VIBARES DETERMINANTS OF THE USAGE OF E-CIGARETTES AMONG TEENAGERS IN THE PHILIPPINES AND VIETNAM: CROSS-SECTIONAL BACHELOR THESIS Study Mode: Full-time Major: Agricultural Economics Facu
INTRODUCTION
Research rationale
Electronic cigarettes, also known as e-cigarettes or electronic nicotine delivery systems, were created in 2003 by a Chinese pharmacist named Hon Lik The Ruyan Group, a Hong Kong manufacturer, introduced electronic cigarettes to the market for the first time in 2004 (Nguyen et al., 2022) As mentioned by Kinnunen et al (2015), electronic cigarettes (e-cigarettes) or vape is a device operated by a battery that works by heating a liquid into an aerosol inhaled and exhaled by the user A liquid solution (e-liquid, e-juice) made of propylene glycol and other chemicals is vaporized by these products and then inhaled Additionally, Kinnunen et al (2015) mentioned that E-cigarettes are available in different colors, shapes, and flavors, which raise concern about their potential popularity among young people Since a few years ago, electronic cigarettes have become increasingly popular, and this is the case that concerned the researchers the most
Due to their increasing demand, e-cigarettes were very popular among young adults due to the marketing strategy of the product; taste, design, and promotions (Bigwanto et al., 2019) To satisfy consumer demand, e-cigarette companies were offering a variety of flavors Flavor variability is a factor aspect of the e-cigarette market (Czoli et al., 2016) As mentioned by Czoli et al (2016), consumers prefer products with more desirable features or attributes because they are more convenient, which affects their purchasing decisions Aside from that, electronic nicotine delivery systems (ENDS), which became more widely available and well-liked recently, are promoted as harm-reduction alternatives to cigarette smoking Camenga et al (2014) Additionally, a lack of knowledge about the possible smoking-related damage and good marketing exposure is one of the reasons for the higher risk of use (Zhu et al., 2019) As supported by Kinnunen et al (2015) regarding the findings of National Youth Tobacco the USA, the number of middle and high school students were using e-cigarettes in 2011-2012 increases According to Palipudi et al (2015), the findings showed that 818 500 people in four countries were currently using e-cigarettes In Malaysia, 3.9%, Greece, 2.5%, Indonesia, and Qatar, people were all aware of electronic cigarettes In addition, Nguyen et al (2022) mentioned that in Europe and in the USA, there are about 10 million e-cigarette users Furthermore, as indicated by Nguyen et al (2022), 18.6% of the target population had heard of e-cigarettes, 1.1% had used them, and 0.2% were currently using them, according to the GATS conducted in Vietnam in 2015 among people aged 15 and older Meanwhile, according to Solidum et al (2022), a sizable percentage of 13–15-year-olds in the Philippines use tobacco (12.5%) and e-cigarettes (14.1%) Concerns have been raised recently by the emergence of a new tobacco-like product known as the electronic cigarette (e-cigarette) or electronic nicotine delivery system (ENDS) The quick increase in e-cigarette use and addiction among youth and their consequences for public health, as well as their accessibility and popularity worldwide, have sparked worries (Nguyen et al.,
2022) According to Camenga et al (2014), the focus has been on adolescent e-cigarette use since electronic cigarettes became extensively used in 2007, because e-cigarettes contained harmful ingredients namely; carcino genic nitrosamines, and toxic diethylene glycol) (Kinnunen et al., 2015) According to Qasim et al (2017), who supported the previous study, e-cigarettes also contain significant amounts of the toxicants nicotine, volatile organic compounds, and carbonyls The youths' use of electronic cigarettes was very concerning because it might impact their health Camenga et al (2014) As indicated by Kinnunen et al (2015), teenagers who use nicotine-containing e-liquids will becoming dependent Due to the plasticity of the developing brain during adolescence, nicotine may have long-lasting effects Early research has, however, shown that compared to traditional cigarettes, electronic cigarettes have significantly fewer cytotoxic effects (Camenga et al., 2014) Despite having much lower levels of harmful toxins than tobacco smoke, it is still unknown how long-term use of electronic cigarettes will affect the health of adolescents (Czoli et al., 2016) 3,
292 teenagers between the ages of 13 and 15 died in The Philippines as a result of using e-cigarettes, with 270 (8.2%) dying from cancer, 244 (7.4%) from heart disease, and 35 (1.1%) from chronic pulmonary diseases (Solidum et al., 2022) These raised an alarming case for the Philippines People these days frequently enjoy modern cigarette products like e-cigarettes, heated tobacco items, and shisha (Nguyen et al., 2022) Meanwhile, in Vietnam, new types of cigarettes have grown in appeal among millennial, raising government agencies' awareness of the potential dangers of other tobacco products (Nguyen et al., 2022)
E-cigarette use among minors has surged due to the misconception that they are safer than conventional cigarettes, which is disastrous for the next generation Finding the factors that influence teen e-cigarette use will require more investigation According to a 2015 World Health Organization (WHO) report, 360,000 teens in the Philippines have tried using e-cigarettes Contrary to the Philippines, Vietnam has presented measures to raise tobacco pricing, outlaw electronic smoking, and tighten regulations on online cigarette advertisements in response to the alarming rise in young e-cigarette use However, there hasn't been much research on what influences youths in the Philippines and Vietnam to use electronic cigarettes This study will support the government's implementation and integration of policies regarding tobacco smoking or any types of nicotine-related devices Secondly, the findings of this study will help medical organizations improve research on how tobacco products can help or mitigate depression Finally, the study will benefit tobacco manufacturers and farmers since the findings will contribute to a long-term and successful strategy to aid the developing nations harmed by the rise of electronic cigarettes.
Research’s objectives
The current study aims to identify the causes of e-cigarette use among teenagers in the Philippines and Vietnam and to examine the determinants that affect this behavior.
Research questions and hypotheses
The study questions in this analysis will be;
• What are the factors that can affect the e-cigarette smoking among teenagers in the Philippines and Vietnam?
• What are the determinants of the e-cigarette smoking among teenagers in the Philippines and Vietnam?
Hypothesis for this research is the following:
⚫ Several factors were discovered among teenagers' use of e-cigarettes in the Philippines and Vietnam
⚫ There are numerous determinants that influence adolescent use of E-cigarettes in the Philippines and Vietnam.
Limitations
There are some limitations discovered First, this study was too fixated on electronic cigarettes and placed a restricted concentration on regular cigarette smokers Second, due to the Covid19 pandemic's unanticipated dawn, the sample size of respondents has shrunk Third, there is a linguistic barrier between the respondents and the researcher in Vietnam Lastly, there are few studies on e-cigarette use in Vietnam.
Definitions
Electronic cigarettes (e-cigarettes) - It is a battery-powered device that replicates the taste and feel of conventional cigarettes It comes with a cartridge that holds a liquid solution with or without nicotine (Choucair, 2022)
Nicotine- The addictive tobacco alkaloid nicotine can have both energizing and calming psychoactive effects (Britannica , 2011)
Adolescence- the period of development and growth that occurs between childhood and maturity (Csikszentmihalyi, 2022)
Impulsivity- the personality trait associated with high levels of activity, distraction susceptibility, impulsive behavior, and desire for immediate gratification (Plomin, 2019)
Sensation seeking- describes a person's propensity to look for novel and energizing stimuli (Sargent et al., 2010)
LITERATURE REVIEW
Overview of E-cigarettes and Negative Impact
Electronic nicotine delivery systems (ENDS) or Electronic cigarettes (E-cigarettes) are battery-operated imitations of traditional cigarettes, according to Vardavas et al (2015) In recent years, the so-called tobacco product known as electronic cigarettes or an electronic nicotine delivery system (ENDS) has sparked concern It is a vaporized liquid solution containing propylene glycol and other compounds that the user inhales (Kinnunen et al., 2015) E-cigarettes are also known as vape pens, e-cigars, or vaping devices, according to Qasim et al (2017) Hand-to-mouth gestures, for example, mimic traditional smoking, and the liquid solution tastes the same as e-cigarettes (Vardavas et al., 2015) According to Kinnunen et al (2015), teenagers are into e-cigarettes because it comes in different colors, shapes, and flavors Also, Qasim et al (2017) added that there are different nicotine concentrations contained in e-liquids, different amounts of e-liquids per product, various carrier compounds, additives, flavors, and battery voltage are the consequence of the wide variety of e-cigarettes Hilton et al (2019) mentioned that teenagers drew their attention to the product because of the broad flavor availability, design, and marketing effort According to Qasim et al (2017), E-cigarettes have four generations of devices and trending now on the market The first generation of e-cigarettes is cigar-like devices, new e-cigarette users like this kind of device because it only has 3.7 voltage The second generation has a refillable tank, the battery voltage is adjustable, and also, it is bigger than the first generation The third generation, mods, comprises the heaviest batteries with voltages as high as 8V (Voltage) Sub-ohm tanks are the last and have an atomizer coil resistance of less than 1 ohm It is typical for e-cigarette users to inhale many puffs, which results in a high e-liquid intake Vardavas et al (2015) noted that since e-cigarettes don't require burning tobacco, users are less likely to encounter risks As a result, many people believe that e-cigarettes can help reduce the risk of harm to teenagers who smoke tobacco or traditional cigarettes Most teenagers claim that e-cigarettes can help reduce traditional cigarette smoking Hence, with the growing number of teenagers smoking e-cigarettes, with its popularity, it is also somehow risky for one person who uses it Electronic cigarettes contain potentially harmful substances that teenagers may not be aware of regarding the product's safety and health implications and, these harmful substances can affect the respiratory system (Kinnunen et al., 2015) Additionally, Kinnunen et al (2015) claimed that nicotine has a long-lasting effect on the developing brain since it makes teens more attracted to and dependent on e-cigarettes, who are more likely to smoke cigarettes containing nicotine In contrast to adults, if a teen opted to quit smoking, adverse health impacts would be simple to spot Additionally, another study discovered that nicotine use throughout adolescence might increase the risk of psychiatric illnesses and cognitive decline in later life (Bigwanto et al., 2019) Vardavas et al (2015) mentioned that more research is needed to determine the long-term effect of e-cigarette use on consumer health, smoking cessation, and nicotine addiction Electronic cigarettes, also known as vape pens, e-cigars, or vaping gadgets, are popular among teenagers Teenagers are reportedly drawn to it because, in addition to nicotine, which can lead to addiction, it frequently contains a variety of e-liquids that evaporate when inhaled Furthermore, depending on the generation and color preferences of adolescents, electronic cigarettes may come in a variety of shapes and colors E-cigarettes are widely diversified and have four generations as well There are differences between the types of e-cigarettes in terms of the battery voltage, scale, and puff volume E-cigarettes are different from traditional cigarettes in that they are battery-powered and do not require the use of tobacco before teenagers use them Other studies have found that e-cigarette use among teens from many countries is widespread, and there are some concerns about how using them will affect young people's health Teenagers continue to use e-cigarettes despite being unaware of the serious health consequences because they believe they are not harmful This study will look at additional factors and analyze the influences that people may have after learning about e-cigarettes.
Negative impact of e-cigarettes and trend among teenagers
As stated by Bigwanto et al (2019) the use of electronic cigarettes (e-cigarettes) has become a global public health issue among teenagers E-cigarettes advocates argued that they are a better alternative to smoking, exposing the consumer to less toxins, and that they could assist in preventing or minimizing smoking (Camenga et al., 2017) Camenga et al (2017) stated that e-cigarettes have a lower cytotoxic effect than the conventional cigarettes, because it has been seen on the preliminary test that it has a low level of tobacco toxicants but Bigwanto et al (2019) argued that nearly all e-cigarettes contain nicotine, a systematic analysis found There is a percentage that the use of nicotine products can lead to addiction, especially for teenagers Teenagers’ age are around mid-twenties their brain development might be interrupted because of their early exposure to nicotine, it might also impair their concentration and learning (Qasim et al., 2017) According to Vardavas et al (2015) the findings showed that consumers of e-cigarettes are mainly 15 to 24 years old Additional to that, it is said that normalizing the intake of teenagers on e-cigarettes may lead to addiction (Camenga et al., 2017) The negative effect that many researchers have described could be experienced by adolescents, particularly if they had a lot of nicotine intake that they inhaled through the vaporized liquid The researchers have listed several health problems and those are: brain development, respiratory system, impaired concentration and learning, and more Such studies are useful for the researcher to assess if there is any impact of using e-cigarettes to reduce traditional cigarette addiction
To be able to help teenagers quit smoking e-cigarettes Because there is a scarcity of current data on teenagers, it is critical to understand the trends or determinants of electronic cigarette use among adolescents Understanding the determinants will also assist companies in determining what to reduce so that it is not harmful to teenagers (Camenga et al., 2017) E-cigarettes are marketed by social media and convince adults or teenagers that it is safer than conventional cigarettes; marketing is one of the determinants of the increasing number of electronic cigarettes users (Vardavas et al., 2015) According to Zhu et al (2019) The more advertisements teenagers will see, and the greater risk of use is correlated with a lack of awareness of potential smoking-related damage One of the reasons for the rising number of electronic cigarette users is marketing through convenience stores and the rising number of adolescents using social media such as internet advertisements (Camenga et al., 2017) Vardavas et al (2015) added that in this age group, interest, health literacy and marketing were perceived as possible determinants of e-cigarettes use and may have contributed to this finding Another determinant like gender has been seen according to Kinnunen et al (2013) in teenagers, the use of e-cigarettes is closely related to ever-present tobacco smoking and male sex Camenga et al (2017) also added that there is a study that indicates that they are more likely to try to use e-cigarettes when it comes to a male adolescent who is a tobacco smoker, but they have negative opinions about it for the non-smoker In addition, Kinnunen et al (2013) stated that teenagers who have a bond with adults who have already used it or using it and teenagers who want to quit smoking tobacco are one of the determinants of the use of e-cigarettes In addition, e-cigarettes advocates argued that they are a better alternative to smoking, exposing the consumer to less toxins, and that they could assist in preventing or minimizing smoking (Camenga et al., 2017) Vardavas et al (2015) mentioned that teenagers think electronic cigarettes are safer than traditional cigarettes, and their addiction to conventional cigarettes or tobacco can also be minimized Electronic cigarettes have a negative impact on health despite how fun it can be and all of these negative impacts must be avoidable by figuring out what causes them to try electronic cigarettes or the determinants of their usage Some determinants have been mentioned by the other researchers, those determinants are; gender, marketing, lack of health literature, interest, group and their experience That can be used according to the research study of the researcher
In addition, 9.4% of adolescents were reported to have used e-cigarettes in
2011 and 1.4% in South Korea without previous use of conventional cigarettes Also, 86.4% of 15-24 years old students had heard about e-cigarettes in the year 2011-2010 and 23.5 % of 15-19 years old students had used e-cigarettes in the country of Poland (Kinnunen et al., 2013) But despite its popularity there are some countries that are not allowed to sell tobacco for the age under 18 years old but minors (age 18 years old below) can buy e-cigarettes, for example is in Finland (Kinnunen et al., 2013) Furthermore, Kinnunen et al (2013) stated that they see e-liquids and e-cigarettes as medicine in Finland It is a prescription medication if the goods contain over 0.42 g nicotine/product or 10 mg/cartridge, whereas products with lower nicotine content can be obtained as over-the-counter drugs Due to the increasing amount gathered from previous studies and the harmful substances that one e-cigarette has, it is very troubling not just for one country, but for the world as a whole.
International Studies
According to the study of Camenga et al (2014) which is entitled “Trends in use of electronic nicotine delivery systems by adolescents” and the data that they have was collected at Connecticut and New York city suburban high schools between the year of 2010 and 2011 over a 16 months period The purpose of their study was to identify and analyze the patterns in e-cigarettes used in high schools with their targeted location The results of their study will be helpful to determine the patterns used of youth in e-cigarettes Their data analysis were three handwritten surveys that assessed the tobacco used behavior Chi square tests were used by the researchers to measure the descriptive statistics by research on the prevalence of e-cigarettes use in the previous 30 days also the patterns and correlates if ENDS use in the previous 30 days researchers used multivariate logistic regression to evaluate it The method that they used will need a bigger sample size, if their respondents are not enough it will lead them to some bias on their result Variable used were demographic data (grade, gender, race, cigarettes use in the 30 days prior, current E-cigarette’s use was their dependent variable According to their results the use of e-cigarettes increased from February to June with 2.9% with a significant value of p=0.009 The current cigarettes smokers increased from 11.6% to 13,6% with the significant value of p=0.05 while the number of teenagers who were smoking e-cigarettes and conventional cigarettes had a significant value of p=0.03 The study focused on the trends or patterns in use of e-cigarettes by teenagers Hence, any determinants were not said by the past researchers but they mentioned that the increasing number of teenagers who were using e-cigarettes were caused by the promotion in store, advertisement and trends in social media As a result, once a teenager has tried or used traditional cigarettes, they are more likely to try or use e-cigarettes The researchers just figured out the patterns of use thus the best predictor that the researchers had just found was the current smoker or those teenagers who were smoking conventional cigarettes Other variables that have been used might be useful for the current researcher in particular the demographic variables and also the multivariate logistic regression wherein the current researcher aim is to find the determinants The study “Electronic Cigarette Use Among Korean Adolescents: A Cross-Sectional Study of Market Penetration, Dual Use, and Relationship to Quit Attempts and Former Smoking” On the authority of Lee et al (2014), the researchers' previous study was conducted in the researchers' own country, South Korea, in the year 2014, which saw an unexpected increase in the number of e-cigarettes users When e-cigarettes were first introduced in Korea, the number of e-cigarettes users increased dramatically between 2008 and mid-2011 The goal of the researchers was to be able to find the prevalence of e-cigarettes use among Korean teenagers as well as the link between e-cigarettes use and current smoking (past 30-day), cigarettes per day, attempts to quit conventional cigarettes and both Public dataset's weights, strata, primary sampling unit and logistic regressions was used as the research method of the study to compute the descriptive statistics and to correct the complex survey design and the data that they gathered was from the self-administered and internet-based questionnaire namely, Korean Youth Risk Behavior Web-based Survey it was divided into secondary sampling units, wherein 79,202 students aged 13 to 18 in 2,400 classroom and primary sampling unit, for all 400 middle and high school students split into three classes E-cigarettes use, cigarette smoking, current (past 30-day) cigarette smokers, current smokers and the demographic variables were used as the determinants of the researchers’ study As per the results of their study in Korea, 85.5 percent of seventh grade students aged 13 had never used e-cigarettes or conventional cigarettes, while 16.9% of 12th graders had used cigarettes, 5.9% had used e-cigarettes, and 5.0 percent had used both traditional cigarettes and e-cigarettes E-cigarette use was significantly higher among boys 7.8% with a p.001 compared to girls with 1.8%, older students who were grade
12 students with 6.2% and p