Knowledge and attitudes towards E-cigarette use in Lebanon and their associated factors

Abstract

Background: Despite the misconceptions regarding E-cigarettes (ECs), only a few studies have been conducted in the Middle East that focused on this topic. This study assesses the knowledge of and attitudes towards ECs in Lebanon, determines how these two measures are associated, and identifies the variables that explain each of these measures.

Methods: A cross sectional study was conducted on a convenience sample of Lebanese pedestrians aged between 18 and 64 inclusive. A structured self-administered questionnaire comprising of knowledge and attitude scales, and questions on demographical, health and smoking characteristics was used.

Results: Scores for attitudes and knowledge of ECs were summed and dichotomized using a 75% cutoff, above which the participant was considered to have a positive attitude and good knowledge. Among the 352 participants (56.6% males, 43.3% females, mean age 30.3, 46.2% smokers), 63.3% exhibited a lower level of EC knowledge. More than 50% erroneously thought that ECs are not associated with lung and bladder cancer or impair lung and heart function. 65% falsely thought that it is harmless and not addictive. As for attitude, 43.3, 53.9, and 44.3% thought that it is socially acceptable, helps in smoking cessation, and is a good replacement for cigarettes and an enjoyable recreational device respectively. Our results revealed an inverse correlation between attitude and knowledge scores (Spearman's correlation = -.30, p < .001). Predictors of knowledge included health-related occupation (p = .010), regular exercise (p = .016), healthy diet (p = .026), EC use (p = .026), perception that ECs are not harmful (p = .001), and help in smoking cessation (p = .017). Predictors of attitude included EC use (p = .008), sex (p = .010), and knowledge that most ECs are addictive (p = .006), harmful (p = .014), and impair heart and lung function (p = .047).

Conclusions: Our study revealed a gap in EC knowledge, especially among participants who displayed a positive attitude towards ECs. Hence, measures should be undertaken to regulate its use by instituting more stringent laws and holding nationwide awareness campaigns.

Keywords: Attitude; E-cigarettes; E-liquid; Electronic cigarettes; Knowledge; Perception; Smoking; Smoking cessation; Tobacco; Vaping.

Fig. 1

Frequency distribution of: (a) Types of smoking (Hookah or waterpipe: “a smoking device that consists of a bowl mounted on a vessel of water which is provided with a long tube and arranged so that smoke is drawn through the water where it is cooled and up the tube to the mouth” [38]. Dokha: is tobacco blended with “barks, herbs, spices, dried flowers or dried fruit” and smoked in a particular pipe called “midwakh”. It has a high nicotine content, around five times that of a normal cigarette [39]. Pipe: “a device for smoking usually consisting of a tube having a bowl at one end and a mouthpiece at the other” [39]) used by the participants with N = 260 total count for this subcategory, (b) Smoking cessation methods among participants who have quit or are in the process of quitting smoking with N = 91 total count for this subcategory, (c) E-cigarette flavors used by the E-cigarette smokers among participants with N = 59 total count for this subcategory

Fig. 2

Frequency distribution of questions on EC-cigarettes that participants had: (a) the least knowledge of, and (b) the most negative attitude towards