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Advances in Social Sciences Research Journal – Vol. 10, No. 4
Publication Date: April 25, 2023
DOI:10.14738/assrj.104.14507.
Elsaieh, A. M., Shohaimi, S., Nadzir, N. H., & Puad, H. (2023). Nicotine Dependence Comparison of Dual Use of Cigarettes and E- Cigarettes Among Malaysian University Students. Advances in Social Sciences Research Journal, 10(4). 243-255.
Services for Science and Education – United Kingdom
Nicotine Dependence Comparison of Dual Use of Cigarettes and
E-Cigarettes Among Malaysian University Students
Afaf Masaud Elsaieh
Department of Biology, Faculty of Science, UPM, Malaysia
Shamarina Shohaimi
Department of Biology, Faculty of Science, UPM, Malaysia
Mohd Noor Hisham Mohd Nadzir
Department of Biology, Faculty of Science, UPM, Malaysia
Mohd Hazwan Mohd Puad
Department of Science and Technical Education,
Faculty of Educational Studies, UPM, Malaysia
ABSTRACT
The increasing prevalence of dual cigarette use (traditional cigarettes and e- cigarettes) among higher education students in Malaysia raised concerns about
potential health risks associated with this habit. This study aims to investigate the
differences in nicotine dependence and smoking habits between single and dual
cigarette users. A cross-sectional survey was conducted among 224 students from
four higher education institutions in the Klang Valley. Data were collected using
self-administered questionnaires, which included questions on personal
information, nicotine dependency, and smoking habits. The Mann-Whitney Test
was used to test the hypotheses. The findings indicated no significant difference in
nicotine dependence and smoking habits between single and dual cigarette users.
However, the study highlighted the potential health risks associated with dual
cigarette use. The results emphasize the need for policymakers to implement
stricter smoking regulations in higher education facilities and increase student
awareness of the dangers of smoking. Further research should focus on
understanding the reasons for dual cigarette use and developing targeted
interventions to address this public health issue.
Keywords: dual smoking, smoking habits, nicotine dependence, higher education,
Malaysia
INTRODUCTION
Electronic Nicotine Delivery Systems (ENDS), including electronic cigarettes, also referred to as
"e-cigarettes" or "vapes," have become popular in recent years. An e-cigarette is an electronic
device that uses the battery's electricity to deliver flavoured liquid in the form of vapour into
the body. The number of people who use e-cigarettes has risen quickly in some developed
countries such as the USA and UK [1]. Nicotine and other components are allegedly aerosolised
before inhalation in e-cigarettes rather than being burned. While the lack of combustion
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Advances in Social Sciences Research Journal (ASSRJ) Vol. 10, Issue 4, April-2023
Services for Science and Education – United Kingdom
decreases toxicant exposure for e-cigarette users compared to conventional cigarettes [2, 3],
inhalation poses risks. Existing tobacco smokers have used e-cigarettes in various ways, and for
various reasons [4].
Since the advent of e-cigarettes in 2007, their popularity and interest in their use have been
increasing worldwide, which provides an alternative smoking tool for smokers. As a result,
many conventional smokers either shift to the use of e-cigarettes or become dual users of both
types of smoking. Two possible reasons for dual-use are consumers' perceptions of these
products as safer than cigarettes , and the belief that these products aid in smoking cessation
[5]. Dual users of smokeless tobacco and cigarettes have a higher risk of myocardial infarction
than cigarette users alone [6]. While some argue that promoting smokeless tobacco products
as safer alternatives to cigarettes would reduce health risks at a population level, others say
this is unlikely [7]. In addition, the practice of using both smokeless tobacco and cigarettes may
cause some smokers to delay their efforts to quit, and those who use both are less inclined to
quit compared to those who solely smoke cigarettes, as indicated in previous studies [8]. While
e-cigarette users may believe that they are less harmful than cigarettes and helpful in reducing
cigarette consumption and aiding smoking cessation, several longitudinal studies have found
no evidence to support the claim that e-cigarette use assists in smoking cessation [4].
The identification of factors linked to the concurrent use of multiple tobacco products is crucial
for effectively educating and counseling individuals, as motivations for use may also influence
smoking cessation behavior. E-cigarette use has grown significantly in developed countries,
from an estimated 2.3 million users in 2013 to 5.1 million users in 2015, with global sales
increasing from $685 million in 2009 to $8.4 billion in 2015. This rise has sparked debates
among public health advocates, with some believing that e-cigarettes are riskier than
traditional cigarettes, while others disagree [9]. Although e-cigarette vapor is less harmful than
cigarette smoke, experimental models have shown that it affects the pulmonary endothelium
[10], which is also damaged by exposure to air pollutants and particles and can lead to chronic
asthma or chronic obstructive pulmonary disease (COPD) [11].
Previous studies, such as Wong, Shakir [12], Goh, Dujaili [13], Jankowski, Lawson [14], have
found that the majority of e-cigarette smokers were university students, young professionals,
and managers. The primary reasons for using e-cigarettes were to aid in quitting smoking
tobacco cigarettes, the belief that e-cigarettes are less intrusive than tobacco cigarettes, and the
ability to use them in public places. Many users also believed that e-cigarettes are healthier than
traditional cigarettes and cost less than tobacco cigarettes [15].
Several studies have been conducted to investigate the relationship between tobacco use and
psychological well-being among high school students. For example, Shan, Manzione [16]
examined the psychological well-being of high school students who use both cigarettes and e- cigarettes, while Kalkhoran and Glantz [17] explored the connection between the dual use of
smokeless tobacco and smoking cessation among high school students. Additionally, Wills,
Knight [18] investigated the risk factors associated with adolescents’ exclusive use of e- cigarettes and the concurrent use of both e-cigarettes and tobacco. Rantao and Ayo-Yusuf [19]
focused on the dual use of cigarettes and smokeless tobacco among South African adolescents.
Smith, Gawron [20] investigated whether adolescents in Poland used tobacco and electronic
cigarettes exclusively or combined. The association between smoking e-cigarettes and
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Elsaieh, A. M., Shohaimi, S., Nadzir, N. H., & Puad, H. (2023). Nicotine Dependence Comparison of Dual Use of Cigarettes and E-Cigarettes Among
Malaysian University Students. Advances in Social Sciences Research Journal, 10(4). 243-255.
URL: http://dx.doi.org/10.14738/assrj.104.14507
traditional cigarettes was asymmetric, it means that the relationship between the two is not
equal or balanced. This implies that the use of one product does not always lead to the same
level of use or dependence on the other product. For example, individuals who smoke e- cigarettes may not necessarily smoke traditional cigarettes to the same extent, or vice versa.
Also, the findings confirmed the significant and negative impact of dual smoking on smokers’
overall health, while the effects of single smoking behaviour have a less significant and negative
impact on their overall health [16, 19].
In addition, a study comparing heavy smokers (those who smoked 10 cigarettes or more per
day) to non-smokers revealed that heavy smokers reported significantly lower well-being,
symptom burden, and functional disability. Meanwhile, Grant, Lust [21] examined the
prevalence of e-cigarette (vaping) use among university students and its correlation with
psychosocial factors such as mental health issues, impulsivity, and illicit drug use.
Several studies have been conducted on e-cigarette smoking in Malaysia to explore the reasons
for use, its effectiveness and safety, and factors associated with its usage among Malaysian
adolescents [2, 12, 22]. However, there is a lack of empirical knowledge on the health risks and
impacts of dual usage of cigarettes and e-cigarettes on Malaysians' young generation
psychological well-being and smoking cessation. Therefore, this research aims to find out the
differences of impacts of cigarettes and e-cigarettes dual usage on nicotine dependency among
Malaysian selected university students. The methodology used in the study, as well as the tests
and analyses conducted, are outlined in the following sections.
LITERATURE REVIEW
E-cigarette usage surged from 5.1 million users in 2015 to 41 million in 2018 in developed
nations, and sales worldwide rose from about $8.5 billion in 2015 to $15.7 billion in 2018 [23].
The growth in e-cigarette usage has stirred discussion among public health activists. Some
individuals believe that e-cigarettes are more dangerous than regular cigarettes, while others
think otherwise [24]. There is currently a great debate regarding the safety and health effects
of its long-term use, both for the user and for those who are exposed to this vapor. In addition
to its potential for addiction, the eventual transfer to the use of conventional cigarettes is also
up for debate.
The England public health authorities, which suggest that e-cigarettes are 95% safer than
conventional cigarettes as they do not contain, or are at much lower levels [15], the constituents
of conventional cigarette smoke responsible for adverse health effects. This is mainly because
the products derived from the combustion of conventional cigarettes, rather than tobacco or
nicotine themselves, are the main cause of the harmful effects on health; the e-cigarette only
heats a liquid to lift it, without combustion. Furthermore, the main chemicals in e-cigarette
vapour have not yet been associated with any serious health risks. This more permissive
position is shared by the Royal College of Physicians of London 15 and Action on Smoking
Health (ASH) in the United Kingdom. It is generally known that current cigarette smokers
among young adults and college students are more likely to report using e-cigarettes [25, 26].
However, while e-cigarette usage is most widespread among students who smoke traditional
cigarettes, it is not allowed [27].