• AKU research shows use of e-cigarettes increases from 29pc to over 40pc in five years
• Alarming rise of harmful devices indicates a health crisis in coming years

KARACHI: Despite having sufficient knowledge about the potential health risks associated with nicotine exposure, an increasing number of young people are getting hooked on e-cigarettes, smoking devices that are powered by a battery, says a study recently published in an online journal.

Titled ‘Electronic Cigarettes and their Knowledge, Attitude and Practices among Pakistani Population: A Multi-City Study Across Pakistan’, the research is jointly conducted by the Aga Khan University and Multan Medical and Dental College.

Over 800 individuals with mean age 29.6 years participated in the study during which 43.4 per cent respondents reported using e-cigarettes.

“This is significantly higher than a 2017 study conducted among adolescents when prevalence of e-cigarettes was just 24 per cent. The current study also found that the mean age at which people start using e-cigarettes is 17 years and that 58 per cent of people believe smoking makes young people look ‘cool’,” it says.

The study, the first nation-wide research on the subject, also found that more than half of the respondents (55pc) had sufficient knowledge regarding e-cigarette use.

Among the participants, 6pc of the individuals were found to have hypertension, around 0.1pc reported asthma and 35.4pc had a positive history of anxiety, depression, or any other psychiatric illness.

The total income of 79pc of the respondents was greater than Rs60,000.

E-cigarettes, powered by a battery, are portable and can be used repeatedly. These devices utilise a piezo-electric component to convert a solution into vapour that is then inhaled by the user via a refillable cartridge and mouthpiece.

Use of these devices is associated with a risk of dyspnea, lung cancer, chest pain, nausea, vomiting, and a myriad of other ailments, the study says.

Increasing social acceptability

The study indicates increasing promotion and social acceptability of e-cigarettes in recent years in Pakistan. Most participants had learned about e-cigarettes from either their family and friends or the internet.

Furthermore, 58pc of individuals believed that e-cigarette use helped young people ‘fit in’ and 39.3pc admitted that they would probably try e-cigarettes if their friends asked them to do so.

“This deviates from a previous study conducted in Pakistan in which most respondents did not think that people began smoking due to peer pressure and 59.3pc people claimed that they would not smoke for their friends,” the study says.

Wrong perception

The majority of the participants wrongly believed that e-cigarettes were effective in helping people quit regular smoking while 20.5pc of the people thought that it’s extremely effective.

Around 41pc of the people were of the opinion that e-cigarettes had lesser harmful effects as compared to regular cigarettes. At least 31pc of the people thought that e-cigarettes were just as addictive as regular cigarettes while 11pc thought that they were less addictive.

According to the study, the sale of e-cigarettes in Pakistan primarily began in Karachi in 2008 and rapidly spread to various other cities.

Healthcare professionals have struggled to accurately identify trends in the awareness and use of e-cigarettes due to a lack of research conducted on a national scale in the general population.

Tobacco companies, it says, have flaunted the claim that e-cigarettes are a ‘healthier’ alternative to regular cigarettes, and some even ran social media campaigns about the health advantages of their products during the Covid-19 pandemic.

“These companies have been able to target adolescents and young adults in their promotional campaigns due to lack of legislation regarding e-cigarettes in the country,” Dr Javaid Ahmed Khan, senior professor and consultant pulmonologist at the Aga Khan University Hospital and principal investigator of the study, says.

He attributed the use of e-cigarettes by people under 18 years to the misleading promotion of e-cigarettes by influencers and celebrities, describing these devices as harmless to a young audience who perhaps would have otherwise not smoked at all.

“Pakistan does not have any set minimum age of purchase of e-cigarettes, nor do we have any laws regarding the promotion and regulation of such products. This has resulted in online shops operating unregulated companies selling products without any health warnings on the packaging, and a lack of age-verification at vape stores,” Dr Khan shared.

He described the rise in prevalence of these devices as alarming as it indicated a health crisis in coming years like the one caused by tobacco cigarettes in the 20th century.

“In the current study, most participants believed that e-cigarettes were either slightly or extremely effective at smoking cessation. This perception is at odds with WHO’s recommendation that e-cigarettes could only be used for cessation in patients who refuse other treatment options,” he said, adding that studies had found that individuals aged between 14 and 30 years who used e-cigarettes were likely to start smoking regular cigarettes.

Published in Dawn, August 28th, 2023