ORIGINAL PAPER JUMMEC 2024:27(1)

ELECTRONIC CIGARETTES KNOWLEDGE, ATTITUDE AND

THEIR ASSOCIATED FACTORS AMONG THE COMMUNITY
IN PAHANG, MALAYSIA

Wan Mamat WH1, Asmadi NI2, Mohamad Ismail MF1, Musharyanti L3, and Mahat NA1.
1
Kulliyyah of Nursing, International Islamic University Malaysia, Malaysia
2
Regency Specialist Hospital, Johor, Malaysia
3
Universitas Muhammadiyah Yogyakarta, Indonesia

Correspondence:
Wan Hasliza Wan Mamat,
Department of Professional Nursing Studies, Kulliyyah of Nursing,
International Islamic University Malaysia, Indera Mahkota Campus,
25200 Kuantan, Pahang, Malaysia
Email: whasliza@iium.edu.my

Abstract
The proliferation of electronic cigarettes (e-cigarettes) or vaping users shows the current trend is now on the
rise locally or globally. It has gained popularity because people are accepting it as an alternative to traditional
tobacco smoking. There is a bundle of information about the advantages and disadvantages of e-cigarettes, with
conflicting results that affect public understanding and attitude towards the usage of e-cigarettes. This study aimed
to determine the level of knowledge and attitude on e-cigarettes including their associated factors among one of
the communities in Pahang, Malaysia. A quantitative cross-sectional study was conducted among 394 community
members using online self-administered questionnaires. The questionnaire consists of 3 parts: Socio-demographic,
knowledge, and attitude toward e-cigarettes. The data were analysed by SPSS version 24, using descriptive and
multivariate analysis of variance (MANOVA) to answer the research aim. 48.5% of the participants exhibited a high
level of knowledge regarding e-cigarettes, while 84% of them exhibited a positive attitude towards e-cigarettes.
A MANOVA showed statistically significant multivariate effects of gender and smoking status (p < 0.001). Further
analysis of univariate ANOVA revealed significant main effects of gender and smoking status on the attitude of
e-cigarettes. Post-hoc analysis indicated that both passive and non-smoker have significance effect towards attitude
as compared to smoker (p < 0.001). This study showed that community members are more likely to be knowledgeable
about e-smoking. However, holistic community education programs and health campaigns should be undertaken
to shape attitudes towards e-smoking by providing accurate information on e-cigarettes and preventing the rise
of e-cigarette users. The government should take action by adopting tobacco control measures comprehensively
that including e-cigarette regulations.
Keywords: Knowledge, Attitude, E-Cigarette, Malaysia

Introduction e-cigarette users approximately 14% (3), while a local survey

among 4288 Malaysian showed that the overall prevalence
Recently, the use of e-cigarettes in Malaysia shows a
of current, ever, former, and dual e-cigarette users were
significant rise as more e-cigarette users can be seen in
3.2%, 11.9%, 8.6% and 2.3% respectively (4).
some public places and a large growth of shops that sell
e-cigarette products. The E-cigarette has become more The safety of e-cigarette consumption remains controversial
popular due to its lower cost, attractive features, various due to limited evidence even though abundant in vivo and
flavours of e-liquid, and higher convenience compared in vitro studies have been conducted to understand better
to tobacco cigarettes together with widely advertised the impact of e-cigarette compounds on human health
on social media that encourage adolescents to purchase (5). An increasing number of case reports have been
it (1). Driezen et al. (2) reported that the prevalence of published on various issues related to using e-cigarettes,
e-cigarette users in Malaysia increased from 0.8% in 2011 which are particularly common among young people
to 4.9% in 2019, while in 2020, 5.4% of Malaysian adults and may be harmful to their health such as pneumonia,
were e-cigarette users on a daily basis. Another survey of subacute bronchiolitis, mouth and tongue injuries, dental
10 countries from 2009 to 2013 reported that Malaysia injuries, complex facial fractures, thermal injuries, nickel
is one of the countries with the highest prevalence of contact allergy, and fatal intoxication from liquid ingestion

113
ORIGINAL PAPER JUMMEC 2024:27(1)

(6). The long-term effects of e-cigarette use are still unclear, Malaysia. Convenience sampling was applied to recruit
even though much research has been conducted about it the respondents in this study.
(7). Some countries such as India, Brazil, Singapore, and
Uruguay have banned the use of e-cigarettes because of Sample size
their impact on young people and pose a risk to health
The total population for the selected district is about
(8 - 10). Even the U.S. Food and Drug Administration (FDA)
514,000 (22). Based on the sample size calculation using
announced a series of historic actions related to the sale
Raosoft software, with an additional 10% dropout, the total
and marketing of e-cigarettes since e-cigarettes user
number of respondents required was 422. The inclusion
had reached ‘epidemic proportion’, especially among
criteria were 18 years and above, living in selected districts,
the youth (11). FDA also recognize the magnitude of the
able to read and understand English and/or Bahasa Melayu
problem among adolescent e-cigarette user highlighting
and willing to participate. The exclusion criteria for this
how quickly the tobacco control landscape has shifted
study are cognitive impairments and current substance
over the past decade, and as a consequence, many
abuse.
organizations around the world have emphasised the
need for regulatory agencies to act quickly to keep pace
(12). In Malaysia, the sales, distribution, and advertising Study instrument
of e-cigarettes are regulated under the Control of Tobacco A set of self-administered questionnaires that consists
Product Regulations (CTPR) 2004, enforced by the Ministry of three parts was used in the study. Part A consists of
of Health (MOH). However, the recent decision made by respondent’s sociodemographic information such as
the government to exempt nicotine from Poison Act 1952 gender, age, race, marital status, job status, education level
was unexpected because it will increase the availability and smoking status. Part B consists of 9 items that assessed
and accessibility of nicotine-containing products including the respondents’ level of knowledge regarding e-cigarettes
e-cigarettes (13). with a three points scale answers which are ‘Yes’, ‘No’ or ‘I
do not know’, adopted from the study by Hafiz et al. (14).
Previous studies in Sarawak, Malaysia reported that The level for knowledge was measured by the sum of the
54.3% of 232 adult respondents had good knowledge score obtained. The total knowledge scores (0-18) were
of e-cigarettes (14). In contrast, Aghar et al. (15) found categorised into 3 levels based on Bloom’s cut-off: high
that 63.3% of 350 respondents in Lebanon exhibited a level (80%-100%), moderate level (60%-79%), and low
lower level of e-cigarette knowledge. A similar finding level (< 60%) (23). Part C assessed the attitude towards
was reported in Jordan, in which their community had e-cigarettes that consisted of 13 items with ‘Yes’ or ‘No’,
a low level of knowledge regarding e-cigarettes (16, adopted from Aghar et al. (15). The total attitude scores (0-
17). Uncertainty about the mechanism and constituents 13) were categorised into 3 levels based on Bloom’s cut-off:
of e-cigarettes among the users might be because of positive attitude (80%-100%), neutral attitude (60%-79%),
unavailable or limited information on e-cigarettes (18). and negative attitude (< 60%) (23). The pilot study was
The emergence of e-cigarettes also has triggered positive conducted among 30 respondents and the reliability of
or negative reactions from society. A study by Aghar et this questionnaire was calculated using Cronbach’s Alpha
al. (15) showed that only 20.3% of participants portrayed with a value of 0.85.
a positive attitude towards e-cigarettes with 48.6% of
participants believing e-cigarettes were effective for
Data collection
smoking cessation, 53.9% believed that e-cigarettes could
help people to reduce or quit smoking and 44.3% believed Due to the Covid-19 pandemic in Malaysia, the questionnaire
that e-cigarettes should replace a regular cigarette. was created in Google Forms. The link has been distributed
Despite many studies that have been conducted related to online via 30 WhatsApp neighbouring groups and 7
adolescents’ attitudes towards smoking, only a few have Facebook groups of selected district communities. The
extended the research to adolescents’ attitudes towards purpose and information related to the study and written
e-cigarettes (19 - 21). Since e-cigarette is a relatively new informed consent were mentioned in Google Forms and
product, and their long-term health effects are still largely acquired before answering the questionnaire. The Patient
unknown, the nationally representative data related to Information Sheet’s posted statement states that ‘You are
e-cigarettes are still inadequate in Malaysia (14). Therefore, eligible if you live in District X’.
this study aimed to determine the level of knowledge,
attitude and its associated factors among the Malaysian Data analysis
community, specifically in Pahang regarding e-cigarettes. Data were entered and analysed using SPSS version 24.
Descriptive analysis was conducted to determine the
Materials and Methods sociodemographic factors and level of knowledge and
attitude. For continuous data, the results were presented
Study design and sampling as mean and standard deviation. Results for categorical
A cross-sectional study was conducted from March data were presented as frequency and percentage. The
2021 until June 2021 in one of the districts in Pahang, significance level for analysis was set at a = 0.05 and all
tests were two-sided. A multivariate analysis of variance

114
ORIGINAL PAPER JUMMEC 2024:27(1)

(MANOVA) test was used to compare between gender, Level of knowledge regarding e-cigarette
age, race, marital status, education level and smoking
status as the independent variables with a combination of From 18 marks in the domain knowledge, 48.5% of
multivariate dependent variables, knowledge and attitude. the respondents earned a total knowledge score ≥ 15),
All independent factors are important and had an influence indicating a high level of e-cigarette related knowledge
towards e-cigarette knowledge and attitude based on the (Table 2).
previous study (24 - 26). However, due to the small size
of the respondent in the group, variables such as race,
marital status, and education level were combined for Table 2: Total knowledge score
statistical analysis (Malay vs non-Malay, single vs married,
higher education vs no higher education). Significant test Frequency Percentage
results for MANOVA were based on F statistics, derived Low knowledge 76 19.3
from Wilks’ lambda. When the MANOVA was significant, Moderate knowledge 127 32.2
the univariate ANOVA result was examined. In post hoc High knowledge 191 48.5
comparisons, the Bonferroni procedure was applied. The
interaction term between the independent variables and
model assumptions was checked.
The most correct responses (82.5%) were in response
to question 2 while the lowest percentage of correct
Results responses (10.4%) was observed in response to question
3 (Table 3).
Demographic characteristics of the respondents
Table 1 shows the distribution of sociodemographic
characteristics of the respondents. A total of 394 Table 3: Percentage distribution of respondents by item-
respondents participated in this study, which contributed wise knowledge of e-cigarettes
to a 93.3% response rate. The majority of the respondents
were female (58.4%), Malay (92.6%), single (52.3%), age No. Item of Questions Yes No I do
ranged from 18-25 (46.7%), attended tertiary education not
(84.3%) and not smoking (80.7%). know
1. E-cigarettes can 78.4% 5.3% 16.2%
contain nicotine.
Table 1: Sociodemographic data of respondents 2. E-cigarettes are 82.5% 7.1% 10.4%
addictive.
Frequency Percentage
3. E-cigarettes are not 10.4% 75.6% 14.0%
Demographics n = 394 harmful to health.
Gender 4. E-cigarettes are less 28.9% 50.8% 20.3%
Male 164 41.6 harmful to health than
Female 230 58.4 normal cigarettes.
Age 5. E-cigarettes 72.8% 5.6% 21.6%
18-25 184 46.7 are potential cause of
26-35 64 16.2 asthma attacks and
36-49 122 31.0 allergies.
>50 24 6.1
6. E-cigarettes have the 45.4% 31.7% 22.8%
Race same chemicals as
Malay 368 93.3 normal cigarettes.
Chinese 16 4.1
Indian 7 1.8 7. The health risk of 58.6% 22.8% 18.5%
Others 3 0.8 e-cigarettes is the
same as normal
Marital status cigarettes.
Single 206 52.3
Married 179 45.4 8. E-cigarettes can be 73.6% 9.6% 16.8%
Divorced 9 2.3 regulated by the
government through
Educational level laws.
Primary schooling 2 0.5
Secondary schooling 60 15.2 9. E-cigarettes can be 19.8% 63.2% 17.0%
University/college 332 84.3 used in smoke-free
places.
Smoking status
Smoker 47 11.9
Non-smoker 318 80.7
Passive smoker 29 7.4

115
ORIGINAL PAPER JUMMEC 2024:27(1)

Attitude towards e-cigarette Table 5: Percentage distribution of respondents by item-

Most respondents (84%) earned a total attitude score ≥ 11 wise attitude towards e-cigarettes
indicating a positive attitude toward e-cigarettes (Table 4). No. Item of Questions Yes No
11. Do you think using 46.6% 53.6%
e-cigarettes would be an
Table 4: Total attitude score effective way to help with
smoking cessation?
Frequency Percentage
12. Do you think it is acceptable 41.9% 58.1%
Positive attitude 331 84 to use e-cigarettes as a
Neutral attitude 54 13.7 smoking cessation method?
Negative attitude 9 2.3 13. Do you think e-cigarettes 41.1% 58.9%
can help people cut down on
cigarettes or quit smoking?

In the importance subscale of the attitude section, 92.9%

of the respondents acknowledged the importance of the
government regulating the use of e-cigarettes (Table 5).
Association between socio-demographics
and level of knowledge and attitude toward
e-cigarette
Table 5: Percentage distribution of respondents by item- The MANOVA analysis in one model that included all
wise attitude towards e-cigarettes independent variables showed that gender (Wilks’ lambda
0.960, p < 0.001) and smoking status (Wilks’ lambda 0.967,
No. Item of Questions Yes No p < 0.001) were both significant. Then, the univariate tests
1. Should e-cigarettes be 10.9% 89.1% were examined and revealed significant main effects of
recommended to a non- gender and smoking status on the attitude of e-cigarettes
smoker? (Table 6). In post hoc comparisons of smoker status, the
2. Do you think e-cigarettes are 88.3% 11.7% Bonferroni procedure was applied and indicated that both
harmful to health? passive and non-smoker have a significant effect towards
3. Should the use of 20.6% 79.4%
attitude as compared to smoker (p < 0.001).
e-cigarettes be allowed in
places that do not allow
smoking? Table 6: An association of sociodemographic background
4. Would you consider 83.2% 16.8% with knowledge and attitude domain towards e-cigarettes
someone who uses
e-cigarettes a smoker? Factor Dependent F-stat p-value Partial
variable Eta
5. Do you think the use of 83.5% 16.5%
Square
e-cigarettes can lead to
reliance? Gender Knowledge 1.034 0.310 0.003
Attitude 16.002 0.001 0.040
6. Do you think the 92.9% 7.1%
government should regulate Age Knowledge 1.506 0.212 0.012
the use of e-cigarettes? Attitude 1.337 0.262 0.010
7. Do you feel more 52.3% 47.7% Race Knowledge 0.183 0.669 0.001
comfortable using or openly Attitude 1.171 0.280 0.003
talking about smoking Marital Knowledge 0.353 0.553 0.001
e-cigarettes compared to status Attitude 0.049 0.826 0.001
cigarettes?
8. Do you feel it is more 57.4% 42.6% Educational Knowledge 0.638 0.425 0.002
socially acceptable to smoke Level Attitude 0.178 0.674 0.001
e-cigarettes compared to
cigarettes?
Smoking Knowledge 1.191 0.305 0.006
9. Should e-cigarettes be used 37.6% 62.4% status Attitude 6.395 0.002 0.032
as a replacement for regular
cigarettes? A multivariate analysis of variance was conducted. There
10. Do you think it is acceptable 22.1% 77.9% is no interaction detected amongst independent variables
to experiment with and all assumptions of the model were met.
e-cigarettes for pleasure?

116
ORIGINAL PAPER JUMMEC 2024:27(1)

Discussion be different compared with women. Additionally, this could

also be attributed to the differences between gender in
The level of knowledge about e-cigarettes can vary among
perceiving and practising risk-taking behaviour (30). Similar
different communities and countries. Some people may
findings regarding the association between gender and
deeply understand e-cigarettes while others may have
attitude were reported in Malaysia (31) and Saudi Arabia
low knowledge or even misinformation about it. This
(7). In terms of the significant association between smoking
study revealed that the respondent’s level of knowledge
status and attitude, similar results were reported among
regarding e-cigarettes was very good in which more than a
male school adolescents in Thailand (1). Another study
third quarter of the respondents obtained a score of more
in Jordan found that smoker has a lower mean score of
than 50%. This result is considerably higher as compared
attitudes toward e-cigarettes (p < 0.001) than those who
to previous local studies (14) and abroad (15 - 17). The
did not (32).
possible explanation is that the majority of the respondents
in this study were graduates and young adults, so they may This study has several limitations. Firstly, this study was
have good knowledge about e-cigarettes. Understanding limited to a community-based convenience sample
the harmful effects of smoking is important, because recruited from only one district in Pahang, so generalisation
it will help individuals to recognize their own situation is limited. In the future, surveys with larger sample sizes
regarding smoking, leading to positive changes (27). and conducted in more districts and states in Malaysia are
Moreover, different tools also influence the variability of needed to understand the knowledge and attitude about
the result. However, it is important to note that the usage e-cigarettes better. Moreover, convenience sampling lacks
of e-cigarettes is currently evolving area of research, and clear generalizability (33), which introduces sampling bias
emerging of new knowledge is arising. By having accurate and sampling error, possibly leading to an overrepresented
and up-to-date information, an individual and decision- or underrepresented population. Secondly, compared
makers can evaluate the potential benefits and risks of with face-to-face recruitment, online surveys may be
e-cigarettes and make informed decisions about their more difficult to ensure data quality. This study also
regulation and use. Therefore, health education activities acknowledges that the study population was skewed
for the community should be implemented continuously towards younger and more educated participants even
to provide up-to-date and accurate information about though these two factors (age and education) did not show
e-cigarettes. any significant association with either the knowledge or
the attitude scores obtained.
People may have different attitudes towards e-cigarettes.
Research showed that some people believe that e-cigarette
is less harmful than a cigarette, it does not contain any Conclusion
or only limited amounts of nicotine (20) and help to quit In conclusion, this study suggests that healthcare providers
smoking conventional cigarette (15, 20). However, the need to understand the community members’ knowledge
majority of the respondents in this study did not agree and attitudes towards e-cigarettes as this will influence
with the above statements. Given that majority of the their informed decision about it. Therefore, it is important
respondents in this study were graduated, it is possible to conduct health education programs that consist of
that they have a positive attitude toward e-cigarettes correct and up-to-date information concerning e-cigarettes
compared to other studies. Additionally, the majority of such as ingredients, nicotine content, addictive properties,
the respondents in this study expressed a strong attitude and health risk in the community.
that the government should control the use of e-cigarettes.
A similar finding was reported in America, in which
participants were more supportive of restricting e-cigarette Acknowledgement
policies to protect youth (28). Kennedy et al. (29) reported The authors would like to thank the participants who gave
that 22 countries globally had regulated e-cigarettes using their cooperation to complete the study.
existing regulations, 25 countries had enacted new policies
to regulate e-cigarettes, 7 countries had amended existing Competing interests
legislation; 14 countries applied a combination of new or
amended and existing regulations. It shows that a variety of The authors declare that they have no competing interests.
legal mechanisms can be applied to control the e-cigarette
and the implementation of the regulation depending on the Ethical Clearance
country such as regulations on marketing and advertising, The study was approved by Kulliyyah of Nursing Post
age restrictions on purchasing e-cigarettes, and taxation on Graduate Research Committee and the International Islamic
these products to discourage use. University Malaysia Research Ethics Committee (Ethic no:
This study revealed that gender and smoking status were IREC 2021-KON/66). The consent was obtained from the
significantly associated with attitudes toward e-cigarettes participants and all the information was ensured in terms
(p < 0.05). Generally, men are more likely to smoke than of anonymity and confidentiality.
women, thus their attitude towards e-cigarettes tends to

117
ORIGINAL PAPER JUMMEC 2024:27(1)

Financial support 13. New Straits Times. MMA says minister reluctantly
signed off on nicotine exemption for vape tax.
This research did not receive any financial support.
2023. Available at: https://www.nst.com.my/
news/nation/2023/04/897510/mma-says-minister-
References reluctantly-signed-nicotine-exemption-vape-
1. Chudech S, Janmaimool P. University students’ tax#:~:text=The%20decision%20to%20exclude%20
knowledge about and attitudes toward e-cigarette nicotine,including%20children%20of%20any%20age.
use and factors influencing students’ e-cigarette use. Accessed 10 May 2023.
Health Educ. 2021; 121(2):215-226. 14. Hafiz A, Rahman MM, Jantan, Z. Factors associated
2. Driezen P, Nordin AS, Hairi FM, Yee A, Tajuddin with knowledge, attitude and practice of e-cigarette
NA, Hasan SI, et al. E-cigarette prevalence among among adult population in KOSPEN areas of Kuching
Malaysian adults and types and flavors of e-cigarette district, Sarawak, Malaysia. Int J Community Med
products used by cigarette smokers who vape: Public Health. 2019; 6(6): 2300-2305.
Findings from the 2020 ITC Malaysia Survey. Tob 15. Aghar H, El-Khoury N, Reda M, Hamadeh W, Krayem H,
Induc Dis. 2022; 20:1-7. Mansour M, et al. Knowledge and attitudes towards
3. Gravely S, Fong GT, Cummings KM, Yan M, Quah AC, E-cigarette use in Lebanon and their associated
Borland R, et al. Awareness, trial, and current use of factors. BMC Public Health. 2020; 20(1):1–18.
electronic cigarettes in 10 countries: Findings from 16. Abdel-Qader D, Al Meslamani Ahmad Z. Knowledge
the ITC project. Int J Environ Res Public Health. 2014; and Beliefs of Jordanian Community Toward
11(11):11691-11704. E-cigarettes: A National Survey. J Community Health.
4. Ab Rahman J, Mohd Yusoff MF, Nik Mohamed 2021; 46(3):577-586.
MH, Mahadir Naidu B, Lim KH, Tee GH, et al. The 17. Barakat M, Assaf AM, Raja’a Al-Qudah, Thiab S,
Prevalence of E-Cigarette Uses Among Adults in Alhamed M, Al-Obaidi H, et al. Perception of adults
Malaysia. Asia Pac J Public Health. 2019; 31(7_ toward electronic cigarettes: a cross-sectional
suppl):9S-21S. study from Jordan. Prim Health Care Res Dev. 2021;
5. Marques P, Piqueras L, Sanz MJ. An updated overview 22(e3):1-9.
of e-cigarette impact on human health. Respir 18. Sherratt FC, Newson L, Marcus MW, Field JK,
Res. 2021; 22(151):1-14. Robinson J. Perceptions towards electronic cigarettes
6. Gülşen A, Uslu B. Health hazards and complications for smoking cessation among Stop Smoking Service
associated with electronic cigarettes: a review. Turk users. Br J Health Psychol. 2016; 21(2):421-433.
Thorac J. 2020; 21(3): 201. 19. Berg CJ, Barr DB, Stratton E, Escoffery C, Kegler
7. Alduraywish SA, Aldakheel FM, Alsuhaibani M. Attitudes toward E- Cigarettes, Reasons for
OS, Jabaan ADB, Alballa RS, Alrashed AW, et al. Initiating E-Cigarette Use, and Changes in Smoking
Knowledge and Attitude toward E-Cigarettes among Behavior after Initiation: A Pilot Longitudinal Study of
First Year University Students in Riyadh, Saudi Regular Cigarette Smokers. Open J Prev Med. 2014;
Arabia. Healthcare. 2023; 11(4):1-12. 4(10):789–800.
8. Chakma JK, Kumar H, Bhargava S, Khanna T. The 20. Gorukanti A, Delucchi K, Ling P, Fisher-Travs R,
e-cigarettes ban in India: an important public health Halpern-Felsher B. Adolescents’ attitudes towards
decision. Lancet Public Health. 2020; 5(8):e426. e-cigarette ingredients, safety, addictive properties,
9. Silva ALOD, Moreira JC. The ban of electronic social norms, and regulation. Prev Med. 2016;
cigarettes in Brazil: success or failure? Ciencia & 94:65-71.
Saude Coletiva. 2019; 24(8):3013-3024. 21. Diez SL, Cristello JV, Dillon FR, De La Rosa M, Trucco
10. Doan TTT, Tan KW, Dickens BSL, Lean YA, Yang Q, EM. Validation of the electronic cigarette attitudes
Cook AR. Evaluating smoking control policies in the survey (ECAS) for youth. Addict Behav. 2019; 91:216-
e-cigarette era: a modelling study. Tob Control. 2020; 221.
29(5):522-530. 22. Macrotrends. Kuantan, Malaysia Metro Area
11. United States Food and Drug Administration. FDA Population 1950-2023. 2021. Available at: https://
takes new steps to address epidemic of youth www.macrotrends.net/cities/21810/kuantan/
e-cigarette use, including a historic action against population. Accessed 15 May 2023.
more than 1,300 retailers and 5 major manufacturers 23. Alzahrani MM, Alghamdi AA, Alghamdi SA, Alotaibi
for their roles perpetuating youth access. 2018. RK. Knowledge and attitude of dentists towards
Available at: https://www.fda.gov/news-events/ obstructive sleep apnea. Int Dent J. 2022; 72(3):315-
press-announcements/fda-takes-new-steps-address- 321.
epidemic-youth-e-cigarette-use-including-historic- 24. Shaikh A, Ansari HT, Ahmad Z, Shaikh MY, Khalid I,
action-against-more. Accessed 10 April 2023. Jahangir M, Majeed A, Shakeel N, Ahmed A, Memon
12. Brady BR, De La Rosa JS, Nair US, Leischow SJ. RS, Tariq E, Irfan R, Madni D. Knowledge and Attitude
Electronic cigarette policy recommendations: a of Teenagers Towards Electronic Cigarettes in Karachi,
scoping review. Am J Health Behav. 2019; 43(1):88- Pakistan. Cureus. 2017; 13:9(7):e1468.
104.

118
ORIGINAL PAPER JUMMEC 2024:27(1)

25. Alhajj MN, Al-Maweri SA, Folayan MO, Halboub E,

Khader Y. (2022) Knowledge, beliefs, attitude,
and practices of E-cigarette use among dental
students: A multinational survey. PLOS ONE. 2022;
17(10):e0276191.
26. Baobaid MF, Abdalqader MA, Abdulkhaleq MA, Ghazi
HF, Ads HO, Abdalrazak HA. (2021). Knowledge,
Attitude and Practice of Vaping among Youth in
Section 13, Shah Alam. Ann Romanian Soc Cell Biol.
2021; 25(3):7635-7645.
27. Newson RS, Elmadfa I, Biro G, Cheng Y, Prakash V,
Rust P, et al. Barriers for progress in salt reduction
in the general population. An international
study. Appetite. 2013; 71:22–31.
28. Sanders-Jackson A, Tan AS, Bigman CA, Mello S,
Niederdeppe J. To Regulate or Not to Regulate? Views
on Electronic Cigarette Regulations and Beliefs about
the Reasons for and against Regulation. PLOS One.
2016; 11(8):1-10.
29. Kennedy RD, Awopegba A, De León E, Cohen JE.
Global approaches to regulating electronic cigarettes.
Tob Control. 2017; 26:440-445.
30. Reniers RL, Murphy L, Lin A, Bartolomé SP, Wood
SJ. Risk perception and risk-taking behaviour during
adolescence: the influence of personality and gender.
PLOS One. 2016; 11(4):1-14.
31. Nuurain Amirah MR, Tengku Amatullah Madeehah
TM, Nadeeya ‘Ayn MN, Dzulkhairi MR, Mohamed
Fakhri AB, Shalinawati R, et al. Knowledge, Attitude
and Practice on Electronic Cigarette and their
Associated Factors among Undergraduate Students
in a Public University. IIUM Med J Malays. 2021;
20(2):43-51.
32. Abu-Baker NN, Ananzeh T, Al Modallal H, Shahror
GM, Amarneh BB. Knowledge and Attitudes toward
Electronic Cigarette Smoking: A Survey of School
Male Adolescents in Jordan. Open Public Health J.
2022; 15(1):1-9.
33. Jager J, Putnick DL, Bornstein MH. More than just
convenient: The scientific merits of homogeneous
convenience samples. Monogr Soc Res Child Dev.
2017; 82(2):13-30.

119