Knowledge Attitude and practice about E-cigarettes among University Students: A comparative study between Afghanistan, Netherlands, and Turkey

Knowledge Attitude and practice about E-cigarettes among University Students: A comparative study between Afghanistan, Netherlands, and Turkey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Knowledge Attitude and practice about E-cigarettes among University Students: A comparative study between Afghanistan, Netherlands, and Turkey Mansoorullah Muradi, Lima Oria, Tariq Aziz Azizi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6832062/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The rise in electronic cigarette (e-cigarette) use among young adults has raised significant public health concerns. Initially introduced as a harm-reduction tool, e-cigarettes have increasingly become a popular alternative to traditional smoking. However, misconceptions about their safety, social acceptability, and long-term health effects persist among university students. Objective The aim of this study was to find out the knowledge, attitude, and practice about E-Cigarettes among University Students in Afghanistan, the Netherlands, and Turkey. Methods This study adopts an analytical cross-sectional design and employs a foundational approach by administering an online questionnaire. The study uses a quantitative methodology to explore universities students’ knowledge, attitudes, and perceptions regarding e-cigarettes. Data collection was facilitated through a survey distributed via Google Forms and statistical analysis was performed using SPSS 26 to identify significant associations. Results The findings revealed that 54.2% of students reported using e-cigarettes, with a higher prevalence among those with close friends or family members who smoked. Knowledge about e-cigarettes was generally low, with 56.2% demonstrating poor understanding, particularly regarding the health risks and regulatory status of e-cigarettes. Attitudes were largely negative, with 73.4% expressing concerns about vaping, though 62.7% believed it was more socially acceptable than traditional smoking. Peer influence was a major factor, as 74.6% of e-cigarette users had close friends who also vaped. A significant association was found between smoking tobacco and e-cigarette use (p = 0.00), indicating a trend of dual-use rather than e-cigarettes serving as a quitting tool. Conclusion The study highlights a critical gap in e-cigarette knowledge and a strong influence of social and environmental factors on vaping behaviors. Despite negative attitudes toward vaping, its perceived social acceptability remains high. Public health interventions should focus on targeted educational campaigns, peer-led awareness programs, and regulatory measures to address misconceptions and reduce e-cigarette use among young adults. Knowledge Attitude Practice E-cigarette Afghanistan Netherlands Turkey Introduction Vaping, a form of electronic smoking, has gained widespread popularity among a diverse range of young and adult users in recent years. In the United States, over 40 million people use vaping products, with about 5 million specifically using e-cigarettes. This trend is not limited to the U.S.; other countries, including the UK, have also seen significant increases in vaping. For example, from 2012 to 2016, vaping use in the UK grew by 60%. The rapid advancement in vaping technology has contributed to its rising acceptance and use as an alternative to traditional cigarettes. In North America, particularly the U.S., vaping consumption has been overgrown since 2014, with 20% of adults aged 18 to 26 reporting e-cigarette use. In 2014, about 10% of surveyed individuals acknowledged regular vaping, a number that has consistently increased over the years. By 2013, only 2.6% of adults used e-cigarettes regularly. Among younger age groups. For instance, by 2014, around 20% of adults aged 18–26 reported using electronic cigarettes, with about 13% of the adult population having tried vaping at least once. In addition, there has been a 70% increase in new vaping users in the U.S. from 2013 onwards. Daily usage among North American adults has also increased, with estimates indicating that about 3.7% regularly vape. Similar trends are observed in Canada and Mexico. In Canada, vaping use grew by 13.2% in 2015, with around 1% using them daily with 3.2% of adults reporting e-cigarette use within the last month. Despite a ban on e-cigarettes in Mexico since 2013, usage increased by over 50% in one year, indicating strong public interest in vaping over traditional tobacco products. Vaping consumption is also rising in Europe, with a reported increase of 5% from 2012 to 2014 among adults in 27 EU countries, thus, a reported increase from 27.1% in 2012 to adults reported having used e-cigarettes, highlighting a significant shift despite concerns over health risks associated with vaping. Despite some citizens believing vaping poses health risks, studies have found no concrete evidence to support this. Many ex-smokers find vaping less harmful compared to traditional cigarettes. In Asia, the situation is complex due to significant production and regulatory variances. China is the largest producer of e-cigarettes, accounting for 95% of the global output. However, countries like Malaysia, Vietnam, and Singapore have imposed bans on vaping products, yet the demand remains high. In China, the market for e-cigarettes grew dramatically from $ 14 million in 2013 to over $ 266 million by 2016. Despite facing challenges such as government restrictions and competition from traditional tobacco products, the vaping industry is witnessing robust growth. Many users consider vaping a healthier alternative to traditional smoking, citing lower levels of nicotine and harmful substances. However, perceptions vary, with some non-smokers viewing vaping as potentially more harmful. [ 1 ] The rise in electronic cigarette (e-cigarette) use, especially among young adults, has become a significant public health concern. Initially developed as a harm-reduction tool, e-cigarettes were intended to help smokers transition away from traditional tobacco products. However, despite these claims, e-cigarettes have attracted substantial scrutiny from global health organizations such as the World Health Organization (WHO) and the United Nations (UN). Both agencies have raised alarms over the potential risks of e-cigarettes, stating that they are not entirely risk-free. [ 2 ]. The WHO estimates that more than 8 million deaths occur annually due to tobacco-related illnesses, and concerns are growing that e-cigarettes may add to this burden by fostering nicotine addiction, especially among younger populations. [ 3 ] [ 2 ]. E-cigarettes, often referred to as vapes, are battery-powered devices designed to deliver nicotine in the form of an aerosolized vapor. These devices typically consist of three main components: a rechargeable battery, a heating element, and a cartridge or tank that contains a liquid mixture. [ 4 ] [ 5 ]. The liquid, also known as "e-liquid" or "vape juice," generally contains nicotine, propylene glycol, glycerin, and a variety of flavoring agents. [ 6 ] Also, which vaporizes a nicotine-containing solution, was marketed as a safer alternative to combustible cigarettes, mainly because it avoids the combustion process that produces harmful tar and other toxic chemicals found in traditional tobacco smoke. [ 3 ] [ 7 ]. When the user activates the device, the heating element vaporizes the liquid, creating an aerosol that is then inhaled into the lungs. [ 8 ] E-cigarettes have evolved, with more recent models, such as pod-based systems, delivering significantly higher concentrations of nicotine than earlier devices. These newer devices, particularly popular among young adults, can deliver nicotine levels that rival those found in traditional cigarettes, thus increasing the risk of addiction. [ 9 ] [ 10 ] Notably, the aerosol generated by e-cigarettes contains harmful substances beyond nicotine, including formaldehyde, acetaldehyde, heavy metals like lead and chromium, and other volatile organic compounds, all of which can be inhaled deep into the respiratory system. [ 4 ] [ 5 ] Despite their sleek designs and the marketing of flavored liquids, the safety of these devices remains highly questionable, especially when used over the long term. [ 10 ] The health risks associated with e-cigarette use have been increasingly documented, particularly respiratory and cardiovascular diseases. Chronic exposure to e-cigarette aerosols has been shown to cause airway inflammation, alveolar damage, and ciliary dysfunction, all of which are precursors to conditions such as Chronic Obstructive Pulmonary Disease (COPD) and bronchitis. [ 6 ] [ 8 ] Studies also highlight that the presence of carcinogenic substances, such as formaldehyde and acetaldehyde, elevates the risk of developing cancers, particularly lung cancer. [ 5 ] Furthermore, the inhalation of heavy metals like nickel, chromium, and lead can lead to cardiovascular complications, including an increased risk of myocardial infarction and stroke. [ 8 ] Neurological impairments have also been linked to e-cigarette use, particularly due to the high concentrations of nicotine found in modern devices. Nicotine is known to interfere with brain development in younger users, leading to cognitive impairments and a heightened risk of addiction. [ 10 ] [ 8 ] Therefore, while e-cigarettes are often marketed as a healthier alternative to traditional smoking, emerging evidence suggests that their long-term use may result in serious, potentially life-threatening diseases. [ 4 ] [ 10 ] A growing body of research has investigated the usage patterns, knowledge gaps, and risks associated with e-cigarette use. For instance, a cross-sectional study conducted among university students in Austria revealed a significant lack of understanding regarding the dangers of e-cigarettes. Only 10.3% of the students in the study recommended e-cigarettes as a tool for smoking cessation, pointing to widespread misconceptions about their safety. [ 9 ] Similarly, a study at Cairo University found that while 83.7% of students were aware of e-cigarettes, many continued to hold incorrect beliefs about their safety. The study reported that 32.4% of students had tried vaping, despite acknowledging the potential risks.[ 10 ] In China, research indicated that only 42.6% of university students knew that e-cigarettes contain nicotine, underscoring the significant knowledge gap among young adults about the contents and risks of vaping. [ 4 ] Another study conducted in Saudi Arabia showed that 27.7% of health science students regularly used e-cigarettes, a figure significantly higher than the prevalence of conventional cigarette smoking among the same group. [ 6 ] These findings emphasize the urgent need for public health interventions, educational programs, and stricter regulations to address the growing use of e-cigarettes and mitigate their potential public health risks. [ 5 ] This research will contribute significantly to improving the understanding of e-cigarette use, particularly its health risks and the misconceptions surrounding its safety. By providing insight into the molecular and physiological effects of e-cigarette use, as well as its impact on public health, this study aims to support the development of more effective public health policies and targeted interventions. Methods Research design and Sampling Type of Study This research employs an analytical cross-sectional design, utilizing a structured online questionnaire to gather data. The study follows a quantitative methodology aimed at assessing university students’ knowledge, attitudes, and perceptions concerning e-cigarette use. Data were collected via an online survey distributed through Google Forms. Study Setting The study was conducted across three universities: Kabul University (Afghanistan), NHL Stenden University (Netherlands), and Istanbul Medipol University (Turkey). According to official reports from the Student Affairs departments of these institutions, the total student population includes 22,137 at Kabul University, 24,000 at NHL Stenden University, and 46,988 at Medipol University. These universities comprise various faculties, both in medical and non-medical fields Duration The data collection spanned over a period of eight weeks, beginning in the first week of November 2024 and concluding by the end of December 2024. Sampling Method: A quota sampling technique was adopted for participant selection. Using Epi Info (version 3.2.5.0), a sample size was calculated from the total student population of 93,125. Based on a 5% margin of error, a 50% response distribution, and a 95% confidence level, a sample of 383 students was initially determined. Allowing for a 10% non-response rate (30 students), the final sample size was set at 413 participants. The sample was proportionally allocated to each university as follows: Kabul University – 23.7% (98 students), NHL Stenden University – 50.4% (208 students), and Medipol University – 25.9% (107 students). The questionnaire was then distributed digitally to students from the respective universities. Participants: The study focused on both male and female students from medical and non-medical faculties at the selected universities. All participants were selected according to the quota sample and were accessible for inclusion. In total, 413 students completed the questionnaire, achieving the expected sample size Sample Size: Using Epi Info version 3.5.2.0, and based on a total population of 93,125 students, the required sample size was calculated with an expected frequency of 50%, a 95% confidence interval, and a 5% margin of error. This yielded an initial sample of 383 students, increased to 413 after accounting for an anticipated 10% non-response rate. Data Source and Measurement: Data were gathered using a standardized questionnaire, adapted from literature published in PubMed [ 11 ][ 12 ]. The tool consisted of four sections: 1. Demographic Information – Reporting frequencies and percentages. 2. Knowledge of E-cigarettes – Assessed via 15 binary (true/false) items. A 75% accuracy threshold (at least 11 correct responses) was used to classify participants as having good knowledge, while those scoring below 75% were considered to have poor knowledge. 3. Attitudes Toward E-cigarettes – Included 13 items measured on a binary agree/disagree scale. Positive attitudes were identified by scores of 75% (9) or higher. whereas those scoring below 75% were considered to have a negative attitude [ 12 ] The statements reflected health-related perceptions of e-cigarette use. 4. Practices Regarding E-cigarettes – Evaluated through 13 items examining use patterns, frequency, purchasing behavior, and duration of use. Current users were scored as ‘0’, and non-users or former users were scored as ‘1’. Statistical Methods: Upon completion of data collection, responses were entered into SPSS version 26 for processing. Prior to analysis, the dataset was reviewed to ensure accuracy and address any inconsistencies. Data analysis was conducted using SPSS software, and visual representations were generated accordingly. Ethical Consideration I hereby declare that this research titled “Knowledge, Attitude, and Practice about E-cigarettes among University Students: A Comparative Study between Afghanistan, Netherlands, and Turkey” has been reviewed and approved by the Research Ethics Committee of Khatam Al Nabieen University. The study complies with the ethical principles and standards for conducting medical research in Afghanistan. —Approval Code: AF, knu.edu.af.rec 02 —Approval Date: September 10, 2023 The approval was granted based on the documents submitted to the committee on August 10, 2023. The Principal Investigator bears full responsibility for ensuring that all legal and professional obligations are fulfilled throughout the research process. Written informed consent was obtained from each participant prior to their inclusion in the study. The confidentiality and anonymity of participants were strictly maintained throughout the research process. All ethical standards outlined in the Declaration of Helsinki were carefully followed. Result Demographic characteristics A total of 413 university students participated in this study, comprising 210 males (50.8%), 200 females (48.4%), and 3 participants (0.7%) who preferred not to disclose their gender. Among them, 295 (71.8%) were non-medical students, while 118 (28.2%) were from medical backgrounds. The majority of respondents were aged 20 years. Tobacco use was most frequently reported by Dutch students (61.5%, n = 123), followed by Afghan students (26.5%, n = 53) and Turkish students (12.0%, n = 24). A substantial number of Dutch participants (60.0%, n = 132) reported cohabiting with smokers, compared to 21.8% of Afghan and 18.2% of Turkish students. Furthermore, 60.4% of Dutch students indicated that a family member used e-cigarettes. The paternal education level was highest among those holding tertiary degrees (63.2%), whereas 21.8% of mothers had only completed primary education or less. Turkish mothers showed the highest rate of tertiary education (42.9%), compared to Afghan mothers (12.3%). Close friends’ use of e-cigarettes was affirmed by 24.7% of Afghan students, 53.4% of Dutch students, and 21.9% of Turkish students. This demographic composition provides a diverse representation across the three countries, although some limitations, such as gender imbalance and differences in parental education, should be acknowledged as potential confounding variables. A detailed demographic breakdown of all three countries is presented in comparative Table 1 Table 1 demographic breakdown of all three countries Variables Countries Afghanistan Netherlands Turkey Total Sex Male 56(26.7%) 118(56.2%) 36(17.1%) 210(100%) Female 42(21.0%) 88(44.0%) 70(35.0%) 200(100.0%) Prefer not to say 0(0%) 3(100%) 0(0%) 3(100%) Age 20 Years 30(23.6%) 57(44.9%) 40(31.5%) 127(100.0%) 20 years 39(26.9%) 75(51.7%) 31(21.4%) 145(100.0%) Major Medical University 9(7.6%) 14(11.9%) 95(80.5%) 118(100.0%) Non-Medical University 89(30.2%) 194(65.8%) 12(4.1%) 295(100.0%) Year in University First-Second Year 46(18.9%) 127(52.3%) 70(28.8%) 243(100.0%) Third-Fourth Year 52(30.6%) 81(47.6%) 37(21.8%) 170(100.0%) Living area Urban 83(27.1%) 133(43.5%) 90(29.4%) 306(100.0%) Rural 15(14.0%) 75(70.1%) 17(15.9%) 107(100.0%) Father's educational level primary or less 23(47.9%) 23(47.9%) 2(4.2%) 48(100.0%) Secondary education (high school or equivalent) 29(27.9%) 55(52.9%) 20(19.2%) 104(100.0%) Tertiary education (college, university, or higher) 46(17.6%) 130(49.8%) 85(32.6%) 261(100.0%) Mother's educational level primary or less 40(44.4%) 40(44.4%) 10(11.1%) 90(100.0%) Secondary education (high school or equivalent) 38(23.8%) 95(59.4%) 27(16.9%) 160(100.0%) Tertiary education (college, university, or higher) 20(12.3%) 73(44.8%) 70(42.9%) 163(100.0%) Monthly living cost (USD) ≤ 300 77(34.1%) 89(39.4%) 60(26.5%) 226(100.0%) > 300 21(11.2%) 119(63.6%) 47(25.1%) 187(100.0%) Smoking tobacco cigarette Yes 53(26.5%) 123(61.5%) 24(12.0%) 200(100.0%) No 45(21.1%) 85(39.9%) 83(39.0%) 213(100.0%) Currently live with smokers. Yes 48(21.8%) 132(60.0%) 40(18.2%) 220(100.0%) No 50(25.9%) 76(39.4%) 67(34.7%) 193(100.0%) Family members ever use tobacco cigarettes. Yes 53(24.0%) 121(54.8%) 47(21.3%) 221(100.0%) No 45(23.4%) 87(45.3%) 60(31.3%) 192(100.0%) Family members ever use e-cigarettes Yes 41(22.5%) 110(60.4%) 31(17.0%) 182(100.0%) No 57(24.7%) 98(42.4%) 76(32.9%) 231(100.0%) Close friends ever use tobacco cigarettes Yes 61(24.2%) 136(54.0%) 55(21.8%) 252(100.0%) No 37(23.0%) 72(44.7%) 52(32.3%) 161(100.0%) Close friends ever use e-cigarettes (vaping) Yes 62(24.7%) 134(53.4%) 55(21.9%) 251(100.0%) No 36(22.2%) 74(45.7%) 52(32.1%) 162(100.0%) 92.3% of the study population has heard of ECs mostly through, university/school, social media, and friends (30.9%, 23.2% 21.9% respectively). For additional information about the source of information regarding e-cigarettes kindly refer to Table 2 below. Table 2 Source of Information about E-cigarettes Have you heard of E-cigarettes (vaping)? Frequency(n) Percent (%) Yes 381 92.3% No 32 7.7% Total 413 100.0% If yes, where have you heard of E-cigarettes? (Circle all that apply) Frequency(n) Percent (%) Advertisements 131 12.2% Friends 235 21.9% Social Media 247 23.1% Family 93 8.7% University/School 331 30.9% Doctor 20 1.9% Centre for Smoking Cessation 14 1.3% Knowledge gaps among participants were evident in various key areas. A significant 64.6% of students mistakenly believed that e-cigarettes were approved by the U.S. Food and Drug Administration (FDA), and 51.3% falsely believed that these products do not contribute to secondhand smoke exposure. Conversely, 70.1% correctly recognized that flavorings vary in harmfulness. Knowledge concerning health risks was moderately strong: 66.8% acknowledged the link between e-cigarettes and bladder cancer, 56.2% recognized the association with lung cancer, and 73.8% understood their potential to impair heart and lung function. These findings suggest that while there is a foundational understanding of some health risks associated with vaping, major misconceptions persist, particularly in areas involving regulatory status and indirect exposure risks. The questions in the knowledge scale and the distributions of the answers are displayed in Table 3 . Table 3 E-cigarette knowledge questions frequency and percentage Knowledge questions No. Valid % 1 E-cigarettes are associated with bladder cancer False__Wrong Answer 137 33.2% True__Correct Answer 276 66.8% 2 E-cigarettes are FDA Approved True__ Wrong Answer 267 64.6% False__ Correct Answer 146 35.4% 3 Some flavors of E-cigarettes are more harmful than others False__ Wrong Answer 122 29.5% True__ Correct Answer 291 70.5% 4 Swallowing the liquid in E-cigarettes accidentally can cause poisoning that is potentially fatal False__ Wrong Answer 96 23.2% True__ Correct Answer 317 76.8% 5 E-cigarettes are not associated with lung cancer True__ Wrong Answer 181 43.8% False__ Correct Answer 232 56.2% 6 E-cigarettes impair lung and heart functions False__ Wrong Answer 108 26.2% True__ Correct Answer 305 73.8% 7 E-cigarettes are not contributed to secondhand smoking True__ Wrong Answer 212 51.3% False__ Correct Answer 201 48.7% 8 E-cigarettes can have an effect on fetal development False__ Wrong Answer 85 20.6% True__ Correct Answer 328 79.4% 9 Nicotine is present in most E-cigarettes False__ Wrong Answer 87 21.1% True__ Correct Answer 326 78.9% 10 Harmful flavourings and toxins are found in the E-cigarette aerosol False__ Wrong Answer 76 18.4% True__ Correct Answer 337 81.6% 11 E-cigarettes are harmful True__ Wrong Answer 178 43.1% False__ Correct Answer 235 56.9% 12 Some components of the liquid found in E-cigarettes can cause harmful lung conditions False__ Wrong Answer 93 22.5% True__ Correct Answer 320 77.5% 13 E-cigarettes are not addictive True__ Wrong Answer 163 39.5% False__ Correct Answer 250 60.5% 14 E-cigarettes are suitable for pregnant women True__ Wrong Answer 137 33.2% False__ Correct Answer 276 66.8% 15 E-cigarettes are suitable for children True__ Wrong Answer 141 34.1% False__ Correct Answer 272 65.9% The attitudinal responses of participants revealed mixed perceptions toward e-cigarette use. About 62.7% of respondents perceived vaping to be more socially acceptable than traditional smoking. Nearly half (48.9%) believed that experimenting with e-cigarettes for recreational purposes is acceptable. Furthermore, 55.4% believed e-cigarettes serve as an effective cessation aid, while 59.8% thought they could help reduce or quit smoking, and 54.5% supported their use as a replacement for conventional cigarettes. The distribution of answers to all the questions included in the negative attitude scale is displayed in Table 4 Table 4 E-cigarette attitude questions frequency and percentage Attitude questions No. Valid % 1 Should E-cigarettes be recommended to a non-smoker? No__ Negative Attitude 217 52.5% Yes__ Positive Attitude 196 47.5% 2 Do you think E-cigarettes are harmful to health? Yes__ Negative Attitude 308 74.6% No__ Positive Attitude 105 25.4% 3 Should the use of E-cigarettes be allowed in places that do not allow smoking? No__ Negative Attitude 229 55.4% Yes__ Positive Attitude 184 44.6% 4 Would you consider someone who uses E-cigarettes a smoker? Yes__ Negative Attitude 276 66.85 No__ Positive Attitude 137 33.2% 5 Do you think the use of E-cigarettes can lead to reliance? Yes__ Negative Attitude 275 66.6% No__ Positive Attitude 138 33.4% 6 Do you think the government should regulate the use of E-cigarettes? Yes__ Negative Attitude 267 64.6% No__ Positive Attitude 146 35.4% 7 Do you feel more comfortable using or openly talking about smoking E-cigarettes, compared to cigarettes? No__ Negative Attitude 158 38.3% Yes__ Positive Attitude 255 61.7% 8 Do you feel it is more socially acceptable to smoke E-cigarettes, compared to cigarettes? No__ Negative Attitude 154 37.3% Yes__ Positive Attitude 259 62.7% 9 Should E-cigarettes be used as a replacement for regular cigarettes? No__ Negative Attitude 188 45.5% Yes__ Positive Attitude 225 54.5% 10 experiment with E-cigarettes for pleasure? No__ Negative Attitude 211 51.1% Yes__ Positive Attitude 202 48.9% 11 Do you think using E-cigarettes would be an effective way to help in smoking cessation? No__ Negative Attitude 184 44.6% Yes__ Positive Attitude 229 55.4% 12 Do you think it is acceptable to use E-cigarettes as a smoking cessation method? No__ Negative Attitude 200 48.4% Yes__ Positive Attitude 213 51.6% 13 Do you think E-cigarettes can help people cut down on cigarettes or quit smoking? No__ Negative Attitude 166 40.2% Yes__ Positive Attitude 247 59.8% E-cigarette practice The prevalence of e-cigarette use across the sample was 54.2%. Of these, 27.1% reported vaping on 1–2 days in the previous week, and 24.9% used e-cigarettes more than 20 times per day. Notably, 41.2% of users purchased their devices from authorized retailers, and 38.5% found it easy to access such products. Most users reported spending between 10–28 EUR per purchase (29.8%). The first experience with e-cigarettes generally occurred after the age of 18, and 39.5% of participants indicated they had no intention to quit vaping. Detailed information regarding these findings is presented in Table 5 . Table 5 E-cigarette practice question frequency and percentage Practice questions No. Valid % 1 Currently using e-cigarettes Yes 224 54.2% No 189 45.8% 2 If yes, Duration of use within the last 7 days > 5 days 86 20.8% 3–4 days 26 6.3% 1–2 days 112 27.1% 3 Frequencies of e-cigarette usage per day 20 times a day 26 6.3% Not Daily 95 23.0% 4 Time of initiating usage after waking up After 1–2 hours 97 23.5% It varies 94 22.8% Immediately after waking-up 33 8.0% 5 Place of purchase e-cigarette Authentic store 170 41.2% Online shop 54 13.1% 6 Ease of purchase? Yes 159 38.5% No 65 15.7% 7 Price of per purchase (EUR) > 28 10 2.4% ≥ 10 91 22.0% 10─28 123 29.8% 8 Price of e-cigarette liquid (EUR) 4 87 21.1% 4─5 116 28.1% 9 Age of the first trail < 18 years old 155 37.5% ≥ 18 years old 69 16.7% 10 Intention to quit Yes 164 39.7% No 60 14.5% This study provides valuable insights into the factors influencing e-cigarette use, particularly its association with traditional smoking habits, social and family influence, and demographic characteristics. Additionally, the findings highlight significant patterns in knowledge, attitudes, and practices (KAP) related to smoking and vaping. The statistically significant p-values (0.00) across multiple variables indicate strong associations, underscoring the impact of environmental, social, and educational factors on smoking behavior. Knowledge about e-cigarettes A total of 232 (56.2%) students demonstrated a poor level of e-cigarette knowledge. Turkish students exhibited a higher level of knowledge about e-cigarettes 78(43.1%) compared to Afghan students 38(21.0%) and Netherlands students 65(35.9%), with a statistical significance (P = 0.00). Attitude was largely negative, with 73.4% showing poor attitudes toward e-cigarettes and only 26.6% exhibiting a positive outlook. Regarding e-cigarette practices, 54.2% engaged in good practices, whereas 45.8% exhibited poor practices. These findings highlight a lack of knowledge and generally negative attitudes, despite a relatively balanced distribution in e-cigarette use practices. Educational efforts are needed to improve knowledge and promote healthier attitudes and behaviors. Correspondingly, poor knowledge was most prevalent in the Netherlands (61.6%), compared to Afghanistan (25.9%) and Turkey (12.5%). Attitudes toward e-cigarettes also showed significant variation (p = 0.00). The Netherlands had the highest proportion of positive attitudes (62.7%), whereas Turkey (12.7%) and Afghanistan (23.4%) had lower positive perceptions. Regarding e-cigarette practices, a significant difference was observed (p = 0.00). Poor practices were most common in Turkey (44.4%), compared to Afghanistan (23.3%) and the Netherlands (32.3%). The analysis showed a significant association between sex and knowledge (p = 0.001). Females (59.1%) had better knowledge compared to males (40.3%), while poor knowledge was more prevalent among males (59.1%). For attitude, no significant association was found (p = 0.2). Males and females had similar attitudes, with 52.7% of males and 45.5% of females showing positive attitudes toward e-cigarettes. However, practice differed significantly by sex (p = 0.001). Females demonstrated better practices (59.4%) compared to males (40.2%), while poor practices were more common among males (58.2%) than females (40.7%). The aforementioned findings pertain to the knowledge, attitude and practice regarding E-cigarette. For further details, please refer to Table 6 below. The analysis revealed a significant association (p = 0.00) between smoking tobacco cigarettes and e-cigarette use. Among current e-cigarette users, 72.8% were also tobacco cigarette smokers, while 27.2% had never smoked traditional cigarettes. Conversely, among those who did not use e-cigarettes, only 19.6% were tobacco smokers. A significant association (p = 0.00) was found between living with smokers and e-cigarette use. Among current e-cigarette users, 69.2% lived with smokers, while 30.8% were e-cigarette users who didn’t live with smokers. A significant association (p = 0.00) was found between having family members who use tobacco cigarettes and e-cigarette use. Among current e-cigarette users, 65.2% had family members who smoked tobacco, while 34.8% were e-cigarette users who had no family members who smoked tobacco. Whereas 39.7% were non-e-cigarette users who had family members who smoked tobacco cigarettes. These findings suggest that having family members who use tobacco increases the likelihood of e-cigarette use, reinforcing the role of familial influence in vaping behavior. A significant association (p = 0.00) was found between family members 'e-cigarette use and participants' e-cigarette use. Among current e-cigarette users, 65.2% had family members who also used e-cigarettes, while 37.5% were e-cigarette users who had not family members who vaped. In contrast, among non-e-cigarette users, 22.2% of non-e-cigarette smokers had family members who vaped. A significant association (p = 0.00) was found between close friends 'e-cigarette use and participants' e-cigarette use. Among current e-cigarette users, 74.6% had close friends who also used e-cigarettes. While 44.4% of non-vapers had friends who vaped. A significant association (p = 0.00) was found between having close friends who smoke tobacco cigarettes and participants' e-cigarette use. Among current e-cigarette users, 74.1% had close friends who smoked tobacco. For additional information, kindly refer to Table 7 below. Table 7 Currently using e-cigarettes Smoking tobacco cigarette yes No Total P- value yes 163(72.8%) 61(27.2%) 224(100.0%) 0.00 No 37(19.6%) 152(80.4%) 189(100.0%) Currently using e-cigarettes Currently live with smokers yes No Total P- value yes 155(69.2%) 69(30.8%) 224(100.0%) 0.00 No 65(34.4%) 124(65.6%) 189(100.0%) Currently using e-cigarettes Family members ever use tobacco cigarettes yes No Total P- value yes 146(65.2%) 78(34.8%) 224(100.0%) 0.00 No 75(39.7%) 114(60.3%) 189(100.0%) Currently using e-cigarettes Family members ever use e-cigarettes (vaping) yes No Total P- value yes 140(62.5%) 84(37.5%) 224(100.0%) 0.00 No 42(22.2%) 147(77.8%) 189(100.0%) Currently using e-cigarettes Close friends ever use e-cigarettes (vaping) yes No Total P- value yes 167(74.6%) 57(25.4%) 224(100.0%) 0.00 No 84(44.4%) 105(55.6%) 189(100.0%) Currently using e-cigarettes Close friends ever use tobacco cigarettes yes No Total P- value yes 166(74.1%) 58(25.9%) 224(100.0%) 0.00 No 86(45.5%) 103(54.5%) 189(100.0%) Conclusions Conclusion and Recommendations Key Takeaways E-cigarette use is strongly linked to traditional smoking habits, indicating a potential dual-use problem rather than e-cigarettes serving as an alternative to quitting. Household smoking environments significantly influence e-cigarette use, reinforcing the need for family-based prevention programs. Peer influence is one of the most powerful predictors of smoking behavior, making peer-led interventions critical in tobacco control strategies. Despite moderate knowledge levels, attitudes toward smoking remain poor, suggesting that awareness alone is insufficient—interventions must address social and behavioral aspects. Cultural, gender, and educational differences play a role in smoking behavior, requiring customized public health approaches based on demographic characteristics. Policy and Intervention Recommendations Targeted Awareness Campaigns Educational programs should not just provide information but actively challenge attitudes and behaviors. Campaigns should target peer groups rather than just individuals. Stronger Family-Based Interventions Smoke-free home initiatives and parental education programs could significantly reduce youth vaping and smoking. Peer-Led Prevention Programs Schools and universities should implement peer-led anti-smoking initiatives, as peer influence plays a dominant role in the adoption of behavior. Regulations and Restrictions Stricter regulations on e-cigarette sales, especially among youth, could help reduce accessibility. Policies should not only target individual behavior but also address environmental factors (e.g., public bans, social norm shifts). Gender-Specific Strategies Female-focused health interventions may be needed to further reinforce positive smoking-avoidance behaviors. Male-oriented campaigns should emphasize the health risks and social consequences of smoking. Cultural Adaptation of Anti-Smoking Strategies Since knowledge and smoking behavior vary by country, prevention programs should be adapted based on cultural norms and smoking prevalence. Final Thoughts This study highlights the complex interplay between knowledge, social environment, and demographic factors in shaping e-cigarette and tobacco use. To combat the rising prevalence of smoking and vaping, holistic interventions combining education, behavioral reinforcement, policy regulation, and peer influence—are essential. By addressing these factors, public health programs can create lasting behavioral changes and reduce smoking rates in society. Discussion This study assessed the Knowledge, Attitudes, and Practices (KAP) regarding e-cigarettes among university students in Afghanistan, the Netherlands, and Turkey. To provide a broader context, we compare our findings with studies conducted in Saudi Arabia. [ 6 ], China [ 4 ], Indonesia [ 11 ], Egypt [ 10 ], Jordan [ 13 ], Malaysia [ 14 ] and France [ 15 ]. The findings highlight significant variations in e-cigarette awareness, attitudes, and usage trends across different cultural and regulatory environments. Our study found that e-cigarette use varied significantly based on demographic factors such as age, gender, and academic background. In Afghanistan, the Netherlands, and Turkey, the majority of e-cigarette users were male students aged 19–25. This aligns with findings from Saudi Arabia, where 66.2% of e-cigarette users were male, and most users were between 19 and 22 years old [ 6 ]. In contrast, studies from France and China showed that while male students were more likely to use e-cigarettes, female users were also prevalent. [ 15 ] [ 4 ]. Financial status also played a role in e-cigarette consumption. In our study, students from middle- to high-income families reported higher e-cigarette use, which is consistent with findings from France, where students facing fewer financial difficulties were more likely to experiment with vaping. [ 15 ]. Similarly, Saudi Arabian students who lived off-campus in rented accommodations were more likely to use e-cigarettes compared to those living with their families. [ 6 ]. Demographic factors such as age, gender, and financial status conditions play a significant role in shaping e-cigarette consumption patterns among university students. While young adult males remain the predominant users, social influences and economic background also contribute to e-cigarette adoption. Future research should explore the long-term health impacts of e-cigarettes across diverse demographic groups, with a focus on mental health interventions and policy regulation to reduce vaping among at-risk populations. Knowledge of E-Cigarettes Our study found that Turkish students exhibited the highest level of awareness (43.1%), followed by Afghan (21.0%) and Dutch students (35,9%). This disparity is consistent with findings from China, where students demonstrated moderate awareness but had significant gaps in understanding the nicotine content and long-term health risks. [ 4 ] The study reported that 10.5% of Jordanians. [ 13 ] Students used e-cigarettes, whereas our study found a significantly higher prevalence (54.2%). This stark difference suggests that cultural, social, and regulatory factors may influence e-cigarette adoption. The higher prevalence in the international sample, particularly in the Netherlands, could be attributed to greater social acceptance and easier access to e-cigarettes compared to Jordan. [ 13 ]. These misconceptions reflect a global issue: students often receive information from social media, friends, and advertisements, which may not provide accurate health information. The study found that medical students in Jordan had better knowledge than non-medical students, a pattern also observed in our study, where Turkish students many of whom were medical students had higher knowledge levels compared to Afghan and Dutch students. Attitudes Toward E-Cigarettes Attitudes toward e-cigarettes varied significantly across different countries. In our study, Afghan and Turkish students held predominantly negative views (23.4%) (30.7%), whereas Dutch students were more accepting (62.7% positive attitude). The studies in Indonesia show that students’ attitudes toward e-cigarettes are influenced by their social environment. The study revealed that many Jordanian students perceived e-cigarettes as a less harmful and less addictive alternative to traditional cigarettes. Similarly, in our study, 62.7% felt e-cigarettes were more socially acceptable than traditional cigarettes, and 54.5% believed e-cigarettes should replace regular cigarettes. However, both studies also indicate a significant portion of students hold negative attitudes toward e-cigarettes, with 73.4% of international students expressing concerns about their safety. In Malaysia, strong opposition was observed, with 62.4% of students supporting a ban on e-cigarettes. [ 14 ]. Similarly, in Saudi Arabia, although some students saw e-cigarettes as a smoking cessation tool, many viewed them as equally addictive as traditional cigarettes. [ 6 ]. Conversely, Indonesian students displayed highly favorable perceptions, with 91.3% expressing positive attitudes. [ 11 ]. French students largely perceived e-cigarettes as a safer alternative, though they associated their use with other risky behaviors such as binge drinking. Meanwhile, in Jordan and Egypt, clinical-year students were more likely to support e-cigarettes for smoking cessation compared to their preclinical counterparts. [ 10 ] [ 13 ]. These findings indicate that cultural beliefs, policy regulations, and exposure to e-cigarette users significantly shape students’ attitudes toward vaping. E-Cigarette Use and Prevalence The prevalence of e-cigarette use among university students showed notable differences across countries. In our study, Turkish students reported the highest e-cigarette use (44.4%), followed by Afghan (23.3%) and Dutch students (32.3%). In Saudi Arabia, 27.7% of health science students reported using e-cigarettes, a rate significantly higher than conventional cigarette smoking (14.1%) [ 6 ]. France had a similar prevalence, with 23.0% of students having tried e-cigarettes. [ 15 ]. Malaysia reported a relatively low prevalence (6.6%) [ 14 ]while in Egypt, 7.3% of medical students reported usage, with a higher prevalence among males [ 10 ]. Jordan had a significantly higher prevalence (37.4%) [ 13 ], whereas China and Indonesia reported lower usage rates (8.2%) [ 11 ] A consistent finding across all studies was the strong influence of peer networks on e-cigarette use. Students who had friends or family members using e-cigarettes were more likely to experiment with vaping. This trend was evident in Saudi Arabia and Malaysia, where students with vaping peers had significantly higher usage rates. [ 14 ] [ 6 ]. E-Cigarettes as a Smoking Cessation Tool In our study, social media (23.1%) and University/Schools (30.9%) were the most common sources of information on e-cigarettes but in Jordan, social media (43.1%) and friends (32.9%) were the most common sources of information on e-cigarettes. Additionally, both studies found a strong correlation between conventional cigarette smoking and e-cigarette use, reinforcing the idea that e-cigarettes are not always used as a smoking cessation tool but rather as an additional form of nicotine consumption. Countries with strict regulations, such as Malaysia and Jordan, exhibited lower e-cigarette prevalence rates. In Malaysia, the National Fatwa Council declared vaping forbidden (haram), significantly influencing students’ attitudes and behaviors. [ 13 , 14 ]. Similarly, Jordan prohibits e-cigarette advertising and sales to individuals under 19 [ 13 ] . By contrast, Saudi Arabia and Indonesia, where regulations are more lenient, reported higher e-cigarette usage rates. [ 6 ] [ 11 ]. France, despite implementing regulations restricting sales to minors, still had a high proportion of experimental users. [ 15 ]. These findings emphasize the impact of government policies and public health campaigns on vaping behaviors. Countries with stronger tobacco control measures tend to see lower e-cigarette usage among youth. Overall, peer influence, social media exposure, and regulatory environments play crucial roles in shaping students’ e-cigarette knowledge, attitudes, and behaviors. Future public health efforts should focus on harmonizing policies and increasing educational initiatives to mitigate the growing trend of e-cigarette use among university students worldwide. This study has several limitations that should be considered. First, the data were collected through an online self-administered questionnaire using Google Forms, which may introduce response bias and limit control over who participated. Second, the use of convenience sampling through voluntary participation may affect the representativeness of the sample and reduce the generalizability of the findings. Third, since the study was conducted only among university students in three countries (Afghanistan, Turkey, and the Netherlands), the results may not be applicable to the general population or to students in other regions. Additionally, due to the cross-sectional design of the study, causal relationships between knowledge, attitudes, and practices toward electronic cigarettes cannot be established. Despite these limitations, the findings provide valuable insights into the awareness and behavior of university students regarding e-cigarette use across diverse cultural contexts. Abbreviations IRB Institutional Review Board KAP Knowledge Attitude and Practice IQ R Interquartile Rang SD Standard Deviation SPSS Statistical Package for the Social Sciences E- Cig Electronic Cigarette Declarations Ethics approval and consent to participate I hereby declare that this research titled “Knowledge, Attitude, and Practice about E-cigarettes among University Students: A Comparative Study between Afghanistan, Netherlands, and Turkey” has been reviewed and approved by the Research Ethics Committee of Khatam Al Nabieen University. The study complies with the ethical principles and standards for conducting medical research in Afghanistan. —Approval Code: AF, knu.edu.af.rec 02 —Approval Date: September 10, 2023 The approval was granted based on the documents submitted to the committee on August 10, 2023. The Principal Investigator bears full responsibility for ensuring that all legal and professional obligations are fulfilled throughout the research process. Nonetheless, all ethical principles outlined in the Declaration of Helsinki were followed, and written informed consent was obtained from all participants. [16] Consent to Participate Declaration All individuals who took part in this study were fully informed about the study’s objectives, procedures, and their rights as participants. Participation was entirely voluntary, and written informed consent was obtained from each participant prior to their inclusion in the research. The informed consent text used for the participants in this study is as follows: This study is designed as a comparative cross-sectional analysis, meaning that the research evaluates responses from a structured questionnaire. The questionnaire was developed specifically for this study and is organized into four sections, containing 50 questions covering demographic information, and assessing knowledge, attitudes, and practices related to e-cigarettes. Before giving your consent, please consider the following: This study involves no physical or psychological harm to participants or researchers. Participation in this study is entirely voluntary. The identity of participants has no impact on the study’s outcomes, and therefore, your name will remain confidential and will not be mentioned in the research. The findings of this study can be made available to you upon request, following the completion of all necessary legal procedures. For any questions or concerns, you may contact "Mansoorullah Muradi" at [email protected] or "Lima Oria" at [email protected] We kindly request that you respond honestly to all questions, as this will help ensure the transparency and accuracy of the information collected. By reading and acknowledging this information, you indicate your willingness to voluntarily participate in this study. You agree to allow the researchers to use the information you provide for research purposes. Consent for publication All participants provided consent for publication of anonymized responses. Availability of data and materials The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing Interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors' contributions Mansoorullah Muradi conceived and designed the study. Data collection was performed by the research team under his supervision. All authors contributed to data analysis, manuscript writing, and approved the final version of the manuscript. Acknowledgements The authors would like to thank all the students who participated in the study, and the administrative support from participating universities. References Morteza, "Statistics of vape and e-cigarette use in the world," Vapersco, 2021. WHO, "Tobacco: E-cigarettes," World Health Organization, Geneva, 2024. "World Health Organization, Tobacco," https://www.who.int/news-room/fact-sheets/detail/tobacco, 31 July 2023. [Online]. Available: https://www.who.int/news-room/fact-sheets/detail/tobacco. Juan Fang, Jianping Ren, Lixian Ren, Wendy Max, Tingting Yao, Falin Zhao, "Electronic cigarette knowledge, attitudes and use among students at a university in Hangzhou, China," vol. 20, 6 Jul 2021. Ronald Hartono, Chaofang Yan, Ying Chen, Boting Ma1, Yaqi Deng, Yijia Sun, Pan Li, Yuye Dao, Rui Deng, "Knowledge, attitude, and practice of e-cigarette use among undergraduate students: A comparative study between China," Kunming Medical University, Kunming, vol. 22, 16 May 2024. Sultan Qanash, Shereen Alemam, Estabraq Mahdi, Jood Softah, Abdelfattah Ahmed Touman, Adil Alsulami, "Electronic cigarette among health science students in Saudi Arabia," Wolters Kluwer ‑ Medknow, vol. 13, no. 1, 12 Mar 2018. Cother Hajat, Emma Stein, Saran Shantikumar, Raymond Niaura, Pietro Ferrara, Riccardo Polosa, "A scoping review of studies on the health impact of electronic nicotine delivery systems," PMC, PubMed Central, vol. 17, no. 2022, pp. 241-268, 12 Oct 2021. Suha AlMuhaissen, Haneen Mohammad, Afnan Dabobash, Marya Q. Nada, Zahra M. Suleiman, "Prevalence, Knowledge, and Attitudes among Health Professions Students toward the Use of Electronic Cigarettes," Healthcare, vol. 10, no. 12, 3 OCt 2022. Priyamvada Paudyal, M Movia, "Knowledge, Attitudes and Beliefs towards Electronic Cigarettes among University Students in Austria," The European Journal of Public Health, vol. 29, no. 4, 13 Nov 2019. Ola Abdelmoniem mostafa, Mahmoud Ahmed Taha, "Knowledge, attitude and use of Electronic Cigarettes among Cairo University Medical Students," Research Square, vol. 1, Jan 2024. Deng Rui, Chen Ying,Yan Chao Fang, Ma Bo Ting, Deng Ya Qi, Sun Yi Jia, Li Pan, Yu Ye Dao, “Knowledge, attitude, and practice of e-cigarette use among undergraduate students: A comparative study between China and Indonesia,” Research Square, p. 25, 24th June 2024. Hanan Aghar, Nathalie El-Khoury, Mahasen Reda, Wissam Hamadeh ,Hussein Krayem, Mohammad Mansour, Hawraa Raouf, and Miran A. Jaffa, "Knowledge and attitudes towards E-cigarette use in Lebanon and their associated factors," BMC Public Health, vol. 20, no. 278 , p. 18, 2 Jun 2020. A. B. M. E. A.-S. S. B. R. Al-Sawalha NA, "E-cigarettes use among university students in Jordan: Perception and related knowledge," PLOS ONE, pp. 1-13, 31 December 2021. T. A. M. T. ,. N. ‘. M. D. M. F. A. S. R. Z. A. N. M. J. H. Nuurain Amirah MR, "Knowledge, Attitude and Practice on Electronic Cigarette and their Associated Factors among Undergraduate Students in a Public University," IIUM Medical Journal Malaysia, Vols. IMJM Volume 20 No.2, Apr 2021, 2021. A. V. L. R. G. K. K. J. L. Marie-Pierre Tavolacci, "Patterns of electronic cigarette use in current and ever users among college students in France: a cross–sectional study," BMJ, no. in current and ever users among college, 27 April 2016. H. World Medical Association, "DECLARATION OF HELSINKI Ethical principles for Medical Research Involving Human Subjects," 1964-2024, p. 5. Table 6 Table 6 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table6.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6832062","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":470378643,"identity":"6fa008e2-b8ca-4c85-afc0-2382e2ee4890","order_by":0,"name":"Mansoorullah Muradi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+0lEQVRIiWNgGAWjYLADicR/NnIgxoEHRGtJYEszBmtJIFoLA9vhxAYQC58W3fazhz98qLgXbXD78MMbD3gOp88PO/wQaIudnG4Ddi1mZ/LSJGecKc7dcC7N2CJBIj134+00A6CWZGOzAzi0HMgxY+ZtS8jdcIbBTCLBwDp34+wEkJYDidtwaTn/xvgzRAv7N4mEBOZ0w9npH/BruZFjIA3RwgO05YBzgrx0DgFbbrwxA/olIXfmGZ5ii8SGNMMN0jkFBxIM8PjlfI4xMMQScvvOsG+8+bPBRl5+dvpmoIidHC4tmMAArNKAWOUgIN9AiupRMApGwSgYCQAAEfhm2EP2nroAAAAASUVORK5CYII=","orcid":"","institution":"Kabul University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Mansoorullah","middleName":"","lastName":"Muradi","suffix":""},{"id":470378644,"identity":"a8b676c5-1cd3-402c-a949-267f03275b8b","order_by":1,"name":"Lima Oria","email":"","orcid":"","institution":"Istanbul Medipol University","correspondingAuthor":false,"prefix":"","firstName":"Lima","middleName":"","lastName":"Oria","suffix":""},{"id":470378645,"identity":"2e2a1a2c-8a09-4807-b130-38a221860525","order_by":2,"name":"Tariq Aziz Azizi","email":"","orcid":"","institution":"Kabul University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Tariq","middleName":"Aziz","lastName":"Azizi","suffix":""}],"badges":[],"createdAt":"2025-06-05 21:38:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6832062/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6832062/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86995267,"identity":"95a9b13b-976e-4787-9a51-1c3daf1d3d62","added_by":"auto","created_at":"2025-07-18 05:33:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2662516,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6832062/v1/ce6c7f23-ca5a-4951-8f99-638ac170741c.pdf"},{"id":84547222,"identity":"87139406-8e47-4ce6-820d-929c2faafaec","added_by":"auto","created_at":"2025-06-13 09:24:05","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":17088,"visible":true,"origin":"","legend":"","description":"","filename":"Table6.docx","url":"https://assets-eu.researchsquare.com/files/rs-6832062/v1/4e217894870e21d62ca6e333.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Knowledge Attitude and practice about E-cigarettes among University Students: A comparative study between Afghanistan, Netherlands, and Turkey","fulltext":[{"header":"Introduction","content":"\u003cp\u003e Vaping, a form of electronic smoking, has gained widespread popularity among a diverse range of young and adult users in recent years. In the United States, over 40\u0026nbsp;million people use vaping products, with about 5\u0026nbsp;million specifically using e-cigarettes. This trend is not limited to the U.S.; other countries, including the UK, have also seen significant increases in vaping. For example, from 2012 to 2016, vaping use in the UK grew by 60%. The rapid advancement in vaping technology has contributed to its rising acceptance and use as an alternative to traditional cigarettes. In North America, particularly the U.S., vaping consumption has been overgrown since 2014, with 20% of adults aged 18 to 26 reporting e-cigarette use. In 2014, about 10% of surveyed individuals acknowledged regular vaping, a number that has consistently increased over the years. By 2013, only 2.6% of adults used e-cigarettes regularly. Among younger age groups. For instance, by 2014, around 20% of adults aged 18\u0026ndash;26 reported using electronic cigarettes, with about 13% of the adult population having tried vaping at least once. In addition, there has been a 70% increase in new vaping users in the U.S. from 2013 onwards. Daily usage among North American adults has also increased, with estimates indicating that about 3.7% regularly vape. Similar trends are observed in Canada and Mexico. In Canada, vaping use grew by 13.2% in 2015, with around 1% using them daily with 3.2% of adults reporting e-cigarette use within the last month. Despite a ban on e-cigarettes in Mexico since 2013, usage increased by over 50% in one year, indicating strong public interest in vaping over traditional tobacco products. Vaping consumption is also rising in Europe, with a reported increase of 5% from 2012 to 2014 among adults in 27 EU countries, thus, a reported increase from 27.1% in 2012 to adults reported having used e-cigarettes, highlighting a significant shift despite concerns over health risks associated with vaping. Despite some citizens believing vaping poses health risks, studies have found no concrete evidence to support this. Many ex-smokers find vaping less harmful compared to traditional cigarettes. In Asia, the situation is complex due to significant production and regulatory variances. China is the largest producer of e-cigarettes, accounting for 95% of the global output. However, countries like Malaysia, Vietnam, and Singapore have imposed bans on vaping products, yet the demand remains high. In China, the market for e-cigarettes grew dramatically from \u003cspan\u003e$\u003c/span\u003e14\u0026nbsp;million in 2013 to over \u003cspan\u003e$\u003c/span\u003e266\u0026nbsp;million by 2016. Despite facing challenges such as government restrictions and competition from traditional tobacco products, the vaping industry is witnessing robust growth. Many users consider vaping a healthier alternative to traditional smoking, citing lower levels of nicotine and harmful substances. However, perceptions vary, with some non-smokers viewing vaping as potentially more harmful. [ \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e ] \u003c/p\u003e \u003cp\u003eThe rise in electronic cigarette (e-cigarette) use, especially among young adults, has become a significant public health concern. Initially developed as a harm-reduction tool, e-cigarettes were intended to help smokers transition away from traditional tobacco products. However, despite these claims, e-cigarettes have attracted substantial scrutiny from global health organizations such as the World Health Organization (WHO) and the United Nations (UN). Both agencies have raised alarms over the potential risks of e-cigarettes, stating that they are not entirely risk-free. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The WHO estimates that more than 8\u0026nbsp;million deaths occur annually due to tobacco-related illnesses, and concerns are growing that e-cigarettes may add to this burden by fostering nicotine addiction, especially among younger populations. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eE-cigarettes, often referred to as vapes, are battery-powered devices designed to deliver nicotine in the form of an aerosolized vapor. These devices typically consist of three main components: a rechargeable battery, a heating element, and a cartridge or tank that contains a liquid mixture. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The liquid, also known as \"e-liquid\" or \"vape juice,\" generally contains nicotine, propylene glycol, glycerin, and a variety of flavoring agents. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] Also, which vaporizes a nicotine-containing solution, was marketed as a safer alternative to combustible cigarettes, mainly because it avoids the combustion process that produces harmful tar and other toxic chemicals found in traditional tobacco smoke. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. When the user activates the device, the heating element vaporizes the liquid, creating an aerosol that is then inhaled into the lungs. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] E-cigarettes have evolved, with more recent models, such as pod-based systems, delivering significantly higher concentrations of nicotine than earlier devices. These newer devices, particularly popular among young adults, can deliver nicotine levels that rival those found in traditional cigarettes, thus increasing the risk of addiction. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] Notably, the aerosol generated by e-cigarettes contains harmful substances beyond nicotine, including formaldehyde, acetaldehyde, heavy metals like lead and chromium, and other volatile organic compounds, all of which can be inhaled deep into the respiratory system. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] Despite their sleek designs and the marketing of flavored liquids, the safety of these devices remains highly questionable, especially when used over the long term. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe health risks associated with e-cigarette use have been increasingly documented, particularly respiratory and cardiovascular diseases. Chronic exposure to e-cigarette aerosols has been shown to cause airway inflammation, alveolar damage, and ciliary dysfunction, all of which are precursors to conditions such as Chronic Obstructive Pulmonary Disease (COPD) and bronchitis. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] Studies also highlight that the presence of carcinogenic substances, such as formaldehyde and acetaldehyde, elevates the risk of developing cancers, particularly lung cancer. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] Furthermore, the inhalation of heavy metals like nickel, chromium, and lead can lead to cardiovascular complications, including an increased risk of myocardial infarction and stroke. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] Neurological impairments have also been linked to e-cigarette use, particularly due to the high concentrations of nicotine found in modern devices. Nicotine is known to interfere with brain development in younger users, leading to cognitive impairments and a heightened risk of addiction. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] Therefore, while e-cigarettes are often marketed as a healthier alternative to traditional smoking, emerging evidence suggests that their long-term use may result in serious, potentially life-threatening diseases. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eA growing body of research has investigated the usage patterns, knowledge gaps, and risks associated with e-cigarette use. For instance, a cross-sectional study conducted among university students in Austria revealed a significant lack of understanding regarding the dangers of e-cigarettes. Only 10.3% of the students in the study recommended e-cigarettes as a tool for smoking cessation, pointing to widespread misconceptions about their safety. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] Similarly, a study at Cairo University found that while 83.7% of students were aware of e-cigarettes, many continued to hold incorrect beliefs about their safety. The study reported that 32.4% of students had tried vaping, despite acknowledging the potential risks.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] In China, research indicated that only 42.6% of university students knew that e-cigarettes contain nicotine, underscoring the significant knowledge gap among young adults about the contents and risks of vaping. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] Another study conducted in Saudi Arabia showed that 27.7% of health science students regularly used e-cigarettes, a figure significantly higher than the prevalence of conventional cigarette smoking among the same group. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] These findings emphasize the urgent need for public health interventions, educational programs, and stricter regulations to address the growing use of e-cigarettes and mitigate their potential public health risks. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThis research will contribute significantly to improving the understanding of e-cigarette use, particularly its health risks and the misconceptions surrounding its safety. By providing insight into the molecular and physiological effects of e-cigarette use, as well as its impact on public health, this study aims to support the development of more effective public health policies and targeted interventions.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eResearch design and Sampling\u003c/h2\u003e\n \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\n \u003ch2\u003eType of Study\u003c/h2\u003e\n \u003cp\u003eThis research employs an analytical cross-sectional design, utilizing a structured online questionnaire to gather data. The study follows a quantitative methodology aimed at assessing university students\u0026rsquo; knowledge, attitudes, and perceptions concerning e-cigarette use. Data were collected via an online survey distributed through Google Forms.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003ch3\u003eStudy Setting\u003c/h3\u003e\n\u003cp\u003eThe study was conducted across three universities: Kabul University (Afghanistan), NHL Stenden University (Netherlands), and Istanbul Medipol University (Turkey). According to official reports from the Student Affairs departments of these institutions, the total student population includes 22,137 at Kabul University, 24,000 at NHL Stenden University, and 46,988 at Medipol University. These universities comprise various faculties, both in medical and non-medical fields\u003c/p\u003e\n\u003ch3\u003eDuration\u003c/h3\u003e\n\u003cp\u003eThe data collection spanned over a period of eight weeks, beginning in the first week of November 2024 and concluding by the end of December 2024.\u003c/p\u003e\n\u003ch3\u003eSampling Method:\u003c/h3\u003e\n\u003cp\u003eA quota sampling technique was adopted for participant selection. Using Epi Info (version 3.2.5.0), a sample size was calculated from the total student population of 93,125. Based on a 5% margin of error, a 50% response distribution, and a 95% confidence level, a sample of 383 students was initially determined. Allowing for a 10% non-response rate (30 students), the final sample size was set at 413 participants. The sample was proportionally allocated to each university as follows: Kabul University \u0026ndash; 23.7% (98 students), NHL Stenden University \u0026ndash; 50.4% (208 students), and Medipol University \u0026ndash; 25.9% (107 students). The questionnaire was then distributed digitally to students from the respective universities.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eParticipants:\u003c/h2\u003e\n \u003cp\u003eThe study focused on both male and female students from medical and non-medical faculties at the selected universities. All participants were selected according to the quota sample and were accessible for inclusion. In total, 413 students completed the questionnaire, achieving the expected sample size\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eSample Size:\u003c/h3\u003e\n\u003cp\u003eUsing Epi Info version 3.5.2.0, and based on a total population of 93,125 students, the required sample size was calculated with an expected frequency of 50%, a 95% confidence interval, and a 5% margin of error. This yielded an initial sample of 383 students, increased to 413 after accounting for an anticipated 10% non-response rate.\u003c/p\u003e\n\u003ch3\u003eData Source and Measurement:\u003c/h3\u003e\n\u003cp\u003eData were gathered using a standardized questionnaire, adapted from literature published in PubMed [\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e][\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e]. The tool consisted of four sections:\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e1. Demographic Information \u0026ndash; Reporting frequencies and percentages.\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e2. Knowledge of E-cigarettes \u0026ndash; Assessed via 15 binary (true/false) items. A 75% accuracy threshold (at least 11 correct responses) was used to classify participants as having good knowledge, while those scoring below 75% were considered to have poor knowledge.\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e3. Attitudes Toward E-cigarettes \u0026ndash; Included 13 items measured on a binary agree/disagree scale. Positive attitudes were identified by scores of 75% (9) or higher. whereas those scoring below 75% were considered to have a negative attitude [\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e] The statements reflected health-related perceptions of e-cigarette use.\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e4. Practices Regarding E-cigarettes \u0026ndash; Evaluated through 13 items examining use patterns, frequency, purchasing behavior, and duration of use. Current users were scored as \u0026lsquo;0\u0026rsquo;, and non-users or former users were scored as \u0026lsquo;1\u0026rsquo;.\u003cbr\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical Methods:\u003c/h2\u003e\n \u003cp\u003eUpon completion of data collection, responses were entered into SPSS version 26 for processing. Prior to analysis, the dataset was reviewed to ensure accuracy and address any inconsistencies. Data analysis was conducted using SPSS software, and visual representations were generated accordingly.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eEthical Consideration\u003c/h2\u003e\n \u003cp\u003eI hereby declare that this research titled \u0026ldquo;Knowledge, Attitude, and Practice about E-cigarettes among University Students: A Comparative Study between Afghanistan, Netherlands, and Turkey\u0026rdquo; has been reviewed and approved by the Research Ethics Committee of Khatam Al Nabieen University. The study complies with the ethical principles and standards for conducting medical research in Afghanistan.\u003c/p\u003e\n \u003cp\u003e\u0026mdash;Approval Code: AF, knu.edu.af.rec 02\u003c/p\u003e\n \u003cp\u003e\u0026mdash;Approval Date: September 10, 2023\u003c/p\u003e\n \u003cp\u003eThe approval was granted based on the documents submitted to the committee on August 10, 2023. The Principal Investigator bears full responsibility for ensuring that all legal and professional obligations are fulfilled throughout the research process. Written informed consent was obtained from each participant prior to their inclusion in the study. The confidentiality and anonymity of participants were strictly maintained throughout the research process. All ethical standards outlined in the Declaration of Helsinki were carefully followed.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Result","content":"\u003ch2\u003eDemographic characteristics\u003c/h2\u003e\u003cp\u003eA total of 413 university students participated in this study, comprising 210 males (50.8%), 200 females (48.4%), and 3 participants (0.7%) who preferred not to disclose their gender. Among them, 295 (71.8%) were non-medical students, while 118 (28.2%) were from medical backgrounds. The majority of respondents were aged 20 years.\u003c/p\u003e\u003cp\u003eTobacco use was most frequently reported by Dutch students (61.5%, n = 123), followed by Afghan students (26.5%, n = 53) and Turkish students (12.0%, n = 24). A substantial number of Dutch participants (60.0%, n = 132) reported cohabiting with smokers, compared to 21.8% of Afghan and 18.2% of Turkish students. Furthermore, 60.4% of Dutch students indicated that a family member used e-cigarettes.\u003c/p\u003e\u003cp\u003eThe paternal education level was highest among those holding tertiary degrees (63.2%), whereas 21.8% of mothers had only completed primary education or less. Turkish mothers showed the highest rate of tertiary education (42.9%), compared to Afghan mothers (12.3%).\u003c/p\u003e\u003cp\u003eClose friends’ use of e-cigarettes was affirmed by 24.7% of Afghan students, 53.4% of Dutch students, and 21.9% of Turkish students.\u003c/p\u003e\u003cp\u003eThis demographic composition provides a diverse representation across the three countries, although some limitations, such as gender imbalance and differences in parental education, should be acknowledged as potential confounding variables.\u003c/p\u003e\u003cp\u003eA detailed demographic breakdown of all three countries is presented in comparative Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003edemographic breakdown of all three countries\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eCountries\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfghanistan\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNetherlands\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eTurkey\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56(26.7%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e118(56.2%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e36(17.1%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e210(100%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42(21.0%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88(44.0%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e70(35.0%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e200(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrefer not to say\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(100%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3(100%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt; 20 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29(20.6%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76(53.9%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e36(25.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e141(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt; 20 Years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30(23.6%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57(44.9%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e40(31.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e127(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39(26.9%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75(51.7%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e31(21.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e145(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMajor\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical University\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(7.6%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(11.9%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e95(80.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e118(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Medical University\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89(30.2%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e194(65.8%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e12(4.1%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e295(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYear in University\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst-Second Year\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46(18.9%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e127(52.3%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e70(28.8%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e243(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThird-Fourth Year\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52(30.6%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81(47.6%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e37(21.8%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e170(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLiving area\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83(27.1%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e133(43.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e90(29.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e306(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15(14.0%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75(70.1%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e17(15.9%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e107(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFather's educational level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eprimary or less\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23(47.9%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(47.9%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2(4.2%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e48(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary education (high school or equivalent)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29(27.9%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55(52.9%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e20(19.2%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e104(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary education (college, university, or higher)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46(17.6%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130(49.8%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e85(32.6%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e261(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMother's educational level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eprimary or less\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40(44.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40(44.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e10(11.1%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e90(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary education (high school or equivalent)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38(23.8%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95(59.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e27(16.9%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e160(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary education (college, university, or higher)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20(12.3%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73(44.8%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e70(42.9%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e163(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMonthly living cost (USD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e≤ 300\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77(34.1%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89(39.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60(26.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e226(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt; 300\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21(11.2%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119(63.6%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47(25.1%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e187(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSmoking tobacco cigarette\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53(26.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e123(61.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24(12.0%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e200(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45(21.1%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85(39.9%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83(39.0%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e213(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCurrently live with smokers.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48(21.8%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e132(60.0%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40(18.2%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e220(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50(25.9%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76(39.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67(34.7%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e193(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily members ever use tobacco cigarettes.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53(24.0%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e121(54.8%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47(21.3%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e221(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45(23.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87(45.3%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60(31.3%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e192(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily members ever use e-cigarettes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41(22.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e110(60.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31(17.0%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e182(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57(24.7%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98(42.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76(32.9%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e231(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClose friends ever use tobacco cigarettes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61(24.2%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e136(54.0%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55(21.8%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e252(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37(23.0%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72(44.7%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52(32.3%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e161(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClose friends ever use e-cigarettes (vaping)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62(24.7%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e134(53.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55(21.9%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e251(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36(22.2%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74(45.7%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52(32.1%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e162(100.0%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e92.3% of the study population has heard of ECs mostly through, university/school, social media, and friends (30.9%, 23.2% 21.9% respectively).\u003c/p\u003e\u003cp\u003eFor additional information about the source of information regarding e-cigarettes kindly refer to Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e below.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSource of Information about E-cigarettes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave you heard of E-cigarettes (vaping)?\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency(n)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e381\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92.3%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.7%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e413\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100.0%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIf yes, where have you heard of E-cigarettes? (Circle all that apply)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFrequency(n)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003ePercent (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdvertisements\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.2%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFriends\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e235\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.9%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial Media\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e247\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.1%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.7%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity/School\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e331\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.9%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDoctor\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.9%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCentre for Smoking Cessation\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.3%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eKnowledge gaps among participants were evident in various key areas. A significant 64.6% of students mistakenly believed that e-cigarettes were approved by the U.S. Food and Drug Administration (FDA), and 51.3% falsely believed that these products do not contribute to secondhand smoke exposure. Conversely, 70.1% correctly recognized that flavorings vary in harmfulness.\u003c/p\u003e\u003cp\u003eKnowledge concerning health risks was moderately strong: 66.8% acknowledged the link between e-cigarettes and bladder cancer, 56.2% recognized the association with lung cancer, and 73.8% understood their potential to impair heart and lung function.\u003c/p\u003e\u003cp\u003eThese findings suggest that while there is a foundational understanding of some health risks associated with vaping, major misconceptions persist, particularly in areas involving regulatory status and indirect exposure risks.\u003c/p\u003e\u003cp\u003eThe questions in the knowledge scale and the distributions of the answers are displayed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eE-cigarette knowledge questions frequency and percentage\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eKnowledge questions\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eValid %\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eE-cigarettes are associated with bladder cancer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFalse__Wrong Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e137\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.2%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrue__Correct Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e276\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.8%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eE-cigarettes are FDA Approved\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrue__ Wrong Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e267\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64.6%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFalse__ Correct Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e146\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.4%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSome flavors of E-cigarettes are more harmful than others\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFalse__ Wrong Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.5%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrue__ Correct Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e291\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70.5%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSwallowing the liquid in E-cigarettes accidentally can cause poisoning that is potentially fatal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFalse__ Wrong Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.2%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrue__ Correct Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e317\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.8%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eE-cigarettes are not associated with lung cancer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrue__ Wrong Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e181\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.8%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFalse__ Correct Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e232\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.2%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eE-cigarettes impair lung and heart functions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFalse__ Wrong Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.2%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrue__ Correct Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e305\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73.8%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eE-cigarettes are not contributed to secondhand smoking\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrue__ Wrong Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e212\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.3%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFalse__ Correct Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e201\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.7%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eE-cigarettes can have an effect on fetal development\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFalse__ Wrong Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.6%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrue__ Correct Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e328\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79.4%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNicotine is present in most E-cigarettes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFalse__ Wrong Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.1%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrue__ Correct Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e326\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78.9%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHarmful flavourings and toxins are found in the E-cigarette aerosol\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFalse__ Wrong Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.4%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrue__ Correct Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e337\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81.6%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eE-cigarettes are harmful\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrue__ Wrong Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e178\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.1%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFalse__ Correct Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e235\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.9%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSome components of the liquid found in E-cigarettes can cause harmful lung conditions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFalse__ Wrong Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.5%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrue__ Correct Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e320\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77.5%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eE-cigarettes are not addictive\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrue__ Wrong Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.5%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFalse__ Correct Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e250\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.5%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eE-cigarettes are suitable for pregnant women\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrue__ Wrong Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e137\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.2%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFalse__ Correct Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e276\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.8%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eE-cigarettes are suitable for children\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrue__ Wrong Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.1%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFalse__ Correct Answer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e272\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65.9%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eThe attitudinal responses of participants revealed mixed perceptions toward e-cigarette use. About 62.7% of respondents perceived vaping to be more socially acceptable than traditional smoking. Nearly half (48.9%) believed that experimenting with e-cigarettes for recreational purposes is acceptable. Furthermore, 55.4% believed e-cigarettes serve as an effective cessation aid, while 59.8% thought they could help reduce or quit smoking, and 54.5% supported their use as a replacement for conventional cigarettes.\u003c/p\u003e\u003cp\u003eThe distribution of answers to all the questions included in the negative attitude scale is displayed in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eE-cigarette attitude questions frequency and percentage\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAttitude questions\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eValid %\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eShould E-cigarettes be recommended to a non-smoker?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo__ Negative Attitude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e217\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.5%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes__ Positive Attitude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e196\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.5%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDo you think E-cigarettes are harmful to health?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes__ Negative Attitude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e308\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74.6%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo__ Positive Attitude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.4%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eShould the use of E-cigarettes be allowed in places that do not allow smoking?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo__ Negative Attitude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e229\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.4%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes__ Positive Attitude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.6%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eWould you consider someone who uses E-cigarettes a smoker?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes__ Negative Attitude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e276\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.85\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo__ Positive Attitude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e137\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.2%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDo you think the use of E-cigarettes can lead to reliance?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes__ Negative Attitude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e275\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.6%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo__ Positive Attitude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.4%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDo you think the government should regulate the use of E-cigarettes?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes__ Negative Attitude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e267\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64.6%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo__ Positive Attitude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e146\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.4%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDo you feel more comfortable using or openly talking about smoking E-cigarettes, compared to cigarettes?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo__ Negative Attitude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e158\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.3%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes__ Positive Attitude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e255\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.7%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDo you feel it is more socially acceptable to smoke E-cigarettes, compared to cigarettes?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo__ Negative Attitude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e154\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.3%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes__ Positive Attitude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e259\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.7%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eShould E-cigarettes be used as a replacement for regular cigarettes?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo__ Negative Attitude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e188\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.5%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes__ Positive Attitude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.5%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eexperiment with E-cigarettes for pleasure?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo__ Negative Attitude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e211\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.1%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes__ Positive Attitude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e202\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.9%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDo you think using E-cigarettes would be an effective way to help in smoking cessation?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo__ Negative Attitude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.6%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes__ Positive Attitude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e229\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.4%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDo you think it is acceptable to use E-cigarettes as a smoking cessation method?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo__ Negative Attitude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e200\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.4%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes__ Positive Attitude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e213\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.6%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDo you think E-cigarettes can help people cut down on cigarettes or quit smoking?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo__ Negative Attitude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e166\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.2%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes__ Positive Attitude\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e247\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.8%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003ch2\u003eE-cigarette practice\u003c/h2\u003e\u003cp\u003eThe prevalence of e-cigarette use across the sample was 54.2%. Of these, 27.1% reported vaping on 1–2 days in the previous week, and 24.9% used e-cigarettes more than 20 times per day. Notably, 41.2% of users purchased their devices from authorized retailers, and 38.5% found it easy to access such products. Most users reported spending between 10–28 EUR per purchase (29.8%). The first experience with e-cigarettes generally occurred after the age of 18, and 39.5% of participants indicated they had no intention to quit vaping.\u003c/p\u003e\u003cp\u003eDetailed information regarding these findings is presented in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eE-cigarette practice question frequency and percentage\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePractice questions\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eValid %\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eCurrently using e-cigarettes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e224\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.2%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e189\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.8%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eIf yes, Duration of use within the last 7 days\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt; 5 days\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.8%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3–4 days\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.3%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1–2 days\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.1%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFrequencies of e-cigarette usage per day\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 20 times a day\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.9%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt; 20 times a day\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.3%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot Daily\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.0%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTime of initiating usage after waking up\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter 1–2 hours\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.5%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIt varies\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.8%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImmediately after waking-up\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.0%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePlace of purchase e-cigarette\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAuthentic store\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.2%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnline shop\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.1%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eEase of purchase?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e159\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.5%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.7%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePrice of per purchase (EUR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt; 28\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.4%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e≥ 10\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.0%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10─28\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.8%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePrice of e-cigarette liquid (EUR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.1%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt; 4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.1%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4─5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.1%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAge of the first trail\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 18 years old\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e155\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.5%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e≥ 18 years old\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.7%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eIntention to quit\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e164\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.7%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.5%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eThis study provides valuable insights into the factors influencing e-cigarette use, particularly its association with traditional smoking habits, social and family influence, and demographic characteristics. Additionally, the findings highlight significant patterns in knowledge, attitudes, and practices (KAP) related to smoking and vaping. The statistically significant p-values (0.00) across multiple variables indicate strong associations, underscoring the impact of environmental, social, and educational factors on smoking behavior.\u003c/p\u003e\u003cp\u003eKnowledge about e-cigarettes A total of 232 (56.2%) students demonstrated a poor level of e-cigarette knowledge. Turkish students exhibited a higher level of knowledge about e-cigarettes 78(43.1%) compared to Afghan students 38(21.0%) and Netherlands students 65(35.9%), with a statistical significance (P = 0.00).\u003c/p\u003e\u003cp\u003eAttitude was largely negative, with 73.4% showing poor attitudes toward e-cigarettes and only 26.6% exhibiting a positive outlook.\u003c/p\u003e\u003cp\u003eRegarding e-cigarette practices, 54.2% engaged in good practices, whereas 45.8% exhibited poor practices. These findings highlight a lack of knowledge and generally negative attitudes, despite a relatively balanced distribution in e-cigarette use practices. Educational efforts are needed to improve knowledge and promote healthier attitudes and behaviors.\u003c/p\u003e\u003cp\u003eCorrespondingly, poor knowledge was most prevalent in the Netherlands (61.6%), compared to Afghanistan (25.9%) and Turkey (12.5%).\u003c/p\u003e\u003cp\u003eAttitudes toward e-cigarettes also showed significant variation (p = 0.00). The Netherlands had the highest proportion of positive attitudes (62.7%), whereas Turkey (12.7%) and Afghanistan (23.4%) had lower positive perceptions.\u003c/p\u003e\u003cp\u003eRegarding e-cigarette practices, a significant difference was observed (p = 0.00). Poor practices were most common in Turkey (44.4%), compared to Afghanistan (23.3%) and the Netherlands (32.3%).\u003c/p\u003e\u003cp\u003eThe analysis showed a significant association between sex and knowledge (p = 0.001). Females (59.1%) had better knowledge compared to males (40.3%), while poor knowledge was more prevalent among males (59.1%).\u003c/p\u003e\u003cp\u003eFor attitude, no significant association was found (p = 0.2). Males and females had similar attitudes, with 52.7% of males and 45.5% of females showing positive attitudes toward e-cigarettes.\u003c/p\u003e\u003cp\u003eHowever, practice differed significantly by sex (p = 0.001). Females demonstrated better practices (59.4%) compared to males (40.2%), while poor practices were more common among males (58.2%) than females (40.7%).\u003c/p\u003e\u003cp\u003eThe aforementioned findings pertain to the knowledge, attitude and practice regarding E-cigarette. For further details, please refer to Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e below.\u003c/p\u003e\u003cdiv\u003e\n\u003c/div\u003e\n\u003cp\u003eThe analysis revealed a significant association (p = 0.00) between smoking tobacco cigarettes and e-cigarette use. Among current e-cigarette users, 72.8% were also tobacco cigarette smokers, while 27.2% had never smoked traditional cigarettes. Conversely, among those who did not use e-cigarettes, only 19.6% were tobacco smokers.\u003c/p\u003e\n\u003cp\u003eA significant association (p = 0.00) was found between living with smokers and e-cigarette use. Among current e-cigarette users, 69.2% lived with smokers, while 30.8% were e-cigarette users who didn’t live with smokers.\u003c/p\u003e\n\u003cp\u003eA significant association (p = 0.00) was found between having family members who use tobacco cigarettes and e-cigarette use. Among current e-cigarette users, 65.2% had family members who smoked tobacco, while 34.8% were e-cigarette users who had no family members who smoked tobacco. Whereas 39.7% were non-e-cigarette users who had family members who smoked tobacco cigarettes.\u003c/p\u003e\n\u003cp\u003eThese findings suggest that having family members who use tobacco increases the likelihood of e-cigarette use, reinforcing the role of familial influence in vaping behavior.\u003c/p\u003e\n\u003cp\u003eA significant association (p = 0.00) was found between family members 'e-cigarette use and participants' e-cigarette use. Among current e-cigarette users, 65.2% had family members who also used e-cigarettes, while 37.5% were e-cigarette users who had not family members who vaped. In contrast, among non-e-cigarette users, 22.2% of non-e-cigarette smokers had family members who vaped.\u003c/p\u003e\n\u003cp\u003eA significant association (p = 0.00) was found between close friends 'e-cigarette use and participants' e-cigarette use. Among current e-cigarette users, 74.6% had close friends who also used e-cigarettes. While 44.4% of non-vapers had friends who vaped. A significant association (p = 0.00) was found between having close friends who smoke tobacco cigarettes and participants' e-cigarette use.\u003c/p\u003e\n\u003cp\u003eAmong current e-cigarette users, 74.1% had close friends who smoked tobacco.\u003c/p\u003e\n\u003cp\u003eFor additional information, kindly refer to Table\u0026nbsp;7 below.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab7\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 7\u003c/div\u003e\n \u003cdiv\u003e\u003cbr\u003e\u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCurrently using e-cigarettes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eSmoking tobacco cigarette\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eP- value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eyes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e163(72.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61(27.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e224(100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.00\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37(19.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e152(80.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e189(100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrently using e-cigarettes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrently live with smokers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eyes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eP- value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eyes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e155(69.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69(30.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e224(100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.00\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65(34.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e124(65.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e189(100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrently using e-cigarettes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily members ever use tobacco cigarettes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eyes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eP- value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eyes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e146(65.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78(34.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e224(100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.00\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75(39.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e114(60.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e189(100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrently using e-cigarettes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily members ever use e-cigarettes (vaping)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eyes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eP- value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eyes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e140(62.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e84(37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e224(100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.00\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42(22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e147(77.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e189(100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrently using e-cigarettes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eClose friends ever use e-cigarettes (vaping)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eyes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eP- value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eyes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e167(74.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57(25.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e224(100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.00\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e84(44.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e105(55.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e189(100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrently using e-cigarettes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eClose friends ever use tobacco cigarettes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eyes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eP- value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eyes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e166(74.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58(25.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e224(100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.00\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86(45.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e103(54.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e189(100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003e\u003cstrong\u003eConclusion and Recommendations\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKey Takeaways\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eE-cigarette use is strongly linked to traditional smoking habits, indicating a potential dual-use problem rather than e-cigarettes serving as an alternative to quitting.\u003c/li\u003e\n \u003cli\u003eHousehold smoking environments significantly influence e-cigarette use, reinforcing the need for family-based prevention programs.\u003c/li\u003e\n \u003cli\u003ePeer influence is one of the most powerful predictors of smoking behavior, making peer-led interventions critical in tobacco control strategies.\u003c/li\u003e\n \u003cli\u003eDespite moderate knowledge levels, attitudes toward smoking remain poor, suggesting that awareness alone is insufficient\u0026mdash;interventions must address social and behavioral aspects.\u003c/li\u003e\n \u003cli\u003eCultural, gender, and educational differences play a role in smoking behavior, requiring customized public health approaches based on demographic characteristics.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003ePolicy and Intervention Recommendations\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eTargeted Awareness Campaigns\u003cul\u003e\n \u003cli\u003eEducational programs should not just provide information but actively challenge attitudes and behaviors.\u003c/li\u003e\n \u003cli\u003eCampaigns should target peer groups rather than just individuals.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n \u003cli\u003eStronger Family-Based Interventions\u003cul\u003e\n \u003cli\u003eSmoke-free home initiatives and parental education programs could significantly reduce youth vaping and smoking.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n \u003cli\u003ePeer-Led Prevention Programs\u003cul\u003e\n \u003cli\u003eSchools and universities should implement peer-led anti-smoking initiatives, as peer influence plays a dominant role in the adoption of behavior.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n \u003cli\u003eRegulations and Restrictions\u003cul\u003e\n \u003cli\u003eStricter regulations on e-cigarette sales, especially among youth, could help reduce accessibility.\u003c/li\u003e\n \u003cli\u003ePolicies should not only target individual behavior but also address environmental factors (e.g., public bans, social norm shifts).\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n \u003cli\u003eGender-Specific Strategies\u003cul\u003e\n \u003cli\u003eFemale-focused health interventions may be needed to further reinforce positive smoking-avoidance behaviors.\u003c/li\u003e\n \u003cli\u003eMale-oriented campaigns should emphasize the health risks and social consequences of smoking.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n \u003cli\u003eCultural Adaptation of Anti-Smoking Strategies\u003cul\u003e\n \u003cli\u003eSince knowledge and smoking behavior vary by country, prevention programs should be adapted based on cultural norms and smoking prevalence.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eFinal Thoughts\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study highlights the complex interplay between knowledge, social environment, and demographic factors in shaping e-cigarette and tobacco use. To combat the rising prevalence of smoking and vaping, holistic interventions combining education, behavioral reinforcement, policy regulation, and peer influence\u0026mdash;are essential. By addressing these factors, public health programs can create lasting behavioral changes and reduce smoking rates in society.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed the Knowledge, Attitudes, and Practices (KAP) regarding e-cigarettes among university students in Afghanistan, the Netherlands, and Turkey. To provide a broader context, we compare our findings with studies conducted in Saudi Arabia. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], China [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], Indonesia [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], Egypt [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], Jordan [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], Malaysia [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] and France [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The findings highlight significant variations in e-cigarette awareness, attitudes, and usage trends across different cultural and regulatory environments.\u003c/p\u003e \u003cp\u003eOur study found that e-cigarette use varied significantly based on demographic factors such as age, gender, and academic background. In Afghanistan, the Netherlands, and Turkey, the majority of e-cigarette users were male students aged 19\u0026ndash;25. This aligns with findings from Saudi Arabia, where 66.2% of e-cigarette users were male, and most users were between 19 and 22 years old [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn contrast, studies from France and China showed that while male students were more likely to use e-cigarettes, female users were also prevalent. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFinancial status also played a role in e-cigarette consumption. In our study, students from middle- to high-income families reported higher e-cigarette use, which is consistent with findings from France, where students facing fewer financial difficulties were more likely to experiment with vaping. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Similarly, Saudi Arabian students who lived off-campus in rented accommodations were more likely to use e-cigarettes compared to those living with their families. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDemographic factors such as age, gender, and financial status conditions play a significant role in shaping e-cigarette consumption patterns among university students. While young adult males remain the predominant users, social influences and economic background also contribute to e-cigarette adoption. Future research should explore the long-term health impacts of e-cigarettes across diverse demographic groups, with a focus on mental health interventions and policy regulation to reduce vaping among at-risk populations.\u003c/p\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eKnowledge of E-Cigarettes\u003c/h2\u003e \u003cp\u003eOur study found that Turkish students exhibited the highest level of awareness (43.1%), followed by Afghan (21.0%) and Dutch students (35,9%). This disparity is consistent with findings from China, where students demonstrated moderate awareness but had significant gaps in understanding the nicotine content and long-term health risks. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe study reported that 10.5% of Jordanians. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] Students used e-cigarettes, whereas our study found a significantly higher prevalence (54.2%). This stark difference suggests that cultural, social, and regulatory factors may influence e-cigarette adoption. The higher prevalence in the international sample, particularly in the Netherlands, could be attributed to greater social acceptance and easier access to e-cigarettes compared to Jordan. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. These misconceptions reflect a global issue: students often receive information from social media, friends, and advertisements, which may not provide accurate health information. The study found that medical students in Jordan had better knowledge than non-medical students, a pattern also observed in our study, where Turkish students many of whom were medical students had higher knowledge levels compared to Afghan and Dutch students.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eAttitudes Toward E-Cigarettes\u003c/h2\u003e \u003cp\u003eAttitudes toward e-cigarettes varied significantly across different countries. In our study, Afghan and Turkish students held predominantly negative views (23.4%) (30.7%), whereas Dutch students were more accepting (62.7% positive attitude).\u003c/p\u003e \u003cp\u003eThe studies in Indonesia show that students\u0026rsquo; attitudes toward e-cigarettes are influenced by their social environment. The study revealed that many Jordanian students perceived e-cigarettes as a less harmful and less addictive alternative to traditional cigarettes. Similarly, in our study, 62.7% felt e-cigarettes were more socially acceptable than traditional cigarettes, and 54.5% believed e-cigarettes should replace regular cigarettes. However, both studies also indicate a significant portion of students hold negative attitudes toward e-cigarettes, with 73.4% of international students expressing concerns about their safety.\u003c/p\u003e \u003cp\u003eIn Malaysia, strong opposition was observed, with 62.4% of students supporting a ban on e-cigarettes. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Similarly, in Saudi Arabia, although some students saw e-cigarettes as a smoking cessation tool, many viewed them as equally addictive as traditional cigarettes. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConversely, Indonesian students displayed highly favorable perceptions, with 91.3% expressing positive attitudes. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. French students largely perceived e-cigarettes as a safer alternative, though they associated their use with other risky behaviors such as binge drinking. Meanwhile, in Jordan and Egypt, clinical-year students were more likely to support e-cigarettes for smoking cessation compared to their preclinical counterparts. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThese findings indicate that cultural beliefs, policy regulations, and exposure to e-cigarette users significantly shape students\u0026rsquo; attitudes toward vaping.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eE-Cigarette Use and Prevalence\u003c/h2\u003e \u003cp\u003eThe prevalence of e-cigarette use among university students showed notable differences across countries. In our study, Turkish students reported the highest e-cigarette use (44.4%), followed by Afghan (23.3%) and Dutch students (32.3%).\u003c/p\u003e \u003cp\u003eIn Saudi Arabia, 27.7% of health science students reported using e-cigarettes, a rate significantly higher than conventional cigarette smoking (14.1%) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. France had a similar prevalence, with 23.0% of students having tried e-cigarettes. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMalaysia reported a relatively low prevalence (6.6%) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]while in Egypt, 7.3% of medical students reported usage, with a higher prevalence among males [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Jordan had a significantly higher prevalence (37.4%) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], whereas China and Indonesia reported lower usage rates (8.2%) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eA consistent finding across all studies was the strong influence of peer networks on e-cigarette use. Students who had friends or family members using e-cigarettes were more likely to experiment with vaping. This trend was evident in Saudi Arabia and Malaysia, where students with vaping peers had significantly higher usage rates. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eE-Cigarettes as a Smoking Cessation Tool\u003c/h2\u003e \u003cp\u003eIn our study, social media (23.1%) and University/Schools (30.9%) were the most common sources of information on e-cigarettes but in Jordan, social media (43.1%) and friends (32.9%) were the most common sources of information on e-cigarettes. Additionally, both studies found a strong correlation between conventional cigarette smoking and e-cigarette use, reinforcing the idea that e-cigarettes are not always used as a smoking cessation tool but rather as an additional form of nicotine consumption.\u003c/p\u003e \u003cp\u003eCountries with strict regulations, such as Malaysia and Jordan, exhibited lower e-cigarette prevalence rates. In Malaysia, the National Fatwa Council declared vaping forbidden (haram), significantly influencing students\u0026rsquo; attitudes and behaviors. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Similarly, Jordan prohibits e-cigarette advertising and sales to individuals under 19 [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] .\u003c/p\u003e \u003cp\u003eBy contrast, Saudi Arabia and Indonesia, where regulations are more lenient, reported higher e-cigarette usage rates. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. France, despite implementing regulations restricting sales to minors, still had a high proportion of experimental users. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThese findings emphasize the impact of government policies and public health campaigns on vaping behaviors. Countries with stronger tobacco control measures tend to see lower e-cigarette usage among youth. Overall, peer influence, social media exposure, and regulatory environments play crucial roles in shaping students\u0026rsquo; e-cigarette knowledge, attitudes, and behaviors. Future public health efforts should focus on harmonizing policies and increasing educational initiatives to mitigate the growing trend of e-cigarette use among university students worldwide.\u003c/p\u003e \u003cp\u003eThis study has several limitations that should be considered. First, the data were collected through an online self-administered questionnaire using Google Forms, which may introduce response bias and limit control over who participated. Second, the use of convenience sampling through voluntary participation may affect the representativeness of the sample and reduce the generalizability of the findings. Third, since the study was conducted only among university students in three countries (Afghanistan, Turkey, and the Netherlands), the results may not be applicable to the general population or to students in other regions. Additionally, due to the cross-sectional design of the study, causal relationships between knowledge, attitudes, and practices toward electronic cigarettes cannot be established. Despite these limitations, the findings provide valuable insights into the awareness and behavior of university students regarding e-cigarette use across diverse cultural contexts.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eIRB\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Institutional Review Board\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKAP\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Knowledge Attitude and Practice \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIQ\u003c/strong\u003eR \u0026nbsp; \u0026nbsp; \u0026nbsp; Interquartile Rang\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Standard Deviation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSPSS\u003c/strong\u003e\u0026nbsp; \u0026nbsp; Statistical Package for the Social Sciences\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eE- Cig\u003c/strong\u003e\u0026nbsp; \u0026nbsp; Electronic Cigarette\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eI hereby declare that this research titled \u0026ldquo;Knowledge, Attitude, and Practice about E-cigarettes among University Students: A Comparative Study between Afghanistan, Netherlands, and Turkey\u0026rdquo; has been reviewed and approved by the Research Ethics Committee of Khatam Al Nabieen University. The study complies with the ethical principles and standards for conducting medical research in Afghanistan.\u003c/p\u003e\n\u003cp\u003e\u0026mdash;Approval Code: AF, knu.edu.af.rec 02\u003c/p\u003e\n\u003cp\u003e\u0026mdash;Approval Date: September 10, 2023\u003c/p\u003e\n\u003cp\u003eThe approval was granted based on the documents submitted to the committee on August 10, 2023. The Principal Investigator bears full responsibility for ensuring that all legal and professional obligations are fulfilled throughout the research process.\u003c/p\u003e\n\u003cp\u003eNonetheless, all ethical principles outlined in the Declaration of Helsinki were followed, and written informed consent was obtained from all participants.\u0026nbsp;[16]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e \u003cstrong\u003eDeclaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll individuals who took part in this study were fully informed about the study\u0026rsquo;s objectives, procedures, and their rights as participants. Participation was entirely voluntary, and written informed consent was obtained from each participant prior to their inclusion in the research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe informed consent text used for the participants in this study is as follows:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\n\u003cp\u003eThis study is designed as a comparative cross-sectional analysis, meaning that the research evaluates responses from a structured questionnaire. The questionnaire was developed specifically for this study and is organized into four sections, containing 50 questions covering demographic information, and assessing knowledge, attitudes, and practices related to e-cigarettes.\u003c/p\u003e\n\u003cp\u003eBefore giving your consent, please consider the following:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThis study involves no physical or psychological harm to participants or researchers.\u003c/li\u003e\n \u003cli\u003eParticipation in this study is entirely voluntary.\u003c/li\u003e\n \u003cli\u003eThe identity of participants has no impact on the study\u0026rsquo;s outcomes, and therefore, your name will remain confidential and will not be mentioned in the research.\u003c/li\u003e\n \u003cli\u003eThe findings of this study can be made available to you upon request, following the completion of all necessary legal procedures.\u003c/li\u003e\n \u003cli\u003eFor any questions or concerns, you may contact \u0026quot;Mansoorullah Muradi\u0026quot; at\u0026nbsp;\u003cstrong\[email protected]\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eor \u0026quot;Lima Oria\u0026quot; at [email protected]\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eWe kindly request that you respond honestly to all questions, as this will help ensure the transparency and accuracy of the information collected.\u003c/p\u003e\n\u003cp\u003eBy reading and acknowledging this information, you indicate your willingness to voluntarily participate in this study. You agree to allow the researchers to use the information you provide for research purposes.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eAll participants provided consent for publication of anonymized responses.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eMansoorullah Muradi conceived and designed the study. Data collection was performed by the research team under his supervision. All authors contributed to data analysis, manuscript writing, and approved the final version of the manuscript.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe authors would like to thank all the students who participated in the study, and the administrative support from participating universities.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMorteza, \u0026quot;Statistics of vape and e-cigarette use in the world,\u0026quot; Vapersco, 2021.\u003c/li\u003e\n\u003cli\u003eWHO, \u0026quot;Tobacco: E-cigarettes,\u0026quot; World Health Organization, Geneva, 2024.\u003c/li\u003e\n\u003cli\u003e\u0026quot;World Health Organization, Tobacco,\u0026quot; https://www.who.int/news-room/fact-sheets/detail/tobacco, 31 July 2023. [Online]. Available: https://www.who.int/news-room/fact-sheets/detail/tobacco.\u003c/li\u003e\n\u003cli\u003eJuan Fang, Jianping Ren, Lixian Ren, Wendy Max, Tingting Yao, Falin Zhao, \u0026quot;Electronic cigarette knowledge, attitudes and use among students at a university in Hangzhou, China,\u0026quot; vol. 20, 6 Jul 2021. \u003c/li\u003e\n\u003cli\u003eRonald Hartono, Chaofang Yan, Ying Chen, Boting Ma1, Yaqi Deng, Yijia Sun, Pan Li, Yuye Dao, Rui Deng, \u0026quot;Knowledge, attitude, and practice of e-cigarette use among undergraduate students: A comparative study between China,\u0026quot; \u003cem\u003eKunming Medical University, Kunming, \u003c/em\u003evol. 22, 16 May 2024. \u003c/li\u003e\n\u003cli\u003eSultan Qanash, Shereen Alemam, Estabraq Mahdi, Jood Softah, Abdelfattah Ahmed Touman, Adil Alsulami, \u0026quot;Electronic cigarette among health science students in Saudi Arabia,\u0026quot; \u003cem\u003eWolters Kluwer ‑ Medknow, \u003c/em\u003evol. 13, no. 1, 12 Mar 2018. \u003c/li\u003e\n\u003cli\u003eCother Hajat, Emma Stein, Saran Shantikumar, Raymond Niaura, Pietro Ferrara, Riccardo Polosa, \u0026quot;A scoping review of studies on the health impact of electronic nicotine delivery systems,\u0026quot; \u003cem\u003ePMC, PubMed Central, \u003c/em\u003evol. 17, no. 2022, pp. 241-268, 12 Oct 2021. \u003c/li\u003e\n\u003cli\u003eSuha AlMuhaissen, Haneen Mohammad, Afnan Dabobash, Marya Q. Nada, Zahra M. Suleiman, \u0026quot;Prevalence, Knowledge, and Attitudes among Health Professions Students toward the Use of Electronic Cigarettes,\u0026quot; \u003cem\u003eHealthcare, \u003c/em\u003evol. 10, no. 12, 3 OCt 2022. \u003c/li\u003e\n\u003cli\u003ePriyamvada Paudyal, M Movia, \u0026quot;Knowledge, Attitudes and Beliefs towards Electronic Cigarettes among University Students in Austria,\u0026quot; \u003cem\u003eThe European Journal of Public Health, \u003c/em\u003evol. 29, no. 4, 13 Nov 2019. \u003c/li\u003e\n\u003cli\u003eOla Abdelmoniem mostafa, Mahmoud Ahmed Taha, \u0026quot;Knowledge, attitude and use of Electronic Cigarettes among Cairo University Medical Students,\u0026quot; \u003cem\u003eResearch Square, \u003c/em\u003evol. 1, Jan 2024. \u003c/li\u003e\n\u003cli\u003eDeng Rui, Chen Ying,Yan Chao Fang, Ma Bo Ting, Deng Ya Qi, Sun Yi Jia, Li Pan, Yu Ye Dao, \u0026ldquo;Knowledge, attitude, and practice of e-cigarette use among undergraduate students: A comparative study between China and Indonesia,\u0026rdquo; \u003cem\u003eResearch Square, \u003c/em\u003ep. 25, 24th June 2024. \u003c/li\u003e\n\u003cli\u003eHanan Aghar, Nathalie El-Khoury, Mahasen Reda, Wissam Hamadeh ,Hussein Krayem, Mohammad Mansour, Hawraa Raouf, and Miran A. Jaffa, \u0026quot;Knowledge and attitudes towards E-cigarette use in Lebanon and their associated factors,\u0026quot; \u003cem\u003eBMC Public Health, \u003c/em\u003evol. 20, no. 278 , p. 18, 2 Jun 2020. \u003c/li\u003e\n\u003cli\u003eA. B. M. E. A.-S. S. B. R. Al-Sawalha NA, \u0026quot;E-cigarettes use among university students in Jordan: Perception and related knowledge,\u0026quot; \u003cem\u003ePLOS ONE, \u003c/em\u003epp. 1-13, 31 December 2021. \u003c/li\u003e\n\u003cli\u003eT. A. M. T. ,. N. \u0026lsquo;. M. D. M. F. A. S. R. Z. A. N. M. J. H. Nuurain Amirah MR, \u0026quot;Knowledge, Attitude and Practice on Electronic Cigarette and their Associated Factors among Undergraduate Students in a Public University,\u0026quot; \u003cem\u003eIIUM Medical Journal Malaysia, \u003c/em\u003eVols. IMJM Volume 20 No.2, Apr 2021, 2021. \u003c/li\u003e\n\u003cli\u003eA. V. L. R. G. K. K. J. L. Marie-Pierre Tavolacci, \u0026quot;Patterns of electronic cigarette use in current and ever users among college students in France: a cross\u0026ndash;sectional study,\u0026quot; \u003cem\u003eBMJ, \u003c/em\u003eno. in current and ever users among college, 27 April 2016. \u003c/li\u003e\n\u003cli\u003eH. World Medical Association, \u0026quot;DECLARATION OF HELSINKI Ethical principles for Medical Research Involving Human Subjects,\u0026quot; 1964-2024, p. 5. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 6","content":"\u003cp\u003eTable 6 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Knowledge, Attitude, Practice, E-cigarette, Afghanistan, Netherlands, Turkey","lastPublishedDoi":"10.21203/rs.3.rs-6832062/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6832062/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe rise in electronic cigarette (e-cigarette) use among young adults has raised significant public health concerns. Initially introduced as a harm-reduction tool, e-cigarettes have increasingly become a popular alternative to traditional smoking. However, misconceptions about their safety, social acceptability, and long-term health effects persist among university students.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThe aim of this study was to find out the knowledge, attitude, and practice about E-Cigarettes among University Students in Afghanistan, the Netherlands, and Turkey.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study adopts an analytical cross-sectional design and employs a foundational approach by administering an online questionnaire. The study uses a quantitative methodology to explore universities students\u0026rsquo; knowledge, attitudes, and perceptions regarding e-cigarettes. Data collection was facilitated through a survey distributed via Google Forms and statistical analysis was performed using SPSS 26 to identify significant associations.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe findings revealed that 54.2% of students reported using e-cigarettes, with a higher prevalence among those with close friends or family members who smoked. Knowledge about e-cigarettes was generally low, with 56.2% demonstrating poor understanding, particularly regarding the health risks and regulatory status of e-cigarettes. Attitudes were largely negative, with 73.4% expressing concerns about vaping, though 62.7% believed it was more socially acceptable than traditional smoking. Peer influence was a major factor, as 74.6% of e-cigarette users had close friends who also vaped. A significant association was found between smoking tobacco and e-cigarette use (p\u0026thinsp;=\u0026thinsp;0.00), indicating a trend of dual-use rather than e-cigarettes serving as a quitting tool.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe study highlights a critical gap in e-cigarette knowledge and a strong influence of social and environmental factors on vaping behaviors. Despite negative attitudes toward vaping, its perceived social acceptability remains high. Public health interventions should focus on targeted educational campaigns, peer-led awareness programs, and regulatory measures to address misconceptions and reduce e-cigarette use among young adults.\u003c/p\u003e","manuscriptTitle":"Knowledge Attitude and practice about E-cigarettes among University Students: A comparative study between Afghanistan, Netherlands, and Turkey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-13 09:23:58","doi":"10.21203/rs.3.rs-6832062/v1","editorialEvents":[{"type":"communityComments","content":2}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"83ab9588-7c9f-40b6-9b90-11437f48fbdb","owner":[],"postedDate":"June 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-18T05:08:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-13 09:23:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6832062","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6832062","identity":"rs-6832062","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}