Nicotine dependence and associated factors among persons who use electronic e-cigarettes in Malaysia - an online survey

Nicotine dependence, factors associated with dependence, and self-reported side effects among people who use e-cigarettes are scarce in developing countries. A sample of 302 persons who currently use e-cigarettes was recruited from discussion forums on Reddit, Facebook, and the forum 'lowyat'. The online Google form survey collected data on demographics, e-cigarette use, and the reasons, for cigarette smoking, Fagerstorm Test for Nicotine Dependence adapted for e-cigarettes (eFTND), and side effects experienced. The mean age was 25.5 years (6.5), 60.6% were males and 86% had higher education. About 47% were using e-cigarettes only, 27.8% were currently using dual products (both electronic and conventional cigarettes), and 25.2% had also smoked cigarettes in the past. 'Less harmful than cigarettes' (56.3%), 'because I enjoy it' (46.7%), and 'it has a variety of flavors (40.4%) were the common reasons for e-cigarette use. The mean eFTND score was 3.9 (SD = 2.2), with a median of four side effects (IQR 3-6), sore or dry mouth/throat (41.4%), cough 33.4%, headache (20.5%), dizziness (16.2%) were commonly reported side effects. eFTND score and side effects were higher among persons using dual products. By multiple linear regression analysis, males ([beta] = 0.56 95% CI 0.45, 1.05, p = 0.033), dual-use ([beta] = 0.95 95% CI 0.34, 1.56, p < 0.003), and use of nicotine-containing e-cigarettes ([beta] = 0.66 95% CI 0.07, 1.25 p = 0.024) had higher eFTND score. Our findings of the study call for the placement of disclaimers about possible nicotine addiction and side effects of e-cigarette products.