Heavy metals (Cr, Pb, Cd, Ni) in aerosols emitted from electronic cigarettes sold in Malaysia.

While past studies have detected heavy metals in aerosols emitted from electronic cigarettes (ECIG), they have provided little information detailing the practical implications of the findings to the Malaysian population due to variations between products. The aims of this study were to analyse heavy metals of interest (HMOI) in the aerosols emitted from selected ECIG and to evaluate potential health risks by referring to the permissible daily exposure (PDE) from inhalational medications defined by the United States Pharmacopeia Chapter 232. All four HMOI were detected in aerosols emitted from the selected ECIG in Sarawak. Among the four, Cr was present at the highest median levels (6.86 ng/m3), followed by Ni (0.30 ng/m3), Pb (0.19 ng/m3) and Cd (0.01 ng/m3). Five out of 100 combinations (5%) of ECIG and ECIG liquids were found to emit Cr that exceed the recommended PDE. Future studies examining more heavy metal variants, using a larger sample size and different analytical techniques to compare various ECIGs are recommended.

E-Cigarette Users' Attitudes on the Banning of Sales of Nicotine E-Liquid, Its Implication on E-Cigarette Use Behaviours and Alternative Sources of Nicotine E-Liquid.

The banning of sales of nicotine e-liquid in e-cigarette shops has been implemented in several states in Malaysia. The distribution of nicotine e-liquid can only be allowed by licensed pharmacies or registered medical practitioners. This study aimed to evaluate e-cigarette users' responses to the control policy in a cross-sectional survey of 851 e-cigarette users by utilizing a self-report questionnaire that assessed (1) attitudes on regulation policy of e-cigarette banning; (2) e-cigarette use behaviors; and (3) sources of e-liquid after the regulation policy has been implemented. Participants from the state of Selangor where the banning policy was implemented were surveyed. The majority (95.8%) opposed the banning and believed e-cigarettes should be sold to anyone aged 18 years or above as with tobacco cigarettes, only a minority believed that nicotine e-liquid should only be available for sale over the counter in pharmacy stores (14.6%) and in clinics with a doctor's prescription (11.8%). The majority (44.2%) reported that they would continue their e-cigarette use as before the banning policy, while 20% plan to completely stop e-cigarette usage without replacing it with any alternatives. The vast majority (87.9%) was still able to obtained nicotine e-liquid from e-cigarette shops in spite of the ban and the second most common source was from online purchase (63.1%). The sales of nicotine e-liquid from black-market were evidenced as many reported obtaining zero nicotine e-liquid from the black market (54.4%). Self- or home-made (30.8%) nicotine e-liquid was also reported. Majority of respondents that self-made e-liquid were from the average monthly income group (below MYR3000). Obtaining nicotine from the pharmacy was least preferred (21.4%). Provision of professional advice to nicotine e-liquid users along with the ban may lessen the likelihood of users switching to tobacco cigarettes or other nicotine alternatives. Banning of sales of nicotine e-liquid in e-cigarette shops resulted in a boom in the black market supplying nicotine e-liquid and, self- or home-made nicotine e-liquid. Enforcing regulations and monitoring black market sales is warranted. Efforts to educate e-cigarette users of the danger of sourcing nicotine e-liquid from the black market and self- or home-made nicotine e-liquid are essential.