To Determine the Effectiveness of

E-Cigarette in Reducing Smoking in Young Male Adults

Submitted by:
Jayson P. Aban
Patrick Dan Marc O. Sanchez
Antonio Duque

CHAPTER I
BACKGROUND OF THE STUDY

INTRODUCTION
In this day and age, everything seems to be going electronic; and that includes
smoking. Many smokers are turning to electronic cigarettes, also called e-cigs, thinking
they’re better off with these than regular cigarettes. Truth is, we don’t know what the
effects of e-cigs are on the long term because there’s not much scientific data except
the ones their manufacturers have come up with. (Dr. Rafael Castillo, 2013)
The earliest electronic cigarette can be traced to Herbert A. Gilbert, who in 1963
patented a device described as "a smokeless non-tobacco cigarette" that involved
"replacing burning tobacco and paper with heated, moist, flavored air." This device
heated the nicotine solution and produced steam. In 1967, Gilbert was approached by
several companies interested in manufacturing it, but it was never commercialized and
disappeared from the public record after 1967. (Dr. Rafael Castillo)
Hon Lik, a Chinese pharmacist, is widely credited with the invention of the first
generation electronic cigarette. The design produces a smoke-like vapour that can be
inhaled and provides a vehicle for nicotine delivery into the bloodstream via the lungs.
Electronic cigarettes were first introduced to the Chinese domestic market in May
2004 as an aid for smoking cessation and replacement. Golden Dragon Holdings,
changed its name to Ruyan ( 如 烟 , literally "Resembling smoking"), and started
exporting its products in 2005–2006 before receiving its first international patent in
2007.
The electronic cigarette continued to evolve from the first generation three-part
device. In 2006 the "cartomizer" was invented by Umer and Tariq Sheikh. This is a
mechanism which integrates the heating coil into the liquid chamber. The new device
was launched in the UK in 2007 in the Gamucci brand and it is now widely adopted by
the majority of 'cigalike' brands. The grant of the UK patent for the "cartomizer" was
published by the UK Intellectual Property Office in February 2013.
 Blu, a prominent US e-cigarette producer, was acquired by Lorillard Inc. in
2012. Other major tobacco companies announced that they were set to launch brands
during 2013 including British American Tobacco with Vype, while Imperial
Tobacco acquired the intellectual property owned by Hon Lik through Dragonite for $US
75 million.
The World Health Organization (WHO) states that as of July 2013, the efficacy in
using electronic cigarettes to aid in smoking cessation has not been demonstrated
scientifically. They recommend that "consumers should be strongly advised not to use"
electronic cigarettes until a reliable source has found them safe and effective.
A preliminary analysis of e-cigarette cartridges by the US Food and Drug
Administration (FDA) in 2009 identified that some contain tobacco-specific
nitrosamines (TSNAs), known cancer-causing agents. The amounts of TSNAs present
were on par with existing nicotine replacement therapy (NRT) products like nicotine gum
and inhalers. The FDA's analysis also detected diethylene glycol, a poisonous
and hygroscopic liquid, in a single cartridge manufactured by Smoking Everywhere and
nicotine in one cartridge claimed to be nicotine-free. In some e-cigarettes, "Tobacco-
specific impurities suspected of being harmful to humans – anabasine, myosmine, and
β-nicotyrine – were detected in a majority of the samples tested." It is not clear if these
chemicals were detectable in exhaled vapour. The UK National Health Service noted
that the toxic chemicals found by the FDA were at levels one-thousandth that of
cigarette smoke, and that while there is no certainty that these small traces are
harmless, initial test results are reassuring. (US Food and Drug Administration)
Electronic cigarettes, increasingly popular among young Filipinos, are not
advisable for those who want to quit smoking, the Department of Health (DOH) already
warned the public. Anthony Leachon, DOH consultant for non-communicable diseases,
e-cigarettes could not help a person who wants to stop smoking. “Electronic cigarettes
are not advisable since you don’t kick the habit. You can easily go back to smoking,”
said Leachon. He said if a person wants to quit but can’t do it on his own, he should
consult a doctor for proper counseling and medication.

The Philippine Medical Association has called for a ban on the sale of e-cigs to
the public until such time that a proper testing of their safety has been done. It has
pointed out that the sale of e-cigs is unregulated, making them accessible to children
and adolescents, who look at them as cool devices to be seen with. They are promoted
by some marketers as an “alternative lifestyle” and many are made to believe they are
safer and relatively “healthier” than actual smoking.
Dr. Saturnino Javier, the immediate past president of the Philippine Heart
Association, also detailed the uncertainty and risks of e-cig use in his column in Vital
Signs, the newspaper for doctors and healthcare professionals. “One must also contend
with the fact that nicotine vapors are likewise inhaled into the lungs,” he wrote. “One of
the strongest arguments against the use of e-cigarettes is that they may undermine
smoking prevention and cessation by reinforcing the habit of cigarette use in public and
workplaces,” he added.
 Manufacturers of e-cigs claim that this nicotine vapor offers much lesser risk over
traditional cigarette smoke. But no one knows for sure the possible side effects of
inhaling nicotine vapor, as well as other health risks e-cigarettes may cause.
In the Philippines, e-cigarettes are available in shopping malls,
commercial/business establishments, and other public places. You can also buy them
online. Its price ranges from P700 – P20,000 and e-juice are bought separately at P150-
P400. Tobacco cigarette price, on the other hand, ranges from P40-P80 per pack or P4
per piece.
The researchers will conduct this study and focus on the effectiveness of e-
cigarette in reducing smoking in young male adults.

STATEMENT OF THE PROBLEM

The purpose of the study is to determine the effectiveness of e-cigarette in
reducing smoking among young male adults.
Specifically, it sought to answer the following questions:
1. What is the demographic profile of the respondents in terms of:
a. Age
b. Gender
c. Duration
d. Length of time e-cigarette was used

2. What are the reasons for using e-cigarette?

2.1 Health reason
2.2 Cost or less expensive
2.3 To follow the trend
2.4 Peer pressure
2.5 Pressure of significant other
3. Did e-cigarette lessen the frequency of smoking for the respondents?
4. How many tobacco cigarette sticks per day did respondents consume before
using e-cigarette?
5. How many tobacco cigarette sticks per day did respondents consume after using
e-cigarette?
6. Is there any significant difference in the reduction of tobacco smoking between
the two groups: e-cigarette smokers 3 months to one year; and 13months and
above.

HYPOTHESIS
There’s no significant difference in the reduction of tobacco smoking through e-
cigarette.

SIGNIFICANCE OF THE STUDY

The significance of the study is to determine the effectiveness of e-cigarette in
reducing smoking for young male adults. It also aims to find out why some men prefer
e-cigarettes over tobacco cigarettes.

SCOPE AND LIMITATION

 The research covers effectiveness of e-cigarette in reducing smoking for young
male adults. The target respondents are young male adults who are active customers of
King Vape at Sta. Lucia East Grand Mall. Survey will be conducted on July 2014.

THEORETICAL AND CONCEPTUAL FRAMEWORK

In this study, the researchers will use B.F. Skinner’s operant conditioning and
Callista Roy’s Developmental Theory.

B.F. Skinner’s operant conditioning

Through operant conditioning, an association is made between a behavior and a
consequence for that behavior. As a behaviorist, Skinner believed that internal thoughts
and motivations could not be used to explain behavior. Instead, he suggested, we
should look only at the external, observable causes of human behavior. There are 2
main concepts of operand conditioning: reinforcement and punishment.
Reinforcement is any event that strengthens or increases the behavior it follows.
Positive reinforcers are favorable events or outcomes that are presented after the
behavior. In situations that reflect positive reinforcement, a response or behavior is
strengthened by the addition of something, such as praise or approval from loved ones
or friends. Punishment, on the other hand, is the presentation of an adverse event or
outcome that causes a decrease in the behavior it follows. Positive punishment
sometimes referred to as punishment by application, involves the presentation of an
unfavorable event or outcome in order to weaken the response it follows.

Callista Roy’s Developmental Theory

This model comprises the four domain concepts of person, health, environment,
and nursing; it also involves a six-step nursing process. Andrews & Roy (1991) state
that the person can be a representation of an individual or a group of individuals Roy's
model sees the person as "a bio-psychosocial being in constant interaction with a
changing environment "The person is an open, adaptive system who uses coping skills
to deal with stressors. Roy sees the environment as "all conditions, circumstances and
influences that surround and affect the development and behaviour of the person" Roy
describes stressors as stimuli and uses the term residual stimuli to describe those
stressors whose influence on the person is not clear Originally, Roy wrote that health
and illness are on a continuum with many different states or degrees possible. More
recently, she states that health is the process of being and becoming an integrated and
whole person. Roy's goal for nursing is "the promotion of adaptation in each of the four
modes, thereby contributing to the person's health, quality of life and dying with dignity"

These four modes are physiological, self-concept, role function and

interdependence.
I. Adaptation Modes
A. Physiologic Mode
1. To what extent is the e-cigarette smokers be able to meet the basic
needs of maintenance?
2. Are e-cigarette smokers having problem meeting basic needs?
B. Self-Concept Mode
1. What are the values of the e-cigarette?
2. Describe the degree of reduction and understanding given to the e-
cigarette user,
C. Role Function Mode
1. Describe the roles assumed by the family members.
2. How are e-cigarette user decisions reached?
D. Interdependence Mode
1. To what extent are the members supportive of one another?
2. Describe the interaction patterns of the e-cigarette in the community.
II. Adaptive Mechanisms
A. Regulator: health status of the e-cigarette user in terms of health? i.e.,
nutritional state, physical strength, availability of physical resources
B. Cognator: knowledge base of e-cigarette , reducing ,maintenance,
effectiveness , ability to process
III. Stimuli
A. Focal
1. What are the major concerns of e-cigarette smokers at this time?
2. What are the major concerns regarding the effectiveness of reducing
smoking traditional cigarettes?
B. Contextual
1. What elements in the environment, structure, dynamic, are impinging on
the manner and degree to which the e-cigarette smokers can cope with and adapt to
their major concerns (i.e., financial and physical resources, presence or absence of
support systems, clinical setting and so on)?
 C. Residual
1. What knowledge, skills, beliefs, and values of these smokers must be
considered as the smokers attempts to adapt (i.e., stage of development, cultural
background, spiritual/religious beliefs, goals, expectations)?

CONCEPTUAL FRAMEWORK

Our framework shows the behavioral effect of e-Cigarette smoking.

Reinforcement Quitting

Smoking Or
Reward
Reducing
e-Cigarettes Punishment
Or

DEFINITION OF TERMS
The following terms are defined according to how they were used in our study:
1. Electronic cigarette- also known as vaporizer cigarettes and e-cigarettes, are
devices that people use, often instead of tobacco cigarettes that release doses of
water vapor that may or may not include nicotine. E-cigarettes are powered by a
small battery.
Electronic cigarettes are long tube-like devices that either look like
tobacco cigarettes or biros (ballpoint pens). Most of them have replaceable
cartridges; some are throwaway ones.
The user places the device between his lips and sucks in, this action
activates a heating element that immediately vaporizes a liquid solution. The
vapor is inhaled. Learning how to use an e-cigarettes, especially for a regular
tobacco-smoker, is straightforward because the action is virtually identical to
what is done when you smoke a tobacco cigarette.(Medical News Today)
2. Young male adults - men ranging from ages 18-30 years old ‘
3. Nicotine - an addictive substance because it disturbs the balance of chemicals in
a person's brain. It stimulates the blood pressure and oxygen level in the body,
causing the release of dopamine in the brain.
4. Dopamine - a chemical that gives pleasurable feelings
5. Smoking - act of smoking tobacco cigarette or e-cigarette
6. Reducing – lessening a person's activity in smoking
7. Tobacco cigarette - a tobacco stick containing nicotine
8. Vapor - an odorless or flavored smoke
9. Cartomizer – a device consisting of an atomizer and cartridge all in one piece
that connects to the battery
 CHAPTER II
REVIEW OF RELATED LITERATURE
The following related literatures were selected by the researchers to support
the study. They all focused on efficacy of e-cigarette in reducing tobacco smoking.

Electronic Cigarettes:
Foreign Literature
Effects of E-cigarette
WHO (2008) has no scientific evidence to confirm the safety and efficiency of
electronic cigarette. Marketers of the electronic cigarette typically describe it as a
means to help smokers break their addictions to tobacco. Some have even gone so
far as to imply that WHO views it as a legitimate nicotine replacement therapy like
nicotine gum, lozenges and patches.
http://www.who.int/mediacentre/news/releases/2008/pr34/en/

“From our perspective, use of E-cigarettes should be encouraged as a substitute

for conventional cigarettes for cigarette smokers who are unable or unwilling to quit, but
are sincerely interested in reducing their risk of tobacco-related illness, ” according to
Joel L. Nitzkin.
http://www.vapersclub.com/quotes.php
 Proponents of the e-cigarette say they feel better using the device than they did
when they were smoking tobacco cigarettes, and that because the e-cigarette is
reusable, it saves them money. Some praise the e-cig for helping them quit smoking.
But is the e-cigarette as safe as its users -- including celebrities like Katherine Heigl --
believe? Is it a healthier option, or a riskier choice? And what does the FDA have to do
with it? Before you consider taking up the e-cigarette habit, read on to get the facts
(Cassidy, 2013).

The researchers believe the survey shows evidence that electronic cigarettes do
help people stop smoking. Though the response rate was only 4.5 percent, limiting the
study findings, the authors say it maybe the respondents were more likely to have quit
smoking and believe more research is warranted.

E-cigarettes have raised controversy and New York has considered banning
them altogether, but the new finding shows higher success rates for smoking cessation
than other products on the market (Blanchard, 2011).

Effectiveness
Both Abrams and Belinda Borrelli, professor of psychiatry and director of the
Program in Nicotine and Tobacco at Alpert Medical School and the Miriam Hospital,
stressed that there is not enough long-term research to determine exactly how safe e-
cigarettes are.
http://www.browndailyherald.com/2013/12/06/e-cigarette-use-increases-experts-
investigate-health-risks/

The FDA is in the process of having e-cigarettes labeled as a drug-delivery

device so they can be regulated [source: FDA]. Manufacturers, however, say the e-
cigarette is simply recreational, and should not be subject to FDA regulation. Two e-
cigarette companies, Smoking Everywhere and NJOY, sued the FDA in the district court
of the District of Columbia for impounding their products, and won. The judge ruled that
"there is no basis for the FDA to treat electronic cigarettes … as a drug-device
combination when all they purport to do is offer consumers the same recreational
effects as a regular cigarette" (Cassidy, 2013)

The finding, published in the American Journal of Preventive Medicine, result of

an online survey sent to 222 participants purchasing e-cigarettes for the first time. At six
months, 34.3 percent of reports using no nicotine or electronic cigarettes and 67 percent
said they had cut down on smoking.

Lead study author Michael Siegel, professor of community health sciences said,
"While it is well-recognized that nicotine plays a role in smoking addiction, little attention
has been given to the behavioral aspects of the addiction, These devices simulate the
smoking experience, which appears to make them effective as a smoking cessation
tool", that he also says deserves more study about what makes them so effective.

Young Adults
Introductory on adult male

E-cigarettes aren’t subject to US tobacco laws, which mean they can be purchased
without proof of age, especially online. This raises concerns that e-cigs maybe
particularly appealing to kids and may encourage nicotine addiction among young
people. And while manufacturers of the e-cigarette claim that it’s the cigarette you can
“smoke” anywhere, regularly agencies around the world are taking a close look at these
gadgets and instituting a range of restrictions on their use.

Under this university’s smoke-free campus policy, e-cigarettes are not included.
The policy defines smoking as carrying or smoking a lighted tobacco product or burning
a material to inhale, said Anne Martens, administration and finance assistant vice
president.

Cigarette smokers must smoke in one of the four designated smoking areas on
the campus, Martens said, but e-cigarette users are not restricted to those areas.

Even with that option, some smokers at the university said they won’t switch to e-
cigarettes.

“Kids seem to like them here, though. Definitely with the smoking ban, you see a
lot more kids walking around with the e-cigs,” said Tom Dermody, a senior
environmental science and policy major. “But it’s not my thing.”

Junior Mohammad Biglari tried e-cigarettes but went back to regular cigarettes.“I
didn’t like it. It didn’t give me the same feeling,” the biology major said. “I thought I
smoked more when I had it because you can smoke it everywhere.”

But e-cigarettes don’t always help with smoking cessation efforts, senior Sean
Turner said. He said his friend, a smoker of 12 years, used e-cigarettes to help him quit
smoking.

“He hasn’t smoked a cigarette in a year and a half now, but he still smokes the
electronic cigarettes,” said Turner, a geographical sciences and government and politics
major. “So it helped him stop with the actual cigarette, but in terms of weaning himself
off of [the e-cigarette], he’s having a little bit of trouble with it.”

Dermody said he sees the benefits for nonsmokers — e-cigarettes don’t create
any secondhand smoke — but believes the only way to quit is to “do it cold turkey.”

Using e-cigarettes and other types of smoking products is a risk, Place said.
“Anything that allows a person to use an addictive substance more frequently increases
the risk of addiction — the more one uses, the more likely they are to become addicted,”
Place wrote in an email.
 Martens haven’t seen a huge presence of e-cigarettes on the campus, but she
did see someone using one at December’s commencement ceremony. She said she
wouldn’t be surprised if the University System of Maryland soon considers the product’s
place in the smoke-free policy.“The whole process is evolving, and the university
system and the state periodically review of all policies, including this one,” she said.

From a health perspective, Place said she doesn’t advocate the product’s use.
What do you think? “I think there are two compelling reasons not to recommend them:
They are quite expensive and they are an unknown, unregulated delivery mechanism
for a substance that we know to be quite addictive,” Place wrote. “If nothing else, that’s
a recipe for running out of cash quickly and potentially developing health problems we
don’t even really know enough to predict yet.”( Marten, Turner and Dermody, 2012)

Local Literature

In the Philippines, anti-smoking advocates had already expressed concern about

the growing popularity of e-cigarettes. A local newspaper report said the Department of
Health (DOH) had pointed out that the use of e-cigarettes would not help smokers quit
(Philippine Daily Inquirer, 2012).`

Anthony Leachon, DOH consultant for non-communicable diseases, said the

product would make it easy for smokers to resume their habit. Instead of using e-
cigarettes, he advised smokers to seek professional help if they wanted to quit.

The news report said Maricar Limpin, executive director of Framework

Convention on Tobacco Control Alliance Philippines, said the e-cigarette could also be
addictive as the vapor it produced contained nicotine. People who used the e-cigarette
could remain addicted to nicotine and not know where the substance was coming from.
Limpin pointed out the product was flavored to hide the taste of nicotine.
http://lifestyle.inquirer.net/87289/e-cigarettes-wont-help-a-smoker-quit

CHAPTER III
 METHODOLOGY AND RESEARCH DESIGN
This chapter describes the method used by the researchers in conducting the
study. This includes the sources of data, sampling design, methods of gathering data,
research instrumentation and statistical method essential for analysis of the facts based
on the result.
A. Sources of Data
Young male adults will be the main source of data who will answer survey from
given by the researchers. Other information will also come from the books,
journals, magazines, newspapers and different websites.

B. Research Method
A quantitative, non-experimental method will be used in gathering information
from the subject participants wherein interventions are not necessary that may
interfere the nature and conditions of the subject being studied. Descriptive
research was also used to obtain information concerning the status of the
phenomena to describe “what exists” with respect to variables or conditions in a
situation. The methods will involve range from the survey that describes the
status quo, the correlation study that investigates the relationship between
variables, to developmental studies that seek to determine changes over time.
Gathering important information will be done with the use of the world wide web
to search for existing related literatures and articles. The researchers will search
for important facts and statistics and will compile those related to the topic.
Gathering information from the books in the libraries will also be utilized to look
for more essential facts and statistics regarding factors affecting smoking e-
cigarette. Articles from the magazines and newspaper that maybe important will
be collected to have more relevant information that is much related to the study.

C. Sampling Design
The researchers will use the random probability sampling in which subjects will
be randomly selected from the customers of King Vape of Sta.Lucia Grand Mall.
Fifty participants will be the target population.

D. Research Instrumentation
Data and information will be based on the perceptual measurement of the
respondents regarding the variables of the study. A set of questionnaires will be
given using a close-ended question that will allow the respondents to choose
between two responses (e.g. yes or no)

E. Data Collection Procedure

Before study will be conducted, an approval to perform the study will be obtained
from the owner of the e-cigarette store. Informed content will be acquired from all
the study participants and will assure them the privacy and confidentiality of the
information will be kept. The title, purpose and objectives as well as the manner
of answering the question will be explained beforehand so that confusions will be
avoided. Participants will be given 10 minutes to read the questions carefully and
answer the survey. The researchers will be around observing them while waiting
 for the completion of the survey. After finishing the survey, the researchers will
express their gratitude to the participants for sharing their time in answering the
survey.

F. Statistical Treatment of Data

The following statistical method will be used in the study to formulate an
educated analysis of the data that will be collected and will interpret the results
reliably.

Percentage (%) – will be used to determine the percentage ranking of each

factors in the problem.

P = f/n x 100%

Where:
P = percentage
f = frequency of respondents
n = total number of participants

Sample Questionnaire

Name:
Age:
Gender:

1. How many tobacco cigarette sticks per day did you consume before using e-
cigarette?
a. 1-5 sticks
b. 6-10 sticks
c. 11-15 sticks
d. 16 sticks and above

2. How many tobacco cigarette sticks per day did you consume after using e-
cigarette?
a. 1-5 sticks
b. 6-10 sticks
 c. 11-15 sticks
d. 16 sticks and above

3. Did e-cigarette lessen the frequency of smoking for you?

a. Yes
b. No

4. How long have you been using e-cigarette?

a. 3 months – one year
b. 13 months and up

5. What are the reasons for using e-cigarette?

a. Health
b. Cost or less expensive
c. To follow the trend
d. Peer pressure
e. Pressure of significant other

References:
http://business.inquirer.net/133335/e-cigarettes-think-again
http://en.wikipedia.org/wiki/Electronic_cigarette
http://www.philstar.com/headlines/2013/01/21/899285/e-cigarettes-not-advisable-
smokers-doh
http://www.medicalnewstoday.com/articles/249784.php
http://www.drugabuse.gov/publications/drugfacts/electronic-cigarettes-e-cigarettes
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3599549/
http://www.simplypsychology.org/operant-conditioning.html

http://psychology.about.com/od/behavioralpsychology/a/introopcond.htm
http://www.emaxhealth.com/1020/e-cigarette-smoking-cessation-rates-double-
traditional-aids
http://health.howstuffworks.com/wellness/smoking-cessation/10-facts-about-e-
cigarettes.htm
http://www.diamondbackonline.com/news/campus/article_eb688a20-9ddd-11e3-bedb-
0017a43b2370.html