Introduction of electronic cigarette (EC) in the global market posed a new challenge to public health experts
in terms of controlling the widespread use of the device among general population. This systematic review aimed
to explore the trend of EC use among population of adults reported in literature across multiple regions. Using
Scopus search engine and several screening strategies, specific keywords were applied in the advanced search
field and the search have yielded a total of 33 articles. The key findings include i) the existence of dual users of EC
and conventional cigarette smokers and ii) the emergence of EC users who previously never smoked reported
among adult populations. The present study suggests that future tobacco control strategies should be strengthen
in preventing the initiation of nicotine addiction among non-smoking population and established nicotine
replacement therapy instead of EC should be further promoted smokers as a method to quit smoking.
Introduction: Discrepancies of nicotine content labelling of e-liquid products has been reported and it may
have existed to circumvent legal requirements that imposes restrictions on the sale of nicotine-containing
products in the market. Mandatory labelling requirement of e-liquid products is still pending in Malaysia.
This case study aimed to examine labelling discrepancies of e-liquid refill products declared as nicotine-free
sold in e-commerce platform in Malaysia. Methods: A total of 10 Malaysian-made e-liquid refill samples
were purchased via a popular e-commerce platform available to Malaysian. The e-liquid refills were
specifically chosen because it was declared to contain zero-nicotine. Nicotine concentrations were
measured using a Gas-chromatography with flame-ionisation detector (GC-FID). Results: About 80% (n = 8)
of the purchased e-liquid samples were contained nicotine despite being declared as nicotine-free.
The average nicotine levels were 1.092 (0.989) mg/mL. Conclusion: This case study confirmed the
presence of labelling discrepancies which non-comply with the existing Malaysian Poison Act.
Such non-compliance will contribute to the sale of unrestricted nicotine products. As a result, it will increase
addiction among novice smokers because e-liquid refills declared as “nicotine free” contained nicotine.
Implementation of stringent legal requirement on the nicotine content of local e-liquid products is
urgently needed as it will support the accomplishment of Malaysian Tobacco Endgame.
Introduction: The electronic cigarette (EC) usage has raised public health concerns; whether its advantages to smok- ers as a potential smoking cessation aid have outweighed its negative health impacts among EC users. This study aims to estimate health risks associated with chemical exposures to nicotine, propylene glycol (PG) and selected To- bacco-Specific Nitrosamines (TSNAs) namely 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) and N’-nitro- sonornicotine (NNN) in e-liquids locally-manufactured in Malaysia. Methods: The health risk assessment (HRA) was performed using established guideline by the Environmental Protection Agency (EPA). The average daily dose (ADD) and lifetime average daily dose (LADD) were calculated using previously published data on chemical concentration of selected compounds and local EC usage topography data. Next, the non-carcinogenic risk (nicotine and PG) and carcinogenic risk (NNK and NNN) were calculated and denoted as total hazard quotient (HQT) and total lifetime cancer risk (LCRT) value, respectively. Results: For non-carcinogenic risk, the mean of HQT was 78.9 which falls un- der “unacceptable” risk as demonstrated by HQT value of more than 1. While for carcinogenic risk, the mean of total LCRT value was 1.54E-04 which may place EC users at risk of developing cancer resulted from exposure to selected TSNAs. Conclusion: Comprehensive HRA using currently available data of local EC usage topography and chemical evaluation of Malaysian-made e-liquids have revealed that the exposure to nicotine, PG and selected TSNAs are expected to be a significant health concern for local EC users. This finding supports the local health authority to issue a stringent health policy in considering EC as a tool for smoking cessation among heavy smokers.
Electronic Cigarette (EC) usage has been gaining acceptance in Malaysia despite its lack of analytical evidence on the chemical constituents of its liquid formulations. This study aims to evaluate the chemical concentrations of nicotine, propylene glycol (PG) and selected Tobacco-Specific Nitrosamines (TSNAs); 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) and N’-nitrosonornicotine (NNN) in e-liquids locally sourced from the Malaysian market. Methods: A total of 17 e-liquids from a variety of flavours and brands were purchased from local EC retailers in Klang Valley, Malaysia. Nicotine and PG concentrations were assessed using Gas Chromatography-Flame Ionization Detector (GC-FID) while NNK and NNN were quantified using Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS). The concentrations of nicotine and PG (mg/mL) were described in comparison with the levels indicated on the labels when present while levels of TSNAs were descriptively explained. Results: Nicotine was detected in all e-liquid samples, despite several samples being declared as nicotine-free. The average (standard deviation) level of nicotine, PG, NNN and NNK were 3.26 (1.04) mg/mL, 484.10 (98.24) mg/mL, 0.383(0.288) μg/L and 0.086 (0.057) μg/L, respectively. Labelling discrepancies (when indicated on the label) of nicotine and PG were between the range of 27%-73% and 3%-63%, respectively. Conclusion: The concentrations of nicotine and PG in local e-liquids were varied. There were evidences of labelling discrepancy in that local e-liquids. TSNAs were detected in all samples of e-liquids. This study brought forth strong evidence on the need for the implementation of regulation on e-liquid manufacturing and sales, particularly on the accuracy of labelling and licensing to protect the public health.