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Presenter:

Dr. Sushil Anil Phansopkar


2nd year MDS
Public Health Dentistry

Guided by:
Dr. Ariskha Devadiga. (Reader)
Dr. Sahana Hegde-Shetiya. (Prof & Head)
Dr. Deepti Agarwal. (Senior Lecturer)
Dr. Amit Mahuli. (Senior Lecturer)
Dr. Simpy Mahuli. (Senior Lecturer)

DR. D.Y. PATIL VIDYAPEETHS DR. D.Y. PATIL DENTAL COLLEGE, PIMPRI, PUNE 411018.

INTRODUCTION

Electronic cigarettes are not tobacco products.


A typical e-cigarette consists of 3 components: a battery, an atomizer
and a cartridge containing nicotine. 1,2
Brands of electronic cigarettes - Njoy, Ruyan, Liberty Stix, Gamucci,
inLife, e-juice, Instead, Super smoker etc. 3,4
An electronic cigarette (e-cigarette) is commonly used as an alternative
for the smoked tobacco and is being promoted as a nicotine replacement
therapy (NRT) by the companies.

E-CIGARETTE KIT
CHARGER

BATTERY

CARTRIDGE
ATOMIZER

E-CIGARETTE

E-CIGARETTE CHARGERS

E-CIGARETTE CARTRIDGES

NEED FOR THE STUDY


How safe are electronic cigarettes ???
manufacturing defects, satisfaction cravings, ingredients and cessation of
smoking.6
As the chemical composition is not mentioned clearly in detail there was
a need to study it. Nicotine is a harmful drug which has various adverse
effects on brain, central nervous system and foetus. Di-ethylene glycol,
an antifreeze ingredient is toxic to humans and glycerol causes dry
mouth, sore throat and increased thirst on vaping. 5
Hence the study was conducted to assess the knowledge, attitude and
practice regarding electronic cigarette amongst its users in Pune city
along with chemical evaluation of 3 different e-cigarette cartridges for
detection of nicotine, glycerol, di-ethylene glycol.

AIM OF THE STUDY


Assessment of knowledge, attitude and practice regarding ecigarette amongst its users in Pune city and chemical evaluation of
3 different e-cigarette cartridges.

OBJECTIVES OF THE STUDY


Assessment of knowledge, attitude and practise regarding ecigarette amongst its users in Pune city.
To assess the socio demographic variables of e-cigarette users.
Chemical analysis of 3 different e-cigarette cartridges for detection
of
- Nicotine.
- Glycerol.
- Di-ethylene glycol.

MATERIALS AND METHODS


SOURCE OF DATA:
- Subjects using e-cigarettes in Pune city.
METHOD OF DATA COLLECTION:
A 23 item questionnaire was developed and questions based on
knowledge, attitude and practise were framed accordingly and
administered to the participants via personal contact and
electronic mail (e-mail).
The Mass Spectrometry analysis of 3 principal chemicals of ecigarettes were analyzed using 4800 Plus MALDI
TOF/TOFAnalyzer by MALDI TEST in the Indian Institute of
Science Education and Research, Pune (IISER).

4800 PLUS MALDI TOF/TOF


ANALYZER

SCHEDULING
The study was conducted from May 2012 to October 2012. On an
average 2-3 subjects were administered the questionnaire every
week.
The time taken to fill the questionnaire was approximately 10-15
minutes.

SAMPLING TECHNIQUE
Snow ball sampling technique was adopted as there was no data
regarding the prevalence of e-cigarette users in Pune city.

This is a type of non-probability sampling technique in which


there is no sample design or sample size calculation involved.

INCLUSION CRITERIA:
Participants who are current users of electronic cigarettes willing
to participate in the study.

EXCLUSION CRITERIA:
Subjects using e-cigarettes not willing to participate in the study.

Development Of A Questionnaire

Formulation. (Conceptual framework)


Validity. (Face & Content)
Reliability. (Test- Retest)
Translation. ( No translation)
Preparation of analysis. (Generating code book)
Pre-testing. (Pilot Study)

CONCEPTUAL FRAMEWORK
Electronic
cigarette users

Knowledge
Types of e-cigarette
ill effects of e-cigarette
Policies on sale of ecigarette
Economic impact
Nicotine alternatives
Passive smoking

Attitude
Passive smoking
Socio cultural
background
Media
Public places
Peer pressure

Practice
Patterns & Types
Reasons of use

VALIDITY
Face validity:
Was done by 8 SMEs (Subject matter experts). The framework of
the questionnaire was acceptable in matter of looks, length,
language etc.
Content validity:
Questions 1 to 12 & 14 to 24 had a content validity ratio [CVR]
of 1 While for question 13 of 0.25.
Interpretation of CVR: -1.0 and 1.0. (essential / non-essential).
The questionnaire was reduced from 24 items to 23 items.

RELIABILTY
We used the The test-retest method of reliability.
The interval between the administrations i.e. test to re-test was 12
days and 5 participants took part in the test - retest reliability.
Cronbach's Alpha for the test-retest reliability was 1.

PREPARATION OF ANALYSIS
The responses to questionnaires were summarized and this was
accomplished by converting the written information into representative
numbers (codes). The coding system (code book) was considered when
the questionnaire was being developed.
This strategy not only simplified but also speeded up the transfer and
use of codes for analysis and also reduced the risk of errors. This book
was the official record of the codes and the answers they represented for
all the questions. The code book was continually updated and expanded
during the natural evolution of the study.

PRE-TESTING
The dress rehearsal of the study. The number of pre-test trials to
be conducted could not be decided in advance. Instead the pre-test
was repeated with new subjects until the researcher was satisfied.
Therefore, the decision on the sample size was subjective and was
influenced by the availability of subjects.
There were 8 participants in the pre-testing. (Feasibility)

CONSENT
INFORMED CONSENT:
A written informed consent from each participant was obtained
after they agreed to participate in the study.

RESULTS
26.90

MEAN AGE (YRS)

STD. DEVIATION

2.583 DEMOGRAPHIC RESULTS OF E-CIGARETTE USERS IN

MINIMUM

24 PUNE CITY

MAXIMUM

32

OCCUPATION

FREQUENC

PERCENTAGE

(%)

48

71.6

FEMALES (2)

19

28.4

TOTAL

67

100

GENDER
MALES (1)

PROFESSION (1)

FREQUEN

PERCENTAGE

CY

(%)

67

100.0

67

100

(IT INDUSTRY)
TOTAL

MEAN INCOME

28873

(RUPEES.)
EDUCATION
PROFESSION OR HONOURS (1)
GRADUATE OR POST GRADUATE (2)

FREQUENCY

PERCENTAGE (%)

STD.

56

83.6

11

16.4

67

100.0

TOTAL

7621

DEVIATION
MINIMUM
MAXIMUM

19000
42000

ASSESSMENT OF KNOWLEDGE OF
E-CIGARETTE USERS IN PUNE CITY
RESPONSES (%)

QUESTIONS

1. Which kind of e-cigarette do you know about? E-cigarette containing nicotine = 46.3
Nicotine-free E-cigarette = 53.7
2. Which according to you is less harmful?

Electronic cigarette = 100.

3. Are you aware of the ill-effects of nicotine on Yes = 58.2


the human body?

No = 41.8

4. Are you aware of any tobacco product No = 100.


regulation by the government for e-cigarettes?
5. Are you aware of government levying taxes No = 100.
and excise duty on e-cigarettes?

6. Can e-cigarettes be used in smoke-free places?

Yes = 38.8
No = 61.2

7. Do you think e-cigarettes are cost-effective than conventional

Yes = 58.2

cigarettes?

No = 41.8

8. Are you aware of nicotine replacement (alternatives) for

Yes = 100.

substitution of e-cigarette smoking?

9. Are you aware that passive smoking by e-cig causes any adverse

No = 100.

effects on the bystanders?

10. Are your companions more receptive of e-cig smoke when Yes = 100.
compared to conventional smoke?

ASSESSMENT OF ATTITUDE OF ECIGARETTE USERS IN PUNE CITY


Questions

11. If i use

12. E-

13. E-

14. E-

15. I want to

11-15

e-cigarette

cigarettes

cigarette

cigarette

quit e-

i will gain

should be

gives me

relieves

cigarette

superiority banned in

pleasure

stress after

use.

during its

its usage.

among my

India.

usage.

friends.

Percentages (%)
Codes

100

65.7

65.7

88.1

49.3

Strongly
Agree

Disagree

Agree

Agree

Disagree

ASSESSMENT OF PRACTICE OF E-CIGARETTE USERS IN


PUNE CITY
RESPONSES (%)

QUESTIONS
16. What is the frequency of e-cigarette usage? (avg.no of <2 = 58.2
cartridges/day)

3-5 = 41.8

17. From when did you start smoking an e-cigarette?

Post- Graduation = 34.3


At work = 65.7

18. Who introduced e-cigarette use to you?

Friends & colleagues = 34.6


Friends, colleagues & media = 18.5
Colleagues & media = 29.6

19. Has e-cigarettes caused any changes in breathing and

Yes = 16.4

respiration?

No = 83.6

20. Has e-cigarette caused dry mouth and throat?

Yes = 71.6
No = 28.4

21. Have you ever tried to quit smoking?

Yes = 65.7
No = 34.3

22. Are you willing to quit smoking?

Yes = 100.

23. Do you want to participate in any tobacco cessation Yes = 100.

A. LOCAL BRAND E-CIGARETTE

Glycerol

Nicotine
Di-ethylene glycol

B. NICOTINE-FREE BRANDED E-CIGARETTE

Glycerol

Di-ethylene glycol

C. NICOTINE BRANDED E-CIGARETTE

Nicotine

Glycerol

ANALYSIS OF 3 DIFFERENT ECIGARETTE CARTRIDGES:


E-Cigarette

Molecular weight

Name of the chemical:

cartridges:

detected:

A. Local E-cigarette

161.0406 /163.0551.

Nicotine.

130.9344

Glycerol.

98.9197

Di-ethylene glycol.

B. Control E-cigarette 130.9620

Glycerol.

(Nicotine free)

Di-ethylene glycol.

102.0740

C. Control E-cigarette 161.0312 /163.0397

Nicotine.

(nicotine)

Glycerol.

130.9796

CONCLUSION
The study showed that more than half knew about the ill-effects of nicotine and all of
them were willing to quit smoking and join a tobacco cessation programme but
similar attitude was not reflected towards use of e-cigarettes as half of them did not
want to quit e-cigarette smoking nor did they want it to be banned in India. The
probable reasons could be that e-cigarettes gave them a sense of superiority amongst
their peers, acted as a stress reliever and provided pleasure on vaping.
The chemical analysis of the local brand (A) showed presence of nicotine when they are
marketed as a nicotine free product while the branded samples (B) and (C) followed
product regulation as nicotine free and nicotine containing e-cigarettes.

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THANK YOU

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