Knowledge and Perception of e-Cigarettes among Dental Students in Riyadh Region Saudi Arabia.

Background: Tobacco use is one of the leading causes of death in the world. Dentists play a vital role in tobacco abstinence and counseling. Dental institution being a foundation for a clinical practice from where they can practice and implement the habit of tobacco counseling. E-cigarette can be availed over-the-counter and can be used as alternative to conventional tobacco smoking to reduce ill effects of tobacco.
Objectives: The aim of this study is to assess dental student's knowledge, prevalence, and perception about e-cigarette. Materials and
Methods: A cross-sectional study was done on 400 dental students studying in different universities at Riyadh region, KSA. Questions related to prevalence, knowledge, and awareness about e-cigarette were asked.
Results: Forty-four percent of participants were found to be smokers, 26% of the participants had used an e-cigarette themselves with 21% currently using the same.
Conclusion: This effective therapeutic tool should be known well by the upcoming budding and professional practicing dentists with through knowledge of each dimensions, merits and demerits of the same to develop positivity in inculcating and encouraging in patient tobacco abstinence program. Copyright:

INTRODUCTION

Tobacco smoking is associated with many diseases, smoking causes lung cancer, and cancer of many organs such as gastrointestinal tract, liver, pancreas, and cervix.[1] It also causes diseases of heart and lungs.[23] Nicotine is the main addictive agent having multiple effects. Nicotine is a stimulant that has multiple harmful effects also there are more than 500 carcinogenic agents in the tobacco products such as cigarettes and cigars.[4]

According to a systematic review, the prevalence of smoking among college students in Saudi Arabia was 17%[5] Mandil et al. in 2010 reported smoking prevalence of 14.5% among university students with 32.7% males smoking rate and 5.9% in females.[6] The reasons for smoking can be many some smoke to show their power and importance, peer influence or join social group, and build their social network or relieve stress.

In recent years, E-smoking is becoming a trend among youths they are gaining wide acceptance. They are called as electronic cigarette or e–cigarette. The major difference between conventional tobacco cigarettes and e-cigarettes is e-cigarette do not cause bad breath, they do not produce flame or carbon monoxide but these electronic device simulates tobacco smoking. They are battery operated having a cartridge which is refillable, here user inhales vapor instead of smoking.[7]

It is not clear about the health effects of vaping,[8] but harmful effect of vaping is less than tobacco smoking.[910]

E-cigarette vapor contains fewer toxins, in lower amounts, than cigarette smoke. The World Health Organization's position is that it is hard to say if vaping is safer than smoking and it is best to not use nicotine at all.[11]

In Saudi Arabia, little, there is a scarcity of studies which evaluated awareness of e-cigarettes among dental students understanding knowledge about emerging tobacco trends is an important step toward controlling and tobacco counseling practices. Thus, the purpose of the current study was to assess the knowledge regarding e-Cigarettes among dental students studying in Riyadh Region, Saudi Arabia.

Objectives

The objective of this study is to assess the prevalence, knowledge, and perception of dental students about e-cigarettes

MATERIALS AND METHODS

The survey included 400 dental college students studying in various universities at Riyadh region KSA.

The need of the study was explained and received consent for the same. Official permission was obtained from Institutional Review Board of College of Dentistry, Prince Sattam Bin Abdul-Aziz University. Based on the detailed analysis of literature, structured questionnaire was framed with the assistance and guidance of panel of academic experts to achieve validated and relevant questionnaire.

The questionnaire composed of ten questions, which were slotted in to three categories to knowledge about e-cigarettes, use of e-cigarettes, and perception toward e-cigarettes. This study was conducted through digital platform link containing questionnaire was sent through WhatsApp, Snap chat, and E-mail. Participants were asked to fill the questionnaire and resend without discussing with anyone. Nature and purpose of the study were explained with brief introduction.

Statistical analysis

Statistical analysis was done using the IBM SPSS Statistics for Windows, version 23 (IBM Corp., Armonk, N.Y., USA). The Chi-square test was used for comparing knowledge and perception toward e-cigarettes according to gender and year of study. Results were expressed as number and percentages. P value of P < 0.05 was considered to be statistically significant.

RESULTS

Four hundred dental students involved in the study and participation response was 100%, and questionnaire was designed to assess general awareness, knowledge, and attitude about e-cigarettes [Table 1]. Forty-four percent of participants were found to be smokers, whereas 56% of the study population never smoked. Among participants 61% accepts domestic smoking environment with a member of a family smoking, where 39% of participants shared no such experience. Twenty-six percent of the participants had used an e-cigarette themselves with 21% currently using the same and 74% among the participants deny with the past usage of it. Thirty-four percent of participants had an associated family person vaping, where 66% had no family member who vapes. Further 23% of participants taught personal consumption of e cigarette is permitted in Saudi Arabia, where 11% denies the statement, while majority of study population comprising 66% had no idea. Eighty-one percent of the current study population agrees that e-cigarette is an effective tool to stop tobacco smoking, while 14% disapproving the same with 5% of study population had no clear opinion. Around 80% of study population was totally unaware of negative effects of e-cigarette on general health, where 13% of participants disapproving the statement while 7% of participants predicts it to cause health problems. As expected, major proportion of study population that is around 68% of participants thought e-cigarette will have lower potential to cause cancers than tobacco smoking and 74% of participants thinks use of e-cigarette is been approved by FDA and 62% of participants seek information on e-cigarette on social media matching with present trend with 18% on online advertising, 11% depending on television with only 9% participants seek information on newspaper.

Table 1

Response of study participants to questions related to e cigarette

Question	Response	Frequency (%)
Do you smoke	Yes	176 (44.0)
	No	224 (56.0)
Does any one of your family member smokes	Yes	246 (61.5)
	No	154 (38.5)
Have you ever vaped (used an e – Cigarette)	Yes	105 (26.25)
	No	295 (73.75)
Do you currently vape?	Yes	84 (21.0)
	No	316 (79.0)
Does anyone of your family member vapes?	Yes	138 (34.5)
	No	262 (65.5)
Is personal consumption of e-cigarettes is permitted in Saudi Arabia	Yes	92 (23.0)
	No	44 (11.0)
	Don’t know	264 (66.0)
Do you think e cigarettes are effective way to stop tobacco smoking?	Yes	365 (81.25)
	No	55 (13.75)
	Don’t know	20 (5.0)
Do you think e cigarettes will cause health problems?	Yes	28 (7.0)
	No	52 (13.0)
	Don’t know	320 (80.0)
Do you think e cigarettes will have lower chance of cancers than tobacco smoking?	Yes	271 (67.75)
	No	61 (14.75)
	Don’t know	68 (17.0)
Is e cigarettes are approved by FDA	Yes	296 (74.0)
	No	16 (4.0)
	Don’t know	88 (22.0)
What is your source of e-cigarettes?	Newspaper	37 (9.25)
	Television	43 (10.75)
	Online advertising	74 (18.50)
	Social media	246 (61.50)

FDA: Food and Drug Administration

DISCUSSION

Around 1.3 billion people smoke worldwide, with nearly 21% of the Saudi Arabian population smokes. Tobacco smoking being the most popular mean.[1213]

With decades of attempt, there is a development of device comprising of catridge and a battery with an atomizer functions in a complexed way to produce flavored vapor containing nicotine in most of the cases called as e-cigarette, is a potential alternative tool to tobacco cigarette to deplete negative effect of tobacco on human health.[1415] Tobacco being a main component of cigarette causes negative effect on general health effecting different systems and organs of the body which can be avoided by this battery operated e-cigarette, which simulates smoking with abstinence of tobacco. As use of this tool is become popular over the last two decades, Through knowledge on merits and demerits on general health by this complimentary aid is limited and need to be studied further.[1617]

When there is an attempt of smoking cessation individual will seek an professional advice or guidance to be aware of alternative tools like nicotine replacement therapy or use of e cigarette with potential merits and demerits of the same.[1819] Hence, dental professionals or students involved vitally in tobacco abstinence need to be completely aware of alternative pharmacological and nonpharmacological tools to encourage and guide patients in tobacco cessation with proper implementation of aforementioned methods.

Contradictions have been noted in the literature regarding the impact of e-cigarette in tobacco abstinence, various studies quote positive effects of e-cigarette in accomplishing tobacco cessation, where other studies indicates the negative impact of e-cigarette. It is also known through the literature certain nicotine inhalers are safer than e-cigarettes. E-cigarette basically devoid the releasing of any kind hydrocarbons in turn helps in release of carcinogens, which classically happens with tobacco combustion on tobacco smoking.[202122]

The present study aims to assess prevalence, knowledge, and perception of dental students about e-cigarette. Among 400 participants, 44% of students ever smoked with 61% of the participants had domestic exposure with a family member being a smoker and only 26% of students had used e-cigarette and 21% of the participants used at the time of study. Surprisingly, 66% of the participants did not know about the regulations on usage of e-cigarette in Saudi Arabia, as it is known fact that smoking e cigarette is not been prohibited for individuals use, only on impotation there are restrictions. Thirty-three percent of the participants were aware of the regulations.

It has been notes that, the placebo effect of e cigarette has been found to be helpful for smokers to quit tobacco.[22] In the current study, the finding prevails as 81% of the participants agrees e-cigarette to have a positive role in tobacco cessation.

Further, negative reports on the use of e-cigarette causing damage to an individual is noted, problems involving damaging mental health with an increased suicidal tendency, insomnia, lack of interest in learning, less socialization. Also involving other systems of the body by involving heart and lungs by causing acute and chronic lung injury and chronic heart diseases is been noted.[232425]

In the present study, results 80% of the participants had no clear opinion on the health effects of e cigarette indicating lack of knowledge about use, potential merits, and demerits of e-cigarette. Major proportion of the study population was aware that e-cigarettes carry a less potential carcinogenicity when compared to tobacco smoking.

CONCLUSION

This effective therapeutic tool should be known well by the upcoming budding and professional practicing dentists with through knowledge of each dimensions, merits and demerits of the same to develop positivity in inculcating and encouraging in patient tobacco abstinence program. Further clinical studies need to be conducted to assess the potential damaging effect of e-cigarette on different human systems.

Financial support and sponsorship

Self-sponsored.

Conflicts of interest

There are no conflicts of interest.