| What do you think about the statement “all tobacco products are dangerous”? | Strongly agree | 74(18.4%) | 162(40.2%) | 0.028* |
| Agree | 52(12.9%) | 62(15.4%) | ||
| Undecided | 12(3%) | 13(3.2%) | ||
| Disagree | 7(1.7%) | 10(2.5%) | ||
| Strongly disagree | 2(0.5%) | 9(2.2%) | ||
| Do you think smoking e-cigarettes makes people young people “fit in”, feel “cool” and become socially more acceptable? | Yes | 57(14.1%) | 108(26.8%) | 0.503 |
| No | 90(22.3%) | 148(36.7%) | ||
| How easy do you think it is to buy e-cigarettes for young people of your age? | Very easy | 60(14.9%) | 69(17.1%) | 0.004* |
| Easy | 53(13.2%) | 95(23.6%) | ||
| Difficult | 21(5.2%) | 76(18.9%) | ||
| Very difficult | 13(3.2%) | 16(4%) | ||
| If a good friend of yours wanted you to try e-cigarettes, would you try them? | Definitely will | 27(6.7%) | 18(4.5%) | <0.001* |
| Probably will | 37(9.2%) | 34(8.4%) | ||
| Probably will not | 22(5.5%) | 26(6.5%) | ||
| Definitely will not | 61(15.1%) | 178(44.2%) | ||
| If you ever try smoking e-cigarettes, do you think you would do it with your guardian’s permission? | Yes | 40(9.9%) | 107(26.6%) | 0.137 |
| No | 40(9.9%) | 88(21.8%) | ||
| Are you surrounded by, or live with people who use and promote the use of e-cigarettes? | Yes | 50(12.4%) | 72(17.9%) | 0.216 |
| No | 97(24.1%) | 184(45.7%) | ||
| Do you, or have you ever smoked e-cigarettes? (Even one or two puffs.) | Yes | 60(14.9%) | 36(8.9%) | <0.001* |
| No | 87(21.6%) | 220(54.6%) | ||
| Are you a current e-cigarette smoker? (Smoked in the past 30 days.) | Yes | 22(5.5%) | 11(2.7%) | <0.001* |
| No | 125(31%) | 245(60.8%) | ||
| Would you ever promote or recommend the use of e-cigarettes to other people if you got the chance to? | Yes | 20(5%) | 12(3%) | 0.001 |
| No | 127(31.5%) | 244(60.5%) | ||
| Grade | P-Values | ||||
| Middle School | High School | Not enrolled | |||
| Do you know what e-cigarettes are? | Yes | 64(15.9%) | 170(42.2%) | 43(10.7%) | <0.001* |
| No | 78(19.4%) | 42(10.4%) | 6(1.5%) | ||
| If yes, then how did you learn about them? | Internet | 21(5.2%) | 61(15.1%) | 19(4.7%) | <0.001* |
| Friends | 28(6.9%) | 96(23.8%) | 20(5%) | ||
| Television | 9(2.2%) | 10(2.5%) | 0(0%) | ||
| Magazines | 3(0.7%) | 2(0.5%) | 2(0.5%) | ||
| Newspapers | 3(0.7%) | 1(0.2%) | 2(0.5%) | ||
| Did not know about e-cigarettes | 78(19.4%) | 42(10.4%) | 6(1.5%) | ||
| Are you aware of the various ingredients and chemicals in e-cigarette smoke? | Yes | 42(10.4%) | 105(26.1%) | 31(7.7%) | <0.001* |
| No | 100(24.8%) | 107(26.6%) | 18(4.5%) | ||
| Do you know about the different levels of nicotine in e-cigarettes? | Yes | 15(3.7%) | 42(10.4%) | 11(2.7%) | 0.02* |
| No | 127(31.5%) | 170(42.2%) | 38(9.4%) | ||
| What do you think makes people start smoking e-cigarettes? | Stress | 13(3.2%) | 35(8.7%) | 4(1%) | <0.001* |
| Depression | 22(5.5%) | 38(9.4%) | 8(2%) | ||
| Peer pressure | 61(15.1%) | 28(6.9%) | 4(1%) | ||
| Acceptability in family | 6(1.5%) | 7(1.7%) | 3(0.7%) | ||
| Recreational use | 22((5.5%) | 41(10.2%) | 14(3.5%) | ||
| To quit smoking regular cigarettes | 18(4.5%) | 63(15.6%) | 16(4%) | ||
| How effective do you think e-cigarettes are in helping people quit smoking regular cigarettes? | Extremely effective | 34(8.4%) | 13(3.2%) | 5(1.2%) | 0.001* |
| Slightly effective | 34(8.4%) | 56(13.9%) | 13(3.2%) | ||
| No idea | 60(14.9%) | 116(28.8%) | 27(6.7%) | ||
| Slightly ineffective | 5(1.2%) | 12(3%) | 0(0%) | ||
| Extremely ineffective | 9(2.2%) | 15(3.7%) | 4(1%) | ||
| What do you think about the statement “people harm themselves when smoking e-cigarettes”? | Strongly agree | 74(18.4%) | 48(11.9%) | 11(2.7%) | <0.001* |
| Agree | 33(8.2%) | 73(18.1%) | 22(5.5%) | ||
| Undecided | 10(2.5%) | 63(15.6%) | 12(3%) | ||
| Disagree | 8(2%) | 13(3.2%) | 4(1%) | ||
| Strongly disagree | 17(4.2%) | 15(3.7%) | 0(0%) | ||
| When comparing harmful effects of e-cigarettes to regular cigarettes, how harmful do you think they are? | Much more harmful | 35(8.7%) | 29(7.2%) | 8(2%) | 0.003* |
| Slightly more harmful | 16(4%) | 23(5.7%) | 3(0.7%) | ||
| Equally harmful | 55(13.6%) | 72(17.9%) | 13(3.2%) | ||
| Slightly less harmful | 19(4.7%) | 64(15.9%) | 17(4.2%) | ||
| Much less harmful | 17(4.2%) | 24(6%) | 8(2%) | ||
| When comparing the addiction of e-cigarettes to regular cigarettes, how addictive do you think they are? | Much more addictive | 71(17.6%) | 28(6.9%) | 5(1.2%) | <0.001* |
| Slightly more addictive | 14(3.5%) | 22(5.5%) | 4(1%) | ||
| Equally addictive | 16(4%) | 85(21.1%) | 28(6.9%) | ||
| Slightly less addictive | 25(6.2%) | 52(12.9%) | 8(2%) | ||
| Much less addictive | 16(4%) | 25(6.2%) | 4(1%) | ||
| What do you think about the statement “all tobacco products are dangerous”? | Strongly agree | 101(25.1%) | 112(27.8%) | 23(5.7%) | 0.002* |
| Agree | 27(6.7%) | 69(17.1%) | 18(4.5%) | ||
| Undecided | 3(0.7%) | 18(4.5%) | 4(1%) | ||
| Disagree | 4(1%) | 9(2.2%) | 4(1%) | ||
| Strongly disagree | 7(1.7%) | 4(1%) | 0(0%) | ||
| Do you think smoking e-cigarettes makes people young people “fit in”, feel “cool” and become socially more acceptable? | Yes | 63(15.6%) | 83(20.6%) | 19(4.7%) | 0.329 |
| No | 79(19.6%) | 129(32%) | 30(7.4%) | ||
| How easy do you think it is to buy e-cigarettes for young people of your age? | Very easy | 38(9.4%) | 77(19.1%) | 14(3.5%) | <0.001* |
| Easy | 29(7.2%) | 91(22.6%) | 28(6.9%) | ||
| Difficult | 52(12.9%) | 38(9.4%) | 7(1.7%) | ||
| Very difficult | 23(5.7%) | 6(1.5%) | 0(0%) | ||
| If a good friend of yours wanted you to try e-cigarettes, would you try them? | Definitely will | 21(5.2%) | 22(5.5%) | 2(0.5%) | 0.015* |
| Probably will | 13(3.2%) | 44(10.9%) | 14(3.5%) | ||
| Probably will not | 8(2%) | 34(8.4%) | 6(1.5%) | ||
| Definitely will not | 100(24.8%) | 112(27.8%) | 27(6.7%) | ||
| If you ever try smoking e-cigarettes, do you think you would do it with your guardian’s permission? | Yes | 57(14.1%) | 52(12.9%) | 19(4.7%) | 0.002* |
| No | 85(21.1%) | 160(39.7%) | 30(7.4%) | ||
| Are you surrounded by, or live with people who use and promote the use of e-cigarettes? | Yes | 59(14.6%) | 51(12.7%) | 12(3%) | <0.001* |
| No | 83(20.6%) | 161(40%) | 37(9.2%) | ||
| Do you, or have you ever smoked e-cigarettes? (Even one or two puffs.) | Yes | 30(7.4%) | 57(14.1%) | 9(2.2%) | 0.217 |
| No | 112(27.8%) | 155(38.5%) | 40(9.9%) | ||
| Are you a current e-cigarette smoker? (Smoked in the past 30 days.) | Yes | 17(4.2%) | 15(3.7%) | 1(0.2%) | 0.115 |
| No | 125(31%) | 197(48.9%) | 48(11.9%) | ||
| Would you ever promote or recommend the use of e-cigarettes to other people if you got the chance to? | Yes | 11(2.7%) | 18(4.5%) | 3(0.7%) | 0.802 |
| No | 131(32.5%) | 194(48.1%) | 46(11.4%) | ||
Table 2: Table representing the knowledge, attitudes and practices compared with level of schooling
| Grade | P-Values | ||||
| Middle School | High School | Not enrolled | |||
| Do you know what e-cigarettes are? | Yes | 64(15.9%) | 170(42.2%) | 43(10.7%) | <0.001* |
| No | 78(19.4%) | 42(10.4%) | 6(1.5%) | ||
| If yes, then how did you learn about them? | Internet | 21(5.2%) | 61(15.1%) | 19(4.7%) | <0.001* |
| Friends | 28(6.9%) | 96(23.8%) | 20(5%) | ||
| Television | 9(2.2%) | 10(2.5%) | 0(0%) | ||
| Magazines | 3(0.7%) | 2(0.5%) | 2(0.5%) | ||
| Newspapers | 3(0.7%) | 1(0.2%) | 2(0.5%) | ||
| Did not know about e-cigarettes | 78(19.4%) | 42(10.4%) | 6(1.5%) | ||
| Are you aware of the various ingredients and chemicals in e-cigarette smoke? | Yes | 42(10.4%) | 105(26.1%) | 31(7.7%) | <0.001* |
| No | 100(24.8%) | 107(26.6%) | 18(4.5%) | ||
| Do you know about the different levels of nicotine in e-cigarettes? | Yes | 15(3.7%) | 42(10.4%) | 11(2.7%) | 0.02* |
| No | 127(31.5%) | 170(42.2%) | 38(9.4%) | ||
| What do you think makes people start smoking e-cigarettes? | Stress | 13(3.2%) | 35(8.7%) | 4(1%) | <0.001* |
| Depression | 22(5.5%) | 38(9.4%) | 8(2%) | ||
| Peer pressure | 61(15.1%) | 28(6.9%) | 4(1%) | ||
| Acceptability in family | 6(1.5%) | 7(1.7%) | 3(0.7%) | ||
| Recreational use | 22((5.5%) | 41(10.2%) | 14(3.5%) | ||
| To quit smoking regular cigarettes | 18(4.5%) | 63(15.6%) | 16(4%) | ||
| How effective do you think e-cigarettes are in helping people quit smoking regular cigarettes? | Extremely effective | 34(8.4%) | 13(3.2%) | 5(1.2%) | 0.001* |
| Slightly effective | 34(8.4%) | 56(13.9%) | 13(3.2%) | ||
| No idea | 60(14.9%) | 116(28.8%) | 27(6.7%) | ||
| Slightly ineffective | 5(1.2%) | 12(3%) | 0(0%) | ||
| Extremely ineffective | 9(2.2%) | 15(3.7%) | 4(1%) | ||
| What do you think about the statement “people harm themselves when smoking e-cigarettes”? | Strongly agree | 74(18.4%) | 48(11.9%) | 11(2.7%) | <0.001* |
| Agree | 33(8.2%) | 73(18.1%) | 22(5.5%) | ||
| Undecided | 10(2.5%) | 63(15.6%) | 12(3%) | ||
| Disagree | 8(2%) | 13(3.2%) | 4(1%) | ||
| Strongly disagree | 17(4.2%) | 15(3.7%) | 0(0%) | ||
| When comparing harmful effects of e-cigarettes to regular cigarettes, how harmful do you think they are? | Much more harmful | 35(8.7%) | 29(7.2%) | 8(2%) | 0.003* |
| Slightly more harmful | 16(4%) | 23(5.7%) | 3(0.7%) | ||
| Equally harmful | 55(13.6%) | 72(17.9%) | 13(3.2%) | ||
| Slightly less harmful | 19(4.7%) | 64(15.9%) | 17(4.2%) | ||
| Much less harmful | 17(4.2%) | 24(6%) | 8(2%) | ||
| When comparing the addiction of e-cigarettes to regular cigarettes, how addictive do you think they are? | Much more addictive | 71(17.6%) | 28(6.9%) | 5(1.2%) | <0.001* |
| Slightly more addictive | 14(3.5%) | 22(5.5%) | 4(1%) | ||
| Equally addictive | 16(4%) | 85(21.1%) | 28(6.9%) | ||
| Slightly less addictive | 25(6.2%) | 52(12.9%) | 8(2%) | ||
| Much less addictive | 16(4%) | 25(6.2%) | 4(1%) | ||
| What do you think about the statement “all tobacco products are dangerous”? | Strongly agree | 101(25.1%) | 112(27.8%) | 23(5.7%) | 0.002* |
| Agree | 27(6.7%) | 69(17.1%) | 18(4.5%) | ||
| Undecided | 3(0.7%) | 18(4.5%) | 4(1%) | ||
| Disagree | 4(1%) | 9(2.2%) | 4(1%) | ||
| Strongly disagree | 7(1.7%) | 4(1%) | 0(0%) | ||
| Do you think smoking e-cigarettes makes people young people “fit in”, feel “cool” and become socially more acceptable? | Yes | 63(15.6%) | 83(20.6%) | 19(4.7%) | 0.329 |
| No | 79(19.6%) | 129(32%) | 30(7.4%) | ||
| How easy do you think it is to buy e-cigarettes for young people of your age? | Very easy | 38(9.4%) | 77(19.1%) | 14(3.5%) | <0.001* |
| Easy | 29(7.2%) | 91(22.6%) | 28(6.9%) | ||
| Difficult | 52(12.9%) | 38(9.4%) | 7(1.7%) | ||
| Very difficult | 23(5.7%) | 6(1.5%) | 0(0%) | ||
| If a good friend of yours wanted you to try e-cigarettes, would you try them? | Definitely will | 21(5.2%) | 22(5.5%) | 2(0.5%) | 0.015* |
| Probably will | 13(3.2%) | 44(10.9%) | 14(3.5%) | ||
| Probably will not | 8(2%) | 34(8.4%) | 6(1.5%) | ||
| Definitely will not | 100(24.8%) | 112(27.8%) | 27(6.7%) | ||
| If you ever try smoking e-cigarettes, do you think you would do it with your guardian’s permission? | Yes | 57(14.1%) | 52(12.9%) | 19(4.7%) | 0.002* |
| No | 85(21.1%) | 160(39.7%) | 30(7.4%) | ||
| Are you surrounded by, or live with people who use and promote the use of e-cigarettes? | Yes | 59(14.6%) | 51(12.7%) | 12(3%) | <0.001* |
| No | 83(20.6%) | 161(40%) | 37(9.2%) | ||
| Do you, or have you ever smoked e-cigarettes? (Even one or two puffs.) | Yes | 30(7.4%) | 57(14.1%) | 9(2.2%) | 0.217 |
| No | 112(27.8%) | 155(38.5%) | 40(9.9%) | ||
| Are you a current e-cigarette smoker? (Smoked in the past 30 days.) | Yes | 17(4.2%) | 15(3.7%) | 1(0.2%) | 0.115 |
| No | 125(31%) | 197(48.9%) | 48(11.9%) | ||
| Would you ever promote or recommend the use of e-cigarettes to other people if you got the chance to? | Yes | 11(2.7%) | 18(4.5%) | 3(0.7%) | 0.802 |
| No | 131(32.5%) | 194(48.1%) | 46(11.4%) | ||
5.2
Original article
peer-reviewed
Knowledge and Attitude of Teenagers Towards Electronic Cigarettes in Karachi, Pakistan
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Author Information
Asim Shaikh
Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
Hamza T. Ansari Corresponding Author
Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
Zeerak Ahmad
Ziauddin Medical College, Ziauddin University
Mahnoor Y. Shaikh
Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
Ilma Khalid
Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
Maha Jahangir
Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
Amna Majeed
Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
Nimra Shakeel
Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
Arsalan Ahmed
Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
Roha Saeed Memon
Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
Eleze Tariq
Aga Khan University, The Aga Khan University
Rafia Irfan
Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
Dania Madni
Ziauddin University
Ethics Statement and Conflict of Interest Disclosures
Human subjects: Consent was obtained by all participants in this study. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.
Acknowledgements
Article Information
Published: July 13, 2017
DOI
10.7759/cureus.1468
Cite this article as:
Shaikh A, Ansari H T, Ahmad Z, et al. (July 13, 2017) Knowledge and Attitude of Teenagers Towards Electronic Cigarettes in Karachi, Pakistan. Cureus 9(7): e1468. doi:10.7759/cureus.1468
Publication history
Received by Cureus: May 06, 2017
Peer review began: May 15, 2017
Peer review concluded: July 04, 2017
Published: July 13, 2017Copyright
© Copyright 2017
Shaikh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.License
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Categories
Keywords
electronic, cigarettes, pakistan, knowledge, attitude, smoking, e-cigarettes, karachi, teenagers, nicotine
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Gender P-Values Male Female Do you know what e-cigarettes are? Yes 122(30.3%) 25(6.2%) <0.001* No 155(38.5%) 101(25.1%) If yes, then how did you learn about them? Internet 41(10.2%) 2(0.5%) <0.001* Friends 60(14.9%) 5(1.2%) Television 70(17.4%) 1(0.2%) Magazines 74(18.4%) 5(1.2%) Newspapers 8(2%) 25(6.2%) Did not know about e-cigarettes 11(2.7%) 101(25.1%) Are you aware of the various ingredients and chemicals in e-cigarette smoke? Yes 78(19.4%) 100(24.8%) 0.006* No 69(17.1%) 156(38.7%) Do you know about the different levels of nicotine in e-cigarettes? Yes 36(8.9%) 111(27.5%) 0.002* No 32(7.9%) 224(55.6%) What do you think makes people start smoking e-cigarettes? Stress 19(4.7%) 5(1.2%) <0.001* Depression 33(8.2%) 11(2.7%) Peer pressure 10(2.5%) 35(8.7%) Acceptability in family 58(14.4%) 42(10.4%) Recreational use 24(6%) 54(13.4%) To quit smoking regular cigarettes 69(17.1%) 43(10.7%) How effective do you think e-cigarettes are in helping people quit smoking regular cigarettes? Extremely effective 20(5%) 32(7.9%) 0.062 Slightly effective 42(10.4%) 61(15.1%) No idea 62(15.4%) 141(35%) Slightly ineffective 7(1.7%) 10(2.5%) Extremely ineffective 16(4%) 12(3%) What do you think about the statement “people harm themselves when smoking e-cigarettes”? Strongly agree 43(10.7%) 90(22.3%) 0.456 Agree 50(12.4%) 78(19.4%) Undecided 34(8.4%) 51(12.7%) Disagree 12(3%) 13(3.2%) Strongly disagree 8(2%) 24(6%) When comparing harmful effects of e-cigarettes to regular cigarettes, how harmful do you think they are? Much more harmful 27(6.7%) 45(11.2%) <0.001* Slightly more harmful 12(3%) 30(7.4%) Equally harmful 31(7.7%) 109(27%) Slightly less harmful 46(11.4%) 54(13.41%) Much less harmful 31(7.7%) 18(4.5%) When comparing the addiction of e-cigarettes to regular cigarettes, how addictive do you think they are? Much more addictive 30(7.4%) 74(18.4%) 0.061 Slightly more addictive 17(4.2%) 23(5.7%) Equally addictive 46(11.4%) 83(20.6%) Slightly less addictive 33(8.2%) 52(12.9%) Much less addictive 21(5.2%) 24(6%) What do you think about the statement “all tobacco products are dangerous”? Strongly agree 74(18.4%) 162(40.2%) 0.028* Agree 52(12.9%) 62(15.4%) Undecided 12(3%) 13(3.2%) Disagree 7(1.7%) 10(2.5%) Strongly disagree 2(0.5%) 9(2.2%) Do you think smoking e-cigarettes makes people young people “fit in”, feel “cool” and become socially more acceptable? Yes 57(14.1%) 108(26.8%) 0.503 No 90(22.3%) 148(36.7%) How easy do you think it is to buy e-cigarettes for young people of your age? Very easy 60(14.9%) 69(17.1%) 0.004* Easy 53(13.2%) 95(23.6%) Difficult 21(5.2%) 76(18.9%) Very difficult 13(3.2%) 16(4%) If a good friend of yours wanted you to try e-cigarettes, would you try them? Definitely will 27(6.7%) 18(4.5%) <0.001* Probably will 37(9.2%) 34(8.4%) Probably will not 22(5.5%) 26(6.5%) Definitely will not 61(15.1%) 178(44.2%) If you ever try smoking e-cigarettes, do you think you would do it with your guardian’s permission? Yes 40(9.9%) 107(26.6%) 0.137 No 40(9.9%) 88(21.8%) Are you surrounded by, or live with people who use and promote the use of e-cigarettes? Yes 50(12.4%) 72(17.9%) 0.216 No 97(24.1%) 184(45.7%) Do you, or have you ever smoked e-cigarettes? (Even one or two puffs.) Yes 60(14.9%) 36(8.9%) <0.001* No 87(21.6%) 220(54.6%) Are you a current e-cigarette smoker? (Smoked in the past 30 days.) Yes 22(5.5%) 11(2.7%) <0.001* No 125(31%) 245(60.8%) Would you ever promote or recommend the use of e-cigarettes to other people if you got the chance to? Yes 20(5%) 12(3%) 0.001 No 127(31.5%) 244(60.5%) Table 1: Table representing the knowledge, attitudes and practices compared with gender
Gender P-Values Male Female Do you know what e-cigarettes are? Yes 122(30.3%) 25(6.2%) <0.001* No 155(38.5%) 101(25.1%) If yes, then how did you learn about them? Internet 41(10.2%) 2(0.5%) <0.001* Friends 60(14.9%) 5(1.2%) Television 70(17.4%) 1(0.2%) Magazines 74(18.4%) 5(1.2%) Newspapers 8(2%) 25(6.2%) Did not know about e-cigarettes 11(2.7%) 101(25.1%) Are you aware of the various ingredients and chemicals in e-cigarette smoke? Yes 78(19.4%) 100(24.8%) 0.006* No 69(17.1%) 156(38.7%) Do you know about the different levels of nicotine in e-cigarettes? Yes 36(8.9%) 111(27.5%) 0.002* No 32(7.9%) 224(55.6%) What do you think makes people start smoking e-cigarettes? Stress 19(4.7%) 5(1.2%) <0.001* Depression 33(8.2%) 11(2.7%) Peer pressure 10(2.5%) 35(8.7%) Acceptability in family 58(14.4%) 42(10.4%) Recreational use 24(6%) 54(13.4%) To quit smoking regular cigarettes 69(17.1%) 43(10.7%) How effective do you think e-cigarettes are in helping people quit smoking regular cigarettes? Extremely effective 20(5%) 32(7.9%) 0.062 Slightly effective 42(10.4%) 61(15.1%) No idea 62(15.4%) 141(35%) Slightly ineffective 7(1.7%) 10(2.5%) Extremely ineffective 16(4%) 12(3%) What do you think about the statement “people harm themselves when smoking e-cigarettes”? Strongly agree 43(10.7%) 90(22.3%) 0.456 Agree 50(12.4%) 78(19.4%) Undecided 34(8.4%) 51(12.7%) Disagree 12(3%) 13(3.2%) Strongly disagree 8(2%) 24(6%) When comparing harmful effects of e-cigarettes to regular cigarettes, how harmful do you think they are? Much more harmful 27(6.7%) 45(11.2%) <0.001* Slightly more harmful 12(3%) 30(7.4%) Equally harmful 31(7.7%) 109(27%) Slightly less harmful 46(11.4%) 54(13.41%) Much less harmful 31(7.7%) 18(4.5%) When comparing the addiction of e-cigarettes to regular cigarettes, how addictive do you think they are? Much more addictive 30(7.4%) 74(18.4%) 0.061 Slightly more addictive 17(4.2%) 23(5.7%) Equally addictive 46(11.4%) 83(20.6%) Slightly less addictive 33(8.2%) 52(12.9%) Much less addictive 21(5.2%) 24(6%) What do you think about the statement “all tobacco products are dangerous”? Strongly agree 74(18.4%) 162(40.2%) 0.028* Agree 52(12.9%) 62(15.4%) Undecided 12(3%) 13(3.2%) Disagree 7(1.7%) 10(2.5%) Strongly disagree 2(0.5%) 9(2.2%) Do you think smoking e-cigarettes makes people young people “fit in”, feel “cool” and become socially more acceptable? Yes 57(14.1%) 108(26.8%) 0.503 No 90(22.3%) 148(36.7%) How easy do you think it is to buy e-cigarettes for young people of your age? Very easy 60(14.9%) 69(17.1%) 0.004* Easy 53(13.2%) 95(23.6%) Difficult 21(5.2%) 76(18.9%) Very difficult 13(3.2%) 16(4%) If a good friend of yours wanted you to try e-cigarettes, would you try them? Definitely will 27(6.7%) 18(4.5%) <0.001* Probably will 37(9.2%) 34(8.4%) Probably will not 22(5.5%) 26(6.5%) Definitely will not 61(15.1%) 178(44.2%) If you ever try smoking e-cigarettes, do you think you would do it with your guardian’s permission? Yes 40(9.9%) 107(26.6%) 0.137 No 40(9.9%) 88(21.8%) Are you surrounded by, or live with people who use and promote the use of e-cigarettes? Yes 50(12.4%) 72(17.9%) 0.216 No 97(24.1%) 184(45.7%) Do you, or have you ever smoked e-cigarettes? (Even one or two puffs.) Yes 60(14.9%) 36(8.9%) <0.001* No 87(21.6%) 220(54.6%) Are you a current e-cigarette smoker? (Smoked in the past 30 days.) Yes 22(5.5%) 11(2.7%) <0.001* No 125(31%) 245(60.8%) Would you ever promote or recommend the use of e-cigarettes to other people if you got the chance to? Yes 20(5%) 12(3%) 0.001 No 127(31.5%) 244(60.5%) Grade P-Values Middle School High School Not enrolled Do you know what e-cigarettes are? Yes 64(15.9%) 170(42.2%) 43(10.7%) <0.001* No 78(19.4%) 42(10.4%) 6(1.5%) If yes, then how did you learn about them? Internet 21(5.2%) 61(15.1%) 19(4.7%) <0.001* Friends 28(6.9%) 96(23.8%) 20(5%) Television 9(2.2%) 10(2.5%) 0(0%) Magazines 3(0.7%) 2(0.5%) 2(0.5%) Newspapers 3(0.7%) 1(0.2%) 2(0.5%) Did not know about e-cigarettes 78(19.4%) 42(10.4%) 6(1.5%) Are you aware of the various ingredients and chemicals in e-cigarette smoke? Yes 42(10.4%) 105(26.1%) 31(7.7%) <0.001* No 100(24.8%) 107(26.6%) 18(4.5%) Do you know about the different levels of nicotine in e-cigarettes? Yes 15(3.7%) 42(10.4%) 11(2.7%) 0.02* No 127(31.5%) 170(42.2%) 38(9.4%) What do you think makes people start smoking e-cigarettes? Stress 13(3.2%) 35(8.7%) 4(1%) <0.001* Depression 22(5.5%) 38(9.4%) 8(2%) Peer pressure 61(15.1%) 28(6.9%) 4(1%) Acceptability in family 6(1.5%) 7(1.7%) 3(0.7%) Recreational use 22((5.5%) 41(10.2%) 14(3.5%) To quit smoking regular cigarettes 18(4.5%) 63(15.6%) 16(4%) How effective do you think e-cigarettes are in helping people quit smoking regular cigarettes? Extremely effective 34(8.4%) 13(3.2%) 5(1.2%) 0.001* Slightly effective 34(8.4%) 56(13.9%) 13(3.2%) No idea 60(14.9%) 116(28.8%) 27(6.7%) Slightly ineffective 5(1.2%) 12(3%) 0(0%) Extremely ineffective 9(2.2%) 15(3.7%) 4(1%) What do you think about the statement “people harm themselves when smoking e-cigarettes”? Strongly agree 74(18.4%) 48(11.9%) 11(2.7%) <0.001* Agree 33(8.2%) 73(18.1%) 22(5.5%) Undecided 10(2.5%) 63(15.6%) 12(3%) Disagree 8(2%) 13(3.2%) 4(1%) Strongly disagree 17(4.2%) 15(3.7%) 0(0%) When comparing harmful effects of e-cigarettes to regular cigarettes, how harmful do you think they are? Much more harmful 35(8.7%) 29(7.2%) 8(2%) 0.003* Slightly more harmful 16(4%) 23(5.7%) 3(0.7%) Equally harmful 55(13.6%) 72(17.9%) 13(3.2%) Slightly less harmful 19(4.7%) 64(15.9%) 17(4.2%) Much less harmful 17(4.2%) 24(6%) 8(2%) When comparing the addiction of e-cigarettes to regular cigarettes, how addictive do you think they are? Much more addictive 71(17.6%) 28(6.9%) 5(1.2%) <0.001* Slightly more addictive 14(3.5%) 22(5.5%) 4(1%) Equally addictive 16(4%) 85(21.1%) 28(6.9%) Slightly less addictive 25(6.2%) 52(12.9%) 8(2%) Much less addictive 16(4%) 25(6.2%) 4(1%) What do you think about the statement “all tobacco products are dangerous”? Strongly agree 101(25.1%) 112(27.8%) 23(5.7%) 0.002* Agree 27(6.7%) 69(17.1%) 18(4.5%) Undecided 3(0.7%) 18(4.5%) 4(1%) Disagree 4(1%) 9(2.2%) 4(1%) Strongly disagree 7(1.7%) 4(1%) 0(0%) Do you think smoking e-cigarettes makes people young people “fit in”, feel “cool” and become socially more acceptable? Yes 63(15.6%) 83(20.6%) 19(4.7%) 0.329 No 79(19.6%) 129(32%) 30(7.4%) How easy do you think it is to buy e-cigarettes for young people of your age? Very easy 38(9.4%) 77(19.1%) 14(3.5%) <0.001* Easy 29(7.2%) 91(22.6%) 28(6.9%) Difficult 52(12.9%) 38(9.4%) 7(1.7%) Very difficult 23(5.7%) 6(1.5%) 0(0%) If a good friend of yours wanted you to try e-cigarettes, would you try them? Definitely will 21(5.2%) 22(5.5%) 2(0.5%) 0.015* Probably will 13(3.2%) 44(10.9%) 14(3.5%) Probably will not 8(2%) 34(8.4%) 6(1.5%) Definitely will not 100(24.8%) 112(27.8%) 27(6.7%) If you ever try smoking e-cigarettes, do you think you would do it with your guardian’s permission? Yes 57(14.1%) 52(12.9%) 19(4.7%) 0.002* No 85(21.1%) 160(39.7%) 30(7.4%) Are you surrounded by, or live with people who use and promote the use of e-cigarettes? Yes 59(14.6%) 51(12.7%) 12(3%) <0.001* No 83(20.6%) 161(40%) 37(9.2%) Do you, or have you ever smoked e-cigarettes? (Even one or two puffs.) Yes 30(7.4%) 57(14.1%) 9(2.2%) 0.217 No 112(27.8%) 155(38.5%) 40(9.9%) Are you a current e-cigarette smoker? (Smoked in the past 30 days.) Yes 17(4.2%) 15(3.7%) 1(0.2%) 0.115 No 125(31%) 197(48.9%) 48(11.9%) Would you ever promote or recommend the use of e-cigarettes to other people if you got the chance to? Yes 11(2.7%) 18(4.5%) 3(0.7%) 0.802 No 131(32.5%) 194(48.1%) 46(11.4%) Table 2: Table representing the knowledge, attitudes and practices compared with level of schooling
Grade P-Values Middle School High School Not enrolled Do you know what e-cigarettes are? Yes 64(15.9%) 170(42.2%) 43(10.7%) <0.001* No 78(19.4%) 42(10.4%) 6(1.5%) If yes, then how did you learn about them? Internet 21(5.2%) 61(15.1%) 19(4.7%) <0.001* Friends 28(6.9%) 96(23.8%) 20(5%) Television 9(2.2%) 10(2.5%) 0(0%) Magazines 3(0.7%) 2(0.5%) 2(0.5%) Newspapers 3(0.7%) 1(0.2%) 2(0.5%) Did not know about e-cigarettes 78(19.4%) 42(10.4%) 6(1.5%) Are you aware of the various ingredients and chemicals in e-cigarette smoke? Yes 42(10.4%) 105(26.1%) 31(7.7%) <0.001* No 100(24.8%) 107(26.6%) 18(4.5%) Do you know about the different levels of nicotine in e-cigarettes? Yes 15(3.7%) 42(10.4%) 11(2.7%) 0.02* No 127(31.5%) 170(42.2%) 38(9.4%) What do you think makes people start smoking e-cigarettes? Stress 13(3.2%) 35(8.7%) 4(1%) <0.001* Depression 22(5.5%) 38(9.4%) 8(2%) Peer pressure 61(15.1%) 28(6.9%) 4(1%) Acceptability in family 6(1.5%) 7(1.7%) 3(0.7%) Recreational use 22((5.5%) 41(10.2%) 14(3.5%) To quit smoking regular cigarettes 18(4.5%) 63(15.6%) 16(4%) How effective do you think e-cigarettes are in helping people quit smoking regular cigarettes? Extremely effective 34(8.4%) 13(3.2%) 5(1.2%) 0.001* Slightly effective 34(8.4%) 56(13.9%) 13(3.2%) No idea 60(14.9%) 116(28.8%) 27(6.7%) Slightly ineffective 5(1.2%) 12(3%) 0(0%) Extremely ineffective 9(2.2%) 15(3.7%) 4(1%) What do you think about the statement “people harm themselves when smoking e-cigarettes”? Strongly agree 74(18.4%) 48(11.9%) 11(2.7%) <0.001* Agree 33(8.2%) 73(18.1%) 22(5.5%) Undecided 10(2.5%) 63(15.6%) 12(3%) Disagree 8(2%) 13(3.2%) 4(1%) Strongly disagree 17(4.2%) 15(3.7%) 0(0%) When comparing harmful effects of e-cigarettes to regular cigarettes, how harmful do you think they are? Much more harmful 35(8.7%) 29(7.2%) 8(2%) 0.003* Slightly more harmful 16(4%) 23(5.7%) 3(0.7%) Equally harmful 55(13.6%) 72(17.9%) 13(3.2%) Slightly less harmful 19(4.7%) 64(15.9%) 17(4.2%) Much less harmful 17(4.2%) 24(6%) 8(2%) When comparing the addiction of e-cigarettes to regular cigarettes, how addictive do you think they are? Much more addictive 71(17.6%) 28(6.9%) 5(1.2%) <0.001* Slightly more addictive 14(3.5%) 22(5.5%) 4(1%) Equally addictive 16(4%) 85(21.1%) 28(6.9%) Slightly less addictive 25(6.2%) 52(12.9%) 8(2%) Much less addictive 16(4%) 25(6.2%) 4(1%) What do you think about the statement “all tobacco products are dangerous”? Strongly agree 101(25.1%) 112(27.8%) 23(5.7%) 0.002* Agree 27(6.7%) 69(17.1%) 18(4.5%) Undecided 3(0.7%) 18(4.5%) 4(1%) Disagree 4(1%) 9(2.2%) 4(1%) Strongly disagree 7(1.7%) 4(1%) 0(0%) Do you think smoking e-cigarettes makes people young people “fit in”, feel “cool” and become socially more acceptable? Yes 63(15.6%) 83(20.6%) 19(4.7%) 0.329 No 79(19.6%) 129(32%) 30(7.4%) How easy do you think it is to buy e-cigarettes for young people of your age? Very easy 38(9.4%) 77(19.1%) 14(3.5%) <0.001* Easy 29(7.2%) 91(22.6%) 28(6.9%) Difficult 52(12.9%) 38(9.4%) 7(1.7%) Very difficult 23(5.7%) 6(1.5%) 0(0%) If a good friend of yours wanted you to try e-cigarettes, would you try them? Definitely will 21(5.2%) 22(5.5%) 2(0.5%) 0.015* Probably will 13(3.2%) 44(10.9%) 14(3.5%) Probably will not 8(2%) 34(8.4%) 6(1.5%) Definitely will not 100(24.8%) 112(27.8%) 27(6.7%) If you ever try smoking e-cigarettes, do you think you would do it with your guardian’s permission? Yes 57(14.1%) 52(12.9%) 19(4.7%) 0.002* No 85(21.1%) 160(39.7%) 30(7.4%) Are you surrounded by, or live with people who use and promote the use of e-cigarettes? Yes 59(14.6%) 51(12.7%) 12(3%) <0.001* No 83(20.6%) 161(40%) 37(9.2%) Do you, or have you ever smoked e-cigarettes? (Even one or two puffs.) Yes 30(7.4%) 57(14.1%) 9(2.2%) 0.217 No 112(27.8%) 155(38.5%) 40(9.9%) Are you a current e-cigarette smoker? (Smoked in the past 30 days.) Yes 17(4.2%) 15(3.7%) 1(0.2%) 0.115 No 125(31%) 197(48.9%) 48(11.9%) Would you ever promote or recommend the use of e-cigarettes to other people if you got the chance to? Yes 11(2.7%) 18(4.5%) 3(0.7%) 0.802 No 131(32.5%) 194(48.1%) 46(11.4%)
Abstract
Introduction
Studies have shown that electronic cigarettes have gained immense popularity and their use has increased dramatically all over the world. However, little is known about the knowledge and attitudes towards e-cigarettes in third world countries such as Pakistan. The aim of this study was to determine the perceptions of teenagers in Karachi regarding e-cigarettes and whether the differences in said perceptions were affected by gender and level of education.
Methods
We conducted a cross-sectional study in January 2017 using convenience sampling and interviewed 441 young individuals, aged 13 to 19 years, to determine their knowledge, attitudes, and practices regarding e-cigarettes. The participants were questioned about their knowledge and its source. Attitudes were judged using four and five-point Likert scales while questions regarding practices focused on single and current use. Chi-square and Mann-Whitney tests were applied to compare the knowledge, attitudes, and practices of teenagers with gender and level of schooling.
Results
The majority of participants knew what e-cigarettes were (n=277, 68.7%) but did not know about their contents (n=225, 55.8%) and had learned about them from either friends or the internet (n=245, 60.%). Almost half of them (n=190, 47.2%) believed that the reason for e-cigarette use was either peer pressure or to quit smoking conventional cigarettes. An overwhelming majority also stated that; it was either easy or very easy to obtain e-cigarettes (n=277, 68.7%), they would not try smoking e-cigarettes even if a good friend of theirs recommended them (n=287, 71.2%), they were not current e-cigarette smokers (n=370, 91.8%) and they would never promote e-cigarette use (n=371, 92.1%). Statistically significant differences were found with males knowing more about e-cigarettes (p=0.006) and being more common to either have smoked (p <0.001) or be current e-cigarette smokers (p <0.001). Furthermore, middle school students were more likely to have negative attitudes towards e-cigarettes believing they were more harmful (p=0.003) and more addictive (p <0.001) than conventional cigarettes.
Conclusion
Many people were aware of what electronic cigarettes are but still, it was evident that there was the lack of proper knowledge along with negative attitudes towards e-cigarette use among teenagers in Pakistan due to cultural and social stigmas and lack of advertising. Males and females had considerable differences in their opinions regarding e-cigarette use owing to such social practices being considered taboo by females and males having greater freedom due to patriarchal, familial and cultural systems.
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