Dear Editor,

E-cigarettes have become increasingly popular worldwide. A survey in Malaysia, reported that 62% of the respondents were aware of e-cigarettes, 19% have tried and 14% are currently using e-cigarettes¹. Health professionals play a pivotal role in the tobacco cessation process, however there is a possibility that health professionals are unaware of e-cigarettes and the potential harms associated with them². The objective of this study was to determine the knowledge, attitude and willingness to give professional advice to patients about e-cigarettes among health professionals in different Malaysian Universities.

A cross sectional survey was conducted using a pretested questionnaire (available online as Supplementary information) and sent out to 120 health professionals (40 in each discipline) in Faculties of Medicine, Dentistry and Pharmacology working in different universities across Malaysia, 96 responded, a response rate of 80%. Descriptive statistics were employed to analyze the collected data using MedCalc version 14. Ethical approval was obtained from the institutional review board.

Surveyed health care professionals in Malaysia believed that e-cigarettes were commonly purchased online (53%), and from specialized shops (34%). The majority (64%) were not aware of the prevalence of e-cigarette use in Malaysia. Furthermore, 69% were unaware of the current status of e-cigarettes according to the US Food and Drug Administration (FDA). Thirty-five percent felt that the amount of nicotine delivered by EC is less compared to conventional cigarettes and the same percentage were unaware of the amount of nicotine delivered by e-cigarettes. Approximately, a third of the respondents believed that vapours produced by e-cigarettes were as harmful as the second hand smoke produced by conventional cigarettes. The majority responded that nicotine in e-cigarettes can cause cardiovascular, respiratory disease, and dry mouth. Most (76%) had never encountered a patient using e-cigarettes (potentially as the sampled population were primarily not clinicians), and among those who had, 17/20 advised the user to quit. The majority of surveyed health care professionals (60%) believed that e-cigarettes can be a gateway to the use of other tobacco products. Almost 97% were unaware of how e-cigarettes are regulated under Malaysian national tobacco policies. With regards to education, 86% believed there is a need to address the topic of e-cigarettes in undergraduate curriculum and to include the harms associated with e-cigarettes use in tobacco cessation advice, while 97% expressed the need for workshops to be offered to clinicians/ academicians updating them on emerging tobacco trends like e-cigarettes.

In conclusion, many of our respondents were either unaware of the details regarding e-cigarettes or, in some instances, had erroneous information. A misinformed health-care provider may hesitate to discuss tobacco cessation with their patients or even convey inaccurate information. In light of the above, health professionals in Malaysia, who may increasingly need to consult e-cigarette users³, must be better informed.