OBJECTIVES: The study aimed to investigate the use of electronic cigarettes (EC) among medical students, their knowledge and beliefs (opinion about harmfulness and addiction potential) on ECs, perceptions of the risk, as well as to assess the type of education and cessation training they received during their study at Faculty of Medicine, Comenius University in Bratislava, Slovakia. METHODS: This cross-sectional, anonymous online e-mailed survey was conducted among medical students via the Study Department by sending e-mails containing the survey link. Participants completed the online questionnaire adapted from the American Survey on Tobacco and Alternative Tobacco Products. It included questions about the personal use of EC, perceptions about the harms and their role in disease causation, education and cessation training, and practices related to conventional cigarettes (CC), EC, and alternative tobacco products (ATP). The e-mailed questionnaire filled in 577 medical students (71.9% women) from Comenius University in Bratislava, the average age was 23 ± 2 years. The sample comprised 486 (84.2%) Slovak and 91 (15.8%) foreign students. The data were analysed using the Statistical Package for Social Science (SPSS) version 25. RESULTS: There were 385 (66.7%) non-smokers, 111 (19.3%) ex-smokers and 81 (14%) current smokers in the study sample. EC currently use 13.5% of medical students, with a statistically significant intersexual difference (22.2% males vs. 10.12% females; OR = 2.53, 95% CI: 1.55-4.13), more foreign students than Slovak students (24.2% vs. 11.52%; OR = 2.44, 95% CI: 1.41-4.26), more smokers of conventional cigarettes than non-smokers (46.9% vs. 8.06%; OR = 10.07, 95% CI: 5.85-17.34). EC seems to be less harmful to 59.97% of students, mostly in the age group ≤ 24 (61.76% vs. 51.49%; OR = 1.46, 95% CI: 1.03-2.07), 41.25% of students consider EC to be less addictive, 55.6% think they do not get enough education on EC during their medical study. CONCLUSION: The results overall show the high consumption of tobacco products and the lack of knowledge and awareness among medical students, future health care providers. In health promotion and disease prevention, they should serve as a model for their patients and for the general public as well. Our study emphasizes the need for intervention in this field at medical faculties and for support of further monitoring in Slovakia and other countries and draws attention to the ongoing lack of EC regulation.

Department of Pediatrics New York University School of Medicine New York USA

Department of Public Health and Hygiene Faculty of Medicine Pavol Jozef Safarik University in Kosice Kosice Slovak Republic

Institute of Hygiene and Epidemiology 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czech Republic

Institute of Hygiene Faculty of Medicine Comenius University in Bratislava Bratislava Slovak Republic

See more in PubMed

World Health Organization. WHO global report on trends in the prevalence of tobacco use 2000-2025. 3rd ed. [Internet]. Geneva: WHO; 2019 [cited 2020 Dec 2]. Available from: https://www.who.int/publications-detail/who-global-report-on-trends-in-prevalence-of-tobacco-use-2000-2025-third-edition.

The health consequences of smoking - 50 years of progress: a report of the Surgeon General [Internet]. Atlanta: U.S. Department of Health & Human Services; 2014 [cited 2020 Dec 6]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK179276/pdf/Bookshelf_NBK179276.pdf.

World Health Organization. Tobacco [Internet]. Geneva: WHO; 2021 [cited 2021 Sep 23]. Available from: https://www.who.int/news-room/fact-sheets/detail/tobacco.

European Union. Eurobarometer. Attitudes of Europeans towards tobacco and electronic cigarettes [Internet]. 2021 [cited 2021 Sep 23]. Available from: https://europa.eu/eurobarometer/surveys/detail/2240.

Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs - 2014 [Internet]. Atlanta: U.S. Department of Health and Human Services; 2014 [cited 2020 Nov 30]. Available from: https://www.cdc.gov/tobacco/stateandcommunity/best_practices/pdfs/2014/comprehensive.pdf.

La Torre G, Mipatrini D. Country-level correlates of e-cigarette use in the European Union. Int J Public Health. 2016;61(2):269-75.

Pisinger C, Dossing M. A systematic review of health effects of electronic cigarettes. Prev Med. 2014;69:248-60.

Zhou S, Van Devanter N, Fenstermaker M, Cawkwell P, Sherman S, Weitzman M. A study of the use, knowledge, and beliefs about cigarettes and alternative tobacco products among students at one U.S. medical school. Acad Med 2015;90(12):1713-9. PubMed

Kapan A, Stefanac S, Sandner I, Haider S, Grabovac I, Dorner TE. Use of electronic cigarettes in European populations: a narrative review. Int J Environ Res Public Health. 2020 Mar 17;17(6):1971. doi: 10.3390/ijerph17061971. PubMed DOI

Brożek GM, Jankowski M, Lawson JA, Shpakou A, Poznański M, Zielonka TM, et al. The prevalence of cigarette and e-cigarette smoking among students in Central and Eastern Europe - results of the YUPESS Study. Int J Environ Res Public Health. 2019;16(13):2297. doi: 10.3390/ijerph16132297. PubMed DOI

WHO report on the global tobacco epidemic, 2021: addressing new and emerging products [Internet]. Geneva: WHO; 2021 [cited 2021 Sep 23]. Available from: https://www.who.int/teams/health-promotion/tobacco-control/global-tobacco-report-2021.

Baska T, Warren CW, Basková M, Jones NR. Prevalence of youth cigarette smoking and selected social factors in 25 European countries: findings from the Global Youth Tobacco Survey. Int J Public Health. 2009;54(6):439-45.

Centers for Disease Control and Prevention. E-Cigarette use among youth and young adults. A report of the surgeon general [Internet]. Atlanta: U.S. Department of Health and Human Services; 2016 [cited 2019 Dec 7]. Available from: https://www.cdc.gov/tobacco/data_statistics/sgr/e-cigarettes/pdfs/2016_sgr_entire_report_508.pdf.

Kochurani J. Electronic cigarettes: An evidence-based analysis. Prof Case Manag. 2015;20(5)251-9. PubMed

Mirbolouk M, Charkhchi P, Kianoush S, Iftekhar Uddin SM, Orimoloye OA, Jaber R, et al. Prevalence and distribution of e-cigarette use among U.S. adults: Behavioral Risk Factor Surveillance System, 2016. Ann Intern Med. 2018 Oct 2;169(7):429-38.

Eastwood B, Dockrell MJ, Arnott D, Britton J, Cheeseman H, Jarvis MJ, et al. Electronic cigarette use in young people in Great Britain 2013-2014. Public Health. 2015 Sep;129(9):1150-6.

Arrazola RA, Singh T, Corey CG, Husten CG, Neff LJ, Apelberg BJ, et al; Centers for Disease Control and Prevention (CDC). Tobacco use among middle and high school students - United States, 2011-2014. MMWR Morb Mortal Wkly Rep. 2015 Apr 17;64(14):381-5.

Paudyal P, Movia M. Knowledge, attitudes and beliefs towards electronic cigarettes among university students in Austria. Eur J Public Health. 2019 Nov;29 Suppl 4: ckz186.709. doi: https://doi.org/10.1093/eurpub/ckz186.709. DOI

Babjakova J, Vondrova D, Jurkovicova J, Samohyl M, Filova A, Janko Z, et al. Risk behavioral survey in the sample of Slovak adolescents. Bratisl Lek Listy. 2019;120(12):899-907. PubMed

Baška T, Bašková M, Hudečková H, Straka Š, Maďar R. Increasing trends of tobacco use in medical students in Slovakia - a reason for concern? Cent Eur J Public Health. 2007 Mar;15(1):29-32.

Kinouani S, Leflot C, Vanderkam P, Auriacombe M, Langlois E, Tzourio C. Motivations for using electronic cigarettes in young adults: A systematic review. Subst Abus. 2020;41(3):315-322.

Amrock SM, Zakhar J, Zhou S, Weitzman M. Perception of e-cigarette harm and its correlation with use among U.S. adolescents. Nicotine Tob Res. 2015 Mar;17(3):330-6.

WHO report on the global tobacco epidemic, 2017: monitoring tobacco use and prevention policies [Internet]. Geneva: WHO; 2017 [cited 2019 Dec 1]. Available from: https://apps.who.int/iris/handle/10665/255874.

Hajek P, Etter JF, Benowitz N, Eissenberg T, McRobbie H. Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit. Addiction. 2014 Nov;109(11):1801-10.

Royal College of Physicians. Nicotine without smoke: Tobacco harm reduction [Internet]. London: RCP; 2016 [cited 2020 Jan 8]. Available from: https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0.

Kuwabara Y, Kinjo A, Fujii M, Imamoto A, Osaki Y, Jike M, et al. Heat-not-burn tobacco, electronic cigarettes, and combustible cigarette use among Japanese adolescents: a nationwide population survey 2017. BMC Public Health. 2020 May 20;20(1):741. doi: 10.1186/s12889-020-08916-x. PubMed DOI

Worku D, Worku E. A narrative review evaluating the safety and efficacy of e-cigarettes as a newly marketed smoking cessation tool. SAGE Open Med. 2019 Aug 18;7:2050312119871405. doi: 10.1177/2050312119871405. PubMed DOI

Cobb CO, Weaver MF, Eissenberg T. Evaluating the acute effects of oral, non-combustible potential reduced exposure products marketed to smokers. Tob Control. 2010 Oct;19(5):367-73. PubMed

Etter JF, Bullen C. Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy. Addiction. 2011 Nov;106(11):2017-28.

Hrubá, D. Why to use electronic cigarettes? Actual knowledge for practice. Prakt Lek. 2012;92(8):449-51. (In Czech.)

Králíková E, Ježek M. Electronic cigarette. Cas Lek Cesk. 2012;151(4):208-10. (In Czech.) PubMed

Grant JE, Lust K, Fridberg DJ, King AC, Chamberlain SR. E-cigarette use (vaping) is associated with illicit drug use, mental health problems, and impulsivity in university students. Ann Clin Psychiatry. 2019 Feb;31(1):27-35. PubMed

Harrell PT, Simmons VN, Correa JB, Padhya TA, Brandon TH. Electronic nicotine delivery systems (e-cigarettes): review of safety and smoking cessation efficacy. Otolaryngol Head Neck Surg. 2014 Sep;151(3):381-93.

Hartmann-Boyce J, McRobbie H, Butler AR, Lindson N, Bullen C, Begh R, et al. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev. 2021 Sep 14;9(9):CD010216. doi: 10.1002/14651858.CD010216.pub6. PubMed DOI

Natto ZS. Dental students' knowledge and attitudes about electronic cigarettes: a cross-sectional study at one Saudi university. J Dent Educ. 2020 Jan;84(1):27-33. PubMed

Kinnunen JM, Ollila H, El-Amin Sel-T, Pere LA, Lindfors PL, Rimpelä AH. Awareness and determinants of electronic cigarette use among Finnish adolescents in 2013: a population-based study. Tob Control. 2015 Dec;24(e4):e264-70. doi: 10.1136/tobaccocontrol-2013-051512. PubMed DOI

Sheehan KB. E-mail survey response rates: a review, J Comput Mediat Commun. 2001 Jan; 6(2):JCM621. doi: doi.org/10.1111/j.1083-6101.2001.tb00117.x.

Fincham JE. Response rates and responsiveness for surveys, standards, and the Journal. Am J Pharm Educ. 2008 Apr 15;72(2):43. doi: 10.5688/aj720243. PubMed DOI