CHAPTER 4: RESULTS

4.1 Introduction

In this chapter, the Statistical Package for the Social Science (SPSS) version 23 was

used to analyze the data collected and the findings were discussed. The descriptive statistics

and inferential statistics were used to present the data collected in the context of study

objectives which stated in Chapter 1.

4.2 Data screening and management

After data collection, all the data collected were entered into the SPSS version 23 based

on the identification number tagged on to the questionnaire with accordance to the respondents

identify number such as 001, 002, etc. to avoid double entry. All the data was screened and

there was no missing value detected.

On the stage of data management, normality test had been done on the dependent

variables which were knowledge on electronic cigarettes and perception towards electronic

cigarettes use to determine whether the sample data had been drawn from a normally

distributed population. The normality was done to help researcher in selecting the suitable

statistical tests, which is either parametric test or non-parametric test to analyze the data. The

results of the normality test for dependent variables were shown as below in Table 4.1. From

the results, it can be concluded that the percentage of knowledge level on e-cigarette and the

perception towards electronic cigarettes use among nursing personnel and patients with

cardiopulmonary disease were normally distributed.

1
 Table 4.1 Assessment on normality of sociodemographic characteristics, percentage of knowledge on e-
cigarette and overall perception towards e-cigarette use
Conclusion
Mean Skewness ZSkewn Kurtosis ZKurto
Variables Median on
(SD) (SE) ess (SE) sis
Normality
Patient's Age (in 52.02 53 -0.605 -1.763 -0.130 -0.193 Normally
years) (7.33) (0.343) (0.674) distributed
Nursing personnel's 24.92 24 1.087 5.408 0.944 2.366 Not
Age (in years) (4.39) (0.201) (0.399) normally
distributed
Nursing personnel's 3.23 2 1.428 7.104 1.400 3.509 Not
Working Experience (3.99) (0.201) (0.399) normally
(in years) distributed
Percentage of 59.60 61.54 -0.456 -2.636 -0.801 -2.328 Normally
Knowledge Level on (26.22) (0.173) (0.344) distributed
E-cigarette
Overall Perception 3.18 3.25 -0.626 -3.618 -0.097 -0.282 Normally
towards E-cigarette (0.43) (0.173) (0.344) distributed

Note: Z Skewness = Skewness/SE; Z Kurtosis = Kurtosis/SE

4.3 Response rate

A total of 150 online questionnaires was distributed by researchers to the nursing

personnel via Email, WhatsApp, and Telegram. While a total of 48 questionnaires were

distributed by researcher to the patients through face to face. This contributes to a response rate

of 100% for the study. Thus, only 198 sets of questionnaires were able to be collected and can

be used for data analysis. Furthermore, due to Covid-19 pandemic, had restricted our

movement in collecting data among patients in UMMC and in addition, the patient’s admission

was limited in each ward, hence cause inadequate sample of patients collected.

4.4 Participants Background Characteristics

Based on Table 4.2.1, the demographic characteristics data of the nursing personnel

including nursing personnel status, gender, ethnicity, educational level, ward speciality, heard

of e-cigarette, sources of learning e-cigarette, knowledge on e-cigarette, harmfulness of e-

cigarette compared to conventional cigarette, age in years and working experience. Among 150

nursing personnel, there are 99 (66.0%) registered nurses and 51 (34.0%) are nursing students.

2
Most of the nursing personnel are female 125 (83.3%) while 25 (16.7%) of them are male.

Besides, majority of the nursing personnel are Malay 130 (86.7%) while the remaining of them

are non-Malay 20 (13.3%). Most of the nursing personnel were educated up to diploma 86

(57.3%) and higher education 64 (42.7%). Most of nursing personnel are from the medical

(pulmonary) ward 51 (51.5%) and cardiac ward 48 (48.5%). Next, only 8 (5.3%) of the nursing

personnel have never heard of e-cigarette while 142 (94.7%) of them have heard of e-cigarette.

Most of nursing personnel learn about e-cigarettes from the internet website/media

advertisement sources 104 (69.3%), social media 100(66.7%), peers 77(51.3%),

newspaper/magazines 66 (44.0%), roadside poster/ billboards 40 (26.7%) and healthcare

providers 26 (17.3%). Besides, majority of the nursing personnel have a moderate knowledge

level on e-cigarette 69 (46.0%), a little knowledge level 67 (44.7%), know nothing at all 11

(7.3%) and only 3 (2.0%) of them know a lot about e-cigarette. Next, most of nursing personnel

believe the e-cigarette is equally harmful compared to conventional cigarette 92 (61.3%), more

harmful 26 (17.3%), less harmful 22 (14.7%) and do not know 10 (6.7%). The nursing

personnel fall in the age range between 19 years to 40 years and the median age is 24 (IQR=5).

Working experience of nursing personnel fall in the range between 0 years to 16 years and

median working experience is 2 (IQR= 5). The result reported was excluding the missing data

for each characteristic.

3
Table 4.2.1 Background characteristics of nursing personnel (N=150)
Median Missing
Demographic Characteristics n (%) Range
(IQR) Data
Nursing Personnel Nursing Student 51 (34.0)
Status
Registered Nurse 99 (66.0)
Gender Male 25 (16.7)
Female 125 (83.3)
Ethnicity Malay 130 (86.7)
Non-Malay 20 (13.3)
Educational Level Up to Diploma 86 (57.3)
Higher Education 64 (42.7)
Ward Speciality Cardiac Ward 48 (48.5)
Medical (pulmonary) 51 (51.5)
Ward
Ever Heard of Have Heard 142 (94.7)
E-cigarette
Never Heard 8 (5.3)
Sources of Learning Internet 104 (69.3)
E-cigarette Websites/Media
Advertisement
Newspaper/Magazines 66 (44.0)
Healthcare Providers 26 (17.3)
Roadside 40 (26.7)
Poster/Billboards
Peers 77 (51.3)
Social Media 100 (66.7)
How much do you Nothing at all 11 (7.3)
know about e-
cigarettes?
A Little 67 (44.7)
A Moderate 69 (46.0)
Know a lot 3 (2.0)
Harmfulness of Don't Know 10 (6.7)
E-cigarette
compared to
Conventional
Cigarette
Less Harmful 22 (14.7)
Equally Harmful 92 (61.3)
More Harmful 26 (17.3)
Age (in years) 19 - 40 24 (5) 4
Working Experience 0 - 16 2 (5) 4
(in years)
Note: n = Frequency; IQR = Interquartile Range

4
 Based on Table 4.2.2, the demographic characteristics data of the patients including

gender, ethnicity, educational level, smoking status, cardiopulmonary disease status, other

medical condition status, heard of e-cigarettes, sources of learning e-cigarette, harmfulness of

e-cigarette compared to conventional cigarette, knowledge on e-cigarette and age in years.

Most of the patient’s respondents are male 39 (81.3%) while remaining of them are female 9

(18.8%). Besides, most of the patients are Malay 28 (58.3%) and non-Malay 20 (41.7%).

Majority of the patients were educated up to secondary level and the others had higher

education level 22 (45.8%). There were 22 (45.8%) of the patients currently smoker while the

remaining of them are non-smoker. All of patients were underlying cardiac diseases 48 (100%)

and only 8 (16.7%) of them were underlying respiratory disease. Next, there are some patients

underlying other diseases such as dyslipidaemia 17 (35.4%), hypertension 14 (29.2%) and

diabetes mellitus (DM) 10 (20.8%). Most of the patients have heard of e-cigarette 42 (87.5%)

while only 6 (12.5%) of them have never heard of e-cigarette. Most of patients learn about e-

cigarettes from the social media sources 30 (62.5%), peers 29 (60.4%), internet website/media

advertisement sources 22 (45.8%), newspaper/magazines 16 (33.0%), roadside poster/

billboards 11 (22.9%) and healthcare providers 2 (4.2%). Besides, majority of the patients have

a little knowledge level on e-cigarette 25 (52.1%), a moderate knowledge level 18 (37.5%),

know nothing at all 4 (8.3%) and only 1 (2.1%) of them know a lot about e-cigarette. Next,

most of patients believe the e-cigarette is less harmful compared to conventional cigarette 17

(35.4%), equally harmful 16 (33.3%), more harmful 6 (12.5%) and do not know 9 (18.8%).

The patients’ respondents fall in the age range between 35 years to 64 years and the mean age

is 52.02(SD=7.33).

5
Table 4.2.2 Background characteristics of patients (N=48)
Mean
Demographic Characteristics n (%) Range
(SD)
Gender Male 39 (81.3)
Female 9 (18.8)
Ethnicity Malay 28 (58.3)
Non-Malay 20 (41.7)
Educational Level Up to Secondary 26 (54.2)
Higher Education 22 (45.8)
Current Smokers Yes 22 (45.8)
No 26 (54.2)
Cardiopulmonary Cardiac Disease 48 (100)
Disease
Respiratory Disease 8 (16.7)
Other Diseases Hypertension 14 (29.2)
Diabetes Mellitus 10 (20.8)
Dyslipidaemia 17 (35.4)
Ever heard of E- Have Heard 42 (87.5)
cigarette
Never Heard 6 (12.5)
Sources of Internet 22 (45.8)
Learning E- Websites/Media
cigarette Advertisement
Newspaper/Magazines 16 (33.3)
Healthcare Providers 2 (4.2)
Roadside 11 (22.9)
Poster/Billboards
Peers 29 (60.4)
Social Media 30 (62.5)
How much do you Nothing at All 4 (8.3)
know about e-
cigarettes?
A Little 25 (52.1)
A Moderate 18 (37.5)
Know a Lot 1 (2.1)
Harmfulness of E- Don't Know 9 (18.8)
cigarette compared
to Conventional
Cigarette
Less Harmful 17 (35.4)
Equally Harmful 16 (33.3)
More Harmful 6 (12.5)
Age (in years) 35 - 64 52.02
(7.33)
Note: n = Frequency; SD = Standard Deviation

6
4.5 Level of knowledge on electronic cigarette and perception towards electronic

cigarette among nursing personnel and patients with cardiopulmonary diseases

4.5.1 Level of knowledge on electronic cigarette

According to Table 4.3a most of the nursing personnel (130, 86.7%) answered correct

where they agree that e-cigarettes is harmful to vaper. Besides, most of the nursing personnel

(116, 77.3%) answered correct where they agree that e-cigarette is harmful to people around

them. Most of the nursing personnel (91, 60.7%) answered correct where they disagree that e-

cigarette is healthier than conventional cigarette. There were 101 (67.3%) nursing personnel

answered correct where they agree that e-cigarette can cause cancer. However, most of the

nursing personnel (90, 60.0%) answered incorrect where they disagree and not sure that the

risk of cancer is higher for the e-cigarette user compared to conventional cigarette user. Most

of the nursing personnel (101, 67.3%) answered correct where they agree that e-cigarette

increases the risk of heart attack. Besides, most of the nursing personnel (100,66.7%) answered

correct where they agree e-cigarette increases the risk of stroke. There were 90 (60.0%) nursing

personnel answered incorrect where they disagree and not sure that the risk of getting heart

related diseases such as heart attack or stroke is higher for the e-cigarette user compared to

conventional cigarette user. Most of the nursing personnel (116, 77.3%) answered correct

where they agree that e-cigarette increases the risk of lung injury (vaping is associated lung

injury). Most of the nursing personnel (79, 52.7%) answered incorrect where they disagree and

not sure that the risk of chronic lung disease is higher for e-cigarette user compared to

conventional cigarette user. Most of the nursing personnel (120, 80.0%) answered correct

where they agree that nicotine is a harmful component of e-cigarette. Besides, most of the

nursing personnel (136, 90.7%) answered correct where they agree that e-cigarette with

nicotine has an addictive effect. Most of the nursing personnel (123, 82.0%) answered incorrect

where they agree and not sure that e-cigarette user can be addicted to the e-cigarette without

7
nicotine. The percentage of knowledge on e-cigarette among nursing personnel is

63.03(SD=24.42).

Table 4.3a Distribution of scoring on each item for knowledge on electronic

cigarettes among nursing personnel (N=150)
Rating, n (%)
Item contents
Correct Incorrect Mean (SD)
Knowledge on electronic cigarettes
K1: E-cigarette is harmful to
130 (86.7) 20 (13.3)
vaper.
K2: E-cigarette is harmful to 116 (77.3) 34 (22.7)
people around them.
K3: E-cigarette is healthier
91 (60.7) 59 (39.3)
than conventional cigarette.
K4: E-cigarette can cause 101 (67.3) 49 (32.7)
cancer.
K5: Risk of cancer is higher
for the e-cigarette user
60 (40.0) 90 (60.0)
compared to conventional
cigarette user.
K6: E-cigarette increases 101 (67.3) 49 (32.7)
the risk of heart attack.
K7: E-cigarette increases 100 (66.7) 50 (33.3)
the risk of stroke.
K8: Risk of getting heart
related diseases such as
heart attack or stroke is
60 (40.0) 90 (60.0)
higher for the e-cigarette
user compared to
conventional cigarette.
K9: E-cigarette increases
the risk of lung injury
116 (77.3) 34 (22.7)
(vaping is associated lung
injury).
K10: Risk of chronic lung
diseases is higher for e-
71 (47.3) 79 (52.7)
cigarette user compared to
conventional cigarette user.
K11: Nicotine is a harmful 120 (80.0) 30 (20.0)
component of e-cigarette.
K12: E-cigarette with
nicotine has an addictive 136 (90.7) 14 (9.3)
effect.
K13: E-cigarette user can be
addicted to the e-cigarette 27 (18.0) 123 (82.0)
without nicotine.

8
 Percentage of knowledge on 63.03 (24.42)
e-cigarettes

According to Table 4.3b most of the patients (32, 66.7%) answered correct where they

agree that e-cigarettes is harmful to vaper. Besides, most of the patients (26, 54.2%) answered

correct where they agree that e-cigarette is harmful to people around them. Most of the patients

(25, 60.7%) answered incorrect where they agree and not sure that e-cigarette is healthier than

conventional cigarette. There were 26 (54.2%) patients answered correct where they agree that

e-cigarette can cause cancer. However, most of the patients (31, 64.6%) answered incorrect

where they disagree and not sure that the risk of cancer is higher for the e-cigarette user

compared to conventional cigarette user. Most of the patients (28, 58.3%) answered incorrect

where they disagree and not sure that e-cigarette increases the risk of heart attack. Besides,

most of the patients (30,62.5%) answered incorrect where they disagree and not sure that e-

cigarette increases the risk of stroke. There were 31 (64.6%) patients answered incorrect where

they disagree and not sure that the risk of getting heart related diseases such as heart attack or

stroke is higher for the e-cigarette user compared to conventional cigarette user. Most of the

patients (27, 56.3%) answered correct where they agree that e-cigarette increases the risk of

lung injury (vaping is associated lung injury). Most of the patients (31, 64.6%) answered

incorrect where they disagree and not sure that the risk of chronic lung disease is higher for e-

cigarette user compared to conventional cigarette user. Most of the patients (32, 66.7%)

answered correct where they agree that nicotine is a harmful component of e-cigarette. Besides,

most of the patients (36, 75.0%) answered correct where they agree that e-cigarette with

nicotine has an addictive effect. Most of the patients (34, 70.8%) answered incorrect where

they agree and not sure that e-cigarette user can be addicted to the e-cigarette without nicotine.

The percentage of knowledge on e-cigarette among patient with cardiopulmonary disease is

48.88(SD=28.93).

9
Table 4.3b Distribution of scoring on each item for knowledge on electronic
cigarettes among patients with cardiopulmonary disease (N=48)
Rating, n (%)
Item contents
Correct Incorrect Mean (SD)
Knowledge on electronic cigarettes
K1: E-cigarette is harmful to
32(66.7) 16(33.3)
vaper.
K2: E-cigarette is harmful to 26(54.2) 22(45.8)
people around them.
K3: E-cigarette is healthier
23(47.9) 25(52.1)
than conventional cigarette.
K4: E-cigarette can cause 26(54.2) 22(45.8)
cancer.
K5: Risk of cancer is higher
for the e-cigarette user
17(35.4) 31(64.6)
compared to conventional
cigarette user.
K6: E-cigarette increases 20(41.7) 28(58.3)
the risk of heart attack.
K7: E-cigarette increases 18(37.5) 30(62.5)
the risk of stroke.
K8: Risk of getting heart
related diseases such as
heart attack or stroke is
17(35.4) 31(64.6)
higher for the e-cigarette
user compared to
conventional cigarette.
K9: E-cigarette increases
the risk of lung injury
27(56.3) 21(43.8)
(vaping is associated lung
injury).
K10: Risk of chronic lung
diseases is higher for e-
17(35.4) 31(64.6)
cigarette user compared to
conventional cigarette user.
K11: Nicotine is a harmful 32(66.7) 16(33.3)
component of e-cigarette.
K12: E-cigarette with
nicotine has an addictive 36(75.0) 12(25.0)
effect.
K13: E-cigarette user can be
addicted to the e-cigarette 14(29.2) 34(70.8)
without nicotine.
Percentage of knowledge on 48.88(28.93)
e-cigarettes

10
 The level of knowledge on e-cigarette among nursing personnel and the patients were

categorized into 2 groups with a cut-off point of 50%. Those who scored 50% and below has a

poor knowledge on e-cigarette and respondents who scored higher than 50% have a good

knowledge on e-cigarette. Generally, most of the respondents (128, 64.7%) have a good

knowledge on e-cigarette as shown in Table 4.4a.

Table 4.4a Level of knowledge on electronic cigarette among nursing personnel and
patients (N=198)
Knowledge Level on E-cigarette Range Score Frequency, n (%)
Poor Knowledge ≤50.0% 70 (35.4)
Good Knowledge >50.0% 128 (64.6)

Total 198 (100.0)

Note: A knowledge level on e-cigarette 50% was used as a cut-off point to determine the
level of knowledge among nursing personnel and patients with cardiopulmonary disease.

The level of knowledge on e-cigarette among nursing personnel were categorized into

2 groups with a cut-off point of 50%. Those who scored 50% and below has a poor knowledge

on e-cigarette and nursing personnel who scored higher than 50% have a good knowledge on

e-cigarette. Most of the nursing personnel (104, 69.3%) have a good knowledge on e-cigarette

as shown in Table 4.4b.

Table 4.4b Level of knowledge on electronic cigarette among nursing personnel

(N=150)
Knowledge Level on E-cigarette Range Score Frequency, n (%)
Poor Knowledge ≤50.0% 46 (30.7)
Good Knowledge >50.0% 104 (69.3)

Total 150 (100.0)

Note: A knowledge level on e-cigarette 50% was used as a cut-off point to determine the
level of knowledge among nursing personnel.

11
 The level of knowledge on e-cigarette among patients with cardiopulmonary disease

were categorized into 2 groups with a cut-off point of 50%. Those who scored 50% and below

has a poor knowledge on e-cigarette and patients who scored higher than 50% have a good

knowledge on e-cigarette. There were 24(50.0%) patients with cardiopulmonary disease have

good and poor knowledge on e-cigarette as shown in Table 4.4c.

Table 4.4c Level of knowledge on electronic cigarette among patients with

cardiopulmonary disease (N=48)
Knowledge Level on E-cigarette Range Score Frequency, n (%)
Poor Knowledge ≤50.0% 24 (50.0)
Good Knowledge >50.0% 24 (50.0)

Total 48 (100.0)
Note: A knowledge level on e-cigarette 50% was used as a cut-off point to determine the
level of knowledge among patients with cardiopulmonary disease.

12
4.5.2 Perception towards electronic cigarette

According to Table 4.5a, most of the nursing personnel (66, 44.0%) strongly agree that

the e-cigarette cannot be prescribed as medicine to quit smoking. There were 65 (43.3%)

nursing personnel agree that e-cigarette should be treated as if they are conventional cigarette.

Besides, 46 (30.7%) nursing personnel agree that e-cigarettes should only be sold in pharmacies

like other nicotine replacement therapy. (Examples: nicotine patches, gums, and lozenges).

Most of the nursing personnel (87, 58.0%) strongly agree that e-cigarette should not be sold at

any regular shops. There were 87 (58.0%) nursing personnel strongly agree that the supply of

e-cigarettes that contain nicotine should be prohibited. Most of the nursing personnel (121,

80.7%) strongly agree that e-cigarette should be prohibited to minors (below 18 years old).

Besides, most of the nursing personnel (79, 52.7%) strongly agree that e-cigarette should be

banned in Malaysia. There were 110 (73.3%) strongly agree that e-cigarette should be not be

used at smoking area. Most of the nursing personnel (82, 54.7%) agree that they have confident

with their ability to answer questions about e-cigarette. Most of the nursing personnel (70,

46.7%) strongly agree that the family members should not encourage smoker to switch e-

cigarette as it deemed safer compared to conventional cigarette. There were 73 (48.7%) nursing

personnel strongly agree that smokers are not encouraged to use e-cigarette to aid in smoking

cessation. Most of the nursing personnel (66, 44.0%) disagree that e-cigarette is the main choice

for effective quit smoking cessation. Most of the nursing personnel (71, 47.3%) disagree that

e-cigarette is more effective than normal medication therapy to quit smoking. Besides, most of

the nursing personnel (72, 48.0%) agree that e-cigarette can cause harmful effects to patient

with diabetes. Moreover, most of the nursing personnel (77, 51.3%) also agree that e-cigarette

can cause harmful effects to patient with hypertension. Most of the nursing personnel (71,

47.3%) agree and strongly agree that e-cigarette can cause harmful effects to patient with heart

problem. Most of the nursing personnel (76, 50.7%) agree that the vapours from e-cigarette are

13
harmful to other people. There were 77 (51.3%) nursing personnel strongly agree that sharing

of e-cigarette devices can cause transmission of infectious disease like tuberculosis (TB) and

Influenza. Most of the nursing personnel (68, 45.3%) agree that e-cigarette could lead to dual

use of e-cigarette and conventional cigarette. Most of the nursing personnel (77, 51.3%) agree

that e-cigarette is highly addictive. Most of the nursing personnel (68, 45.3%) agree that e-

cigarette can cause an initiation of smoking conventional cigarette. There were 80 (53.3%)

nursing personnel strongly agree that e-cigarette will cause society to treat smoking as a norm.

Most of the nursing personnel (90, 60.0%) strongly agree that it is important to discuss the

effects of e-cigarette with any person who smokes. Most of the nursing personnel (107, 71.3%)

strongly agree that they did not support their family members or friends who want to start using

e-cigarette. Most of the nursing personnel (89, 59.3%) strongly agree that they did not

recommend e-cigarette to person who is currently smoking conventional e-cigarette. Besides,

there were 64 (42.7%) nursing personnel agree that e-cigarette gives the same satisfaction as

conventional cigarette. Most of the nursing personnel (50, 33.3%) agree that e-cigarette is the

choice because it is cost effective. The overall perception towards e-cigarette use among

nursing personnel is 3.23(SD=0.40).

Table 4.5a Distribution of scoring on each item for perception towards e-Cigarettes among
nursing personnel (N=150)
Mean
Rating, n (%)
(SD)
Item contents
Strongly Strongly
disagree Agree
disagree agree
Perception on policy of electronic
cigarettes
PP1: E-cigarette cannot be prescribed
as medicine to quit smoking 6 (4.0) 22 (14.7) 56 (37.3) 66 (44.0)
PP2: E-cigarette should be treated as
if they are conventional cigarette 17 (11.3) 24 (16.0) 65 (43.3) 44 (29.3)

PP3: E-cigarette should only be sold

in pharmacies like other nicotine 42 (28.0) 32 (21.3) 46 (30.7) 30 (20.0)
replacement therapy. (Examples:
nicotine patches, gums, and lozenges)

14
PP4: E-cigarette should not be sold at 8 (5.3) 8 (5.3) 47 (31.3) 87 (58.0)
any regular shops
PP5: The supply of e-cigarettes that 3 (2.0) 12 (8.0) 48 (32.0) 87 (58.0)
contain nicotine should be prohibited
PP6: E-cigarette should be prohibited 5 (3.3) 3 (2.0) 21 (14.0) 121 (80.7)
to minors. (Below 18 years old)
PP7: E-cigarette should be banned in
8 (5.3) 18 (12.0) 45 (30.0) 79 (52.7)
Malaysia
PP8: E-cigarette should not be used at 2 (1.3) 6 (4.0) 32 (21.3) 110 (73.3)
a non-smoking area.
Perception on electronic cigarettes
use in smoking cessation
PQ1: I am confident about my ability 5 (3.3) 34 (22.7) 82 (54.7) 29 (19.3)
to answer questions about e-cigarette
PQ2: Family members should not
encourage smoker to switch to e-
4 (2.7) 23 (15.3) 53 (35.3) 70 (46.7)
cigarette as it is deemed safer
compared to conventional cigarette
PQ3: Smokers are not encouraged to
use e-cigarette to aid in smoking 3 (2.0) 24 (16.0) 50 (33.3) 73 (48.7)
cessation
PQ4: E-cigarette is the main choice 48 (32.0) 66 (44.0) 19 (12.7) 17 (11.3)
for effective quit smoking method.
PQ5: E-cigarette is more effective
than normal medication therapy to 48 (32.0) 71 (47.3) 23 (15.3) 8 (6.3)
quit smoking
PQ6: E-cigarette can cause harmful 1 (0.7) 21 (14.0) 72 (48.0) 56 (37.3)
effects to patient with diabetes
PQ7: E-cigarette can cause harmful 0 (0.0) 9 (6.0) 77 (51.3) 64 (42.7)
effects to patients with hypertension.
PQ8: E-cigarette can cause harmful 0 (0.0) 8 (5.3) 71 (47.3) 71 (47.3)
effects to patients with heart problem
PQ9: Vapours from e-cigarette are 4 (2.7) 12 (8.0) 76 (50.7) 58 (38.7)
harmful to other peoples
PQ10: Sharing of e-cigarette devices
can cause transmission of infectious
5 (3.3) 13 (8.7) 55 (36.7) 77 (51.3)
diseases like tuberculosis (TB) and
Influenza
PQ11: E-cigarette could lead to dual
use of e-cigarette and conventional 4 (2.7) 14 (9.3) 68 (45.3) 64 (42.7)
cigarette
PQ12: E-cigarette is highly addictive 2 (1.3) 13 (8.7) 77 (51.3) 58 (38.7)
PQ13: E-cigarette can cause an
initiation of smoking conventional 4 (2.7) 18 (12.0) 68 (45.3) 60 (40.0)
cigarette

15
 PQ14: I think e-cigarette will cause 4 (2.7) 10 (6.7) 56 (37.3) 80 (53.3)
society to treat smoking as a norm.
PQ15: It is important to discuss the
effect of e-cigarette with any person 1 (0.7) 2 (1.3) 57 (38.0) 90 (60.0)
who smokes
PQ16: I do not support my family
members or friends who want to start 0 (0.0) 6 (4.0) 37 (24.7) 107 (71.3)
using e-cigarette
PQ17: I do not recommend e-cigarette
to person who is currently smoking 4 (2.7) 10 (6.7) 47 (31.3) 89 (59.3)
conventional e-cigarette
PQ18: E-cigarette gives the same 11 (7.3) 38 (25.3) 64(42.7) 37 (24.7)
satisfaction as conventional cigarette.
PQ19: E-cigarette is the choice 35 (23.3) 40 (26.7) 50 (33.3) 25 (16.7)
because it is cost effective.
Overall perception towards e-cigarette 3.23
use (0.40)

According to Table 4.5b, most of the patients (18, 37.5%) strongly agree that the e-

cigarette cannot be prescribed as medicine to quit smoking, however (17, 35.4%) disagree with

the statement. There were 15 (31.3%) patients agree and disagree that e-cigarette should be

treated as if they are conventional cigarette. Besides, 13 (27.1%) patients disagree and strongly

agree that e-cigarettes should only be sold in pharmacies like other nicotine replacement

therapy. (Examples: nicotine patches, gums, and lozenges). Most of the patients (24, 50.0%)

strongly agree that e-cigarette should not be sold at any regular shops. There were 26 (54.2%)

patients strongly agree that the supply of e-cigarettes that contain nicotine should be prohibited.

Most of the patients (39, 81.3%) strongly agree that e-cigarette should be prohibited to minors

(below 18 years old). Besides, most of the patients (24, 50.0%) strongly agree that e-cigarette

should be banned in Malaysia. There were 29 (60.0%) patients strongly agree that e-cigarette

should be not be used at smoking area. Most of the patients (20, 41.7%) agree that they have

confident with their ability to answer questions about e-cigarette. Most of the patients (21,

43.8%) strongly agree that the family members should not encourage smoker to switch e-

cigarette as it deemed safer compared to conventional cigarette. There were 22 (45.8%) patients

16
strongly agree that smokers are not encouraged to use e-cigarette to aid in smoking cessation.

Most of the patients (18, 37.5%) disagree that e-cigarette is the main choice for effective quit

smoking cessation. Most of the patient (17, 35.4%) disagree that e-cigarette is more effective

than normal medication therapy to quit smoking. Besides, most of the patients (18, 37.5%)

agree and strongly agree that e-cigarette can cause harmful effects to patient with diabetes.

Moreover, most of the patients (20, 41.7%) strongly agree that e-cigarette can cause harmful

effects to patient with hypertension. Most of the patients (25, 52.1%) strongly agree that e-

cigarette can cause harmful effects to patient with heart problem. Most of the patients (21,

43.8%) strongly agree that the vapours from e-cigarette are harmful to other people. There were

21 (43.8%) patients strongly agree that sharing of e-cigarette devices can cause transmission

of infectious disease like tuberculosis (TB) and Influenza. Most of the patients (24, 50.0%)

agree that e-cigarette could lead to dual use of e-cigarette and conventional cigarette. Most of

the patients (21, 43.8%) strongly agree that e-cigarette is highly addictive. Most of the patients

(18, 37.5%) strongly agree that e-cigarette can cause an initiation of smoking conventional

cigarette. There were 22 (45.8%) patients strongly agree that e-cigarette will cause society to

treat smoking as a norm. Most of the patients (22, 45.8%) strongly agree that it is important to

discuss the effects of e-cigarette with any person who smokes. Most of the patients (29, 60.4%)

strongly agree that they did not support their family members or friends who want to start using

e-cigarette. Most of the patients (23, 47.9%) strongly agree that they did not recommend e-

cigarette to person who is currently smoking conventional e-cigarette. Besides, there were 19

(39.6%) patients disagree that e-cigarette gives the same satisfaction as conventional cigarette.

Most of the patients (17, 35.4%) disagree that e-cigarette is the choice because it is cost

effective. The overall perception towards e-cigarette use among patients with cardiopulmonary

disease is 3.04(SD=0.50).

17
Table 4.5b Distribution of scoring on each item for perception towards e-Cigarettes among
patients with cardiopulmonary disease (N=48)
Rating, n (%)
Item contents Strongly Strongly Mean
disagree Agree (SD)
disagree agree
Perception on policy of electronic
cigarettes
PP1: E-cigarette cannot be prescribed
as medicine to quit smoking 6 (12.5) 17 (35.4) 7 (14.6) 18 (37.5)
PP2: E-cigarette should be treated as
if they are conventional cigarette 7 (14.6) 15 (31.3) 15 (31.3) 11 (22.9)

PP3: E-cigarette should only be sold

in pharmacies like other nicotine 12 (25.0) 13 (27.1) 10 (20.8) 13 (27.1)
replacement therapy. (Examples:
nicotine patches, gums, and lozenges)
PP4: E-cigarette should not be sold at 1 (2.1) 15 (31.3) 8 (16.7) 24 (50.0)
any regular shops
PP5: The supply of e-cigarettes that 2 (4.2) 11 (22.9) 9 (18.8) 26 (54.2)
contain nicotine should be prohibited
PP6: E-cigarette should be prohibited 1 (2.1) 5 (10.4) 3 (6.3) 39 (81.3)
to minors. (Below 18 years old)
PP7: E-cigarette should be banned in
7 (14.6) 12 (25.0) 5 (10.4) 24 (50.0)
Malaysia
PP8: E-cigarette should not be used at 1 (2.1) 9 (18.8) 9 (18.8) 29 (60.4)
a non-smoking area.
Perception on electronic cigarettes
use in smoking cessation
PQ1: I am confident about my ability 2 (4.2) 9 (18.8) 20 (41.7) 17 (35.4)
to answer questions about e-cigarette
PQ2: Family members should not
encourage smoker to switch to e-
2 (4.2) 14 (29.2) 11 (22.9) 21 (43.8)
cigarette as it is deemed safer
compared to conventional cigarette
PQ3: Smokers are not encouraged to
use e-cigarette to aid in smoking 3 (6.3) 15 (31.3) 8 (16.7) 22 (45.8)
cessation
PQ4: E-cigarette is the main choice 13 (27.1) 18 (37.5) 10 (20.8) 7 (14.6)
for effective quit smoking method.
PQ5: E-cigarette is more effective
than normal medication therapy to 14 (29.2) 17 (35.4) 12 (25.0) 5 (10.4)
quit smoking
PQ6: E-cigarette can cause harmful 2 (4.2) 10 (20.8) 18 (37.5) 18 (37.5)
effects to patient with diabetes
PQ7: E-cigarette can cause harmful 2 (4.2) 13 (27.1) 13 (27.1) 20 (41.7)
effects to patients with hypertension.

18
PQ8: E-cigarette can cause harmful 0 (0.0) 9 (18.8) 14 (29.2) 25 (52.1)
effects to patients with heart problem
PQ9: Vapours from e-cigarette are 1 (2.1) 11 (22.9) 15 (31.3) 21 (43.8)
harmful to other peoples
PQ10: Sharing of e-cigarette devices
can cause transmission of infectious
4 (8.3) 6 (12.5) 17 (35.4) 21 (43.8)
diseases like tuberculosis (TB) and
Influenza
PQ11: E-cigarette could lead to dual
use of e-cigarette and conventional 0 (0.0) 6 (12.5) 24 (50.0) 18 (37.5)
cigarette
PQ12: E-cigarette is highly addictive 2 (4.2) 11 (22.9) 14 (29.2) 21 (43.8)
PQ13: E-cigarette can cause an
initiation of smoking conventional 2 (4.2) 11 (22.9) 17 (35.4) 18 (37.5)
cigarette
PQ14: I think e-cigarette will cause 5 (10.4) 5 (10.4) 16 (33.3) 22 (45.8)
society to treat smoking as a norm.
PQ15: It is important to discuss the
effect of e-cigarette with any person 0 (0.0) 6 (12.5) 20 (41.7) 22 (45.8)
who smokes
PQ16: I do not support my family
members or friends who want to start 0 (0.0) 9 (18.8) 10 (20.8) 29 (60.4)
using e-cigarette
PQ17: I do not recommend e-cigarette
to person who is currently smoking 3 (6.3) 8 (16.7) 14 (29.2) 23 (47.9)
conventional e-cigarette
PQ18: E-cigarette gives the same 7 (14.6) 19 (39.6) 10 (20.8) 12 (25.0)
satisfaction as conventional cigarette.
PQ19: E-cigarette is the choice 7 (14.6) 17 (35.4) 10 (20.8) 14 (29.2)
because it is cost effective.
Overall perception towards e-cigarette 3.04
use (0.50)

19
 The level of perception towards electronic cigarette among nursing personnel and

patients were categorized into 2 groups in which range score between 1.00-2.50 indicated

negative perception towards e-cigarette use while the range between 2.51-4.00 indicated

positive perception towards e-cigarette use. Most of respondents, 184 (92.9%) with score of

2.51-4.00 have a positive perception towards electronic cigarette while the respondents who

score of 1.00-2.50 have a negative perception towards e-cigarette (14, 7.1%).

Table 4.6a Perception towards electronic cigarette among nursing personnel and
patients (N=198)
Overall Perception towards
E-cigarette Range Score Frequency, n (%)

Negative Perception 1.00-2.50 14 (7.1)

Positive Perception 2.51-4.00 184 (92.9)

Total 198 (100.0)

Note: A perception towards e-cigarette use 2.50 was used as a cut-off point to determine the
perception level.

The level of perception towards electronic cigarette use among nursing personnel were

categorized into 2 groups in which range score between 1.00-2.50 indicated negative

perception towards e-cigarette use while the range between 2.51-4.00 indicated positive

perception towards e-cigarette use. Most of the nursing personnel, 144 (96.0%) with score of

2.51-4.00 have a positive perception towards electronic cigarette while the nursing personnel

who score of 1.00-2.50 have a negative perception towards e-cigarette (6, 4.0%).

Table 4.6b Perception towards electronic cigarette among nursing personnel

(N=150)
Overall Perception towards
E-cigarette Range Score Frequency, n (%)

Negative Perception 1.00-2.50 6 (4.0)

Positive Perception 2.51-4.00 144 (96.0)

Total 150 (100.0)

Note: A perception towards e-cigarette use 2.50 was used as a cut-off point to determine the
perception level among nursing personnel.

20
 The level of perception towards electronic cigarette use among patients with

cardiopulmonary disease were categorized into 2 groups in which range score between 1.00-

2.50 indicated negative perception towards e-cigarette use while the range between 2.51-4.00

indicated positive perception towards e-cigarette use. Most of the patients, 40 (83.3%) with

score of 2.51-4.00 have a positive perception towards electronic cigarette while remaining of

them who score of 1.00-2.50 have a negative perception towards e-cigarette (8, 16.7%).

Table 4.6b Perception towards electronic cigarette among patients with

cardiopulmonary disease (N=48)
Overall Perception towards
E-cigarette Range Score Frequency, n (%)

Negative Perception 1.00-2.50 8 (16.7)

Positive Perception 2.51-4.00 40 (83.3)

Total 48 (100.0)
Note: A perception towards e-cigarette use 2.50 was used as a cut-off point to determine the
perception level among patients with cardiopulmonary disease.

21
4.5.3 Tabulation of scoring per items

Table 4.7a and Table 4.7b showed a percentage of knowledge on electronic cigarettes

and overall perception towards electronic cigarette use among nursing personnel and patients

with cardiopulmonary disease.

Table 4.7a Distribution of scores for percentage of knowledge on electronic

cigarettes and overall perception towards electronic cigarettes among nursing
personnel (N=150)
Variables Mean Standard Deviation (SD)

Percentage of Knowledge on
63.03 24.42
Electronic Cigarettes

Overall Perception towards

3.23 0.40
Electronic Cigarettes Use

Table 4.7b Distribution of scores for percentage of knowledge level on electronic

cigarettes and overall perception towards electronic cigarettes use among patients
with cardiopulmonary disease(N=48)
Variables Mean Standard Deviation (SD)

Percentage of Knowledge on
48.88 28.93
Electronic Cigarettes

Overall Perception towards

3.04 0.50
Electronic Cigarettes Use

22
4.6 Sociodemographic factors associated with the percentage of knowledge level on
electronic cigarette among nursing personnel

The result of association between nursing personnel’s sociodemographic characteristics

and percentage of knowledge level on e-cigarette was shown in Table 4.8. For nursing

personnel status, the Levene’s test was p>0.05, hence equal variance between different nursing

personnel status was assumed. The p-value of the t-test was p > 0.05. Thus, the result of

independent t-test indicated there were no significance differences in percentage of knowledge

level on e-cigarette between nursing students and registered nurses, t(148) = -0.101, p = 0.920.

For educational level, the significant level of Levene’s test was p > 0.05, hence equal

variance was assumed. The p-value of the t-test was p < 0.05 indicated that there was a

significant difference in percentage of knowledge level on e-cigarette between educational

level up to diploma and higher educational level, t(148) = 2.070, p < 0.040.

For ward speciality, the significant level of Levene’s test was p > 0.05, hence equal

variance was assumed. The p-value of independent sample t-test was p > 0.05, thus, there was

no significant difference in percentage of knowledge level on e-cigarette between cardiac ward

and medical (pulmonary) ward, t(97) = 1.175, p = 0.243.

A Mann-Whitney U test was conducted to identify the difference in mean between

gender, ethnicity and ever heard of e-cigarette in terms of percentage on knowledge level on e-

cigarette. The Z-value for percentage of knowledge level on e-cigarette was -0.761 among

gender with p-value of 0.447 (p > 0.05) Hence, there is no significant difference in percentage

of knowledge level on e-cigarette between male and female nursing personnel. For ethnicity,

the z-value of percentage of knowledge level on e-cigarette was -1.410 for both malay and non-

malay with p-value of 0.159 (p > 0.05) indicated that there was no significant difference in

percentage of knowledge level on e-cigarette between malay and non-malay nursing personnel.

Meanwhile, the z-value for percentage of knowledge level on e-cigarette for ever heard of e-
23
cigarette was -1.005 in both have heard and never heard. The p-value was 0.315 (p > 0.05),

hence there was no significant difference in percentage of knowledge level on e-cigarette

between nursing personnel who have heard of e-cigarette and never heard of it.

Table 4.8 Association between nursing personnel’s' sociodemographic characteristics and

percentage of knowledge on electronic cigarette (N=150)
Mean Mean
Demographic Characteristics n t/F df Z-value p-value
(SD) Rank
Nursing Personnel Status -0.101t 148 0.920
Nursing Student 51 62.75
(23.85)
Registered Nurse 99 63.17
(24.82)
Gender -0.761m 0.447
Male 25 69.50
Female 125 76.70
Ethnicity -1.410m 0.159
Malay 130 77.45
Non-Malay 20 62.82
Educational Level 2.070t 148 0.040*
Up to Diploma 86 66.55
(24.80)
Higher Education 64 58.29
(23.25)
Ward Speciality 1.175t 97 0.243
Cardiac ward 48 66.19
(25.87)
Medical (pulmonary) ward 51 60.33
(23.70)
Ever heard of e-cigarette -1.005m 0.315
Have heard 142 76.34
Never heard 8 60.56

24
 A Spearman’s rank-order correlation was computed to determine the relationship

between percentage of knowledge level on e-cigarette and nursing personnel’s age. The result

was shown in Table 4.10, indicated that there was no significant correlation between the two

variables, rs = -0.056, n = 150, p = 0.501.

Table 4.10 Spearman’s correlation between percentage of knowledge on e-cigarette and

nursing personnel’s age (in years) (N=150)
Strength of Correlation
Probability (p)
Spearman’s (rs)
Percentage of knowledge Age -0.056 0.501
level on e-cigarette

A Spearman’s rank-order correlation was computed to determine the relationship

between percentage of knowledge level on e-cigarette and nursing personnel’s working

experience. The result was shown in Table 4.11, indicated that there was no significant

correlation between the two variables, rs = -0.058, p = 0.487.

Table 4.11 Spearman’s correlation between percentage of knowledge on e-cigarette and

working experience (N=150)
Strength of Correlation
Probability (p)
Spearman’s (rs)
Percentage of knowledge Working -0.058 0.487
level on e-cigarette Experience

25
4.5 Sociodemographic factors associated with the level of perceptions towards electronic
cigarette use among nursing personnel

The results of association between nursing personnel’s sociodemographic

characteristics and overall perception towards e-cigarette was shown in Table 4.12. Comparing

the nursing personnel status, the Levene’s test was p > 0.05, hence equal variance was assumed.

The p- value for the test was more than 0.05. thus, results of independent t-test indicated that

there was no significant difference in overall perception towards e-cigarette between nursing

student and registered nurse, t(148) = -0.553, p = 0.581.

For educational level, the equal variance was assumed with significant level of

Levene’s test of p > 0.05. The independent t-test indicated that there was no significant (p >

0.05) difference in overall perception towards e-cigarette between educational level up to

diploma and higher educational level, t(148) = 0.063, p = 0.950.

For ward speciality, the significant level of Levene’s test was p = 0.931, which is p >

0.05, hence equal variance was assumed. The p-value of the independent sample t-test was p >

0.05, which it indicated that there was no significant difference in overall perception towards

e-cigarette between nurses’ whose working in cardiac ward or medical (pulmonary) ward, t(97)

= 1.260, p = 0.211.

A Mann-Whitney U test was conducted to identify the difference in mean between

gender, ethnicity and ever heard of e-cigarette in terms of overall perception towards e-cigarette.

The Z-value for overall perception towards e-cigarette was -1.157 among gender with p-value

of 0.247, which p > 0.05, indicate that there was no significant difference in overall perception

towards e-cigarette between male and female nursing personnel. In a meanwhile, for ethnicity,

the Z-value of overall perception towards e-cigarette was -0.017 for both malay and non-malay

with p-value of 0.987 (p > 0.05). Thus, there was no significant difference in overall perception

towards e-cigarette between those malay and non-malay nursing personnel. Other than that, for
26
ever heard of e-cigarette, the result had shown the Z-value of -1.970 in overall perception

towards e-cigarette in both have and never heard of e-cigarette. The results indicated that there

was a significant difference in overall perception towards e-cigarette between nursing

personnel who have heard of e-cigarette and never heard of it with p-value of 0.049 (p < 0.05).

Table 4.12 Association between nursing personnel’s sociodemographic characteristics and overall
perception towards electronic cigarette (N=150)
Mean Mean
Demographic Characteristics n t/F df Z-value p-value
(SD) Rank
Nursing Personnel Status -0.553t 148 0.581
Nursing Student 51 3.21
(0.32)
Registered Nurse 99 3.24
(0.43)
Gender -1.157m 0.247
Male 25 66.32
Female 125 77.34
Ethnicity -0.017m 0.987
Malay 130 75.48
Non-malay 20 75.65
Educational Level 0.063t 148 0.950
Up to Diploma 86 3.23
(0.41)
Higher Education 64 3.23
(0.38)
Ward Speciality 1.26t 97 0.211
Cardiac Ward 48 3.30
(0.44)
Medical (pulmonary) Ward 51 3.19
(0.42)
Ever heard of e-cigarette -1.970m 0.049*
Have heard 142 77.16
Never heard 8 46.06

27
 A Spearman’s rank-order correlation was computed to determine the relationship

between overall perception towards e-cigarette and nursing personnel’s age. The result was

shown in Table 4.14, indicated that there was no significant correlation between the two

variables, rs = 0.022, p = 0.788.

Table 4.14 Spearman correlation between overall perception towards e-cigarette and age
among nursing personnel (N=150)
Strength of Correlation
Probability (p)
Spearman’s (rs)
Overall perception Age 0.022 0.788
towards e-cigarette

A Spearman’s rank-order correlation was computed to determine the relationship

between overall perception towards e-cigarette and nursing personnel’s working experience.

The result was shown in Table 4.15, indicated that there was no significant correlation

between the two variables, rs = 0.001, p = 0.994.

Table 4.15 Spearman correlation between overall of perception towards e-cigarette and
working experience among nursing personnel (N=150)
Strength of Correlation
Probability (p)
Spearman’s (rs)
Overall perception Working 0.001 0.994
towards e-cigarette Experience

4.6 Relation between knowledge and perceptions towards electronic cigarette among
nursing personnel

A Pearson’s product moment correlation coefficient was computed to determine the

relationship between percentage of knowledge level on e-cigarette and overall perception

towards e-cigarette. The result was shown in Table 4.16, indicated that there was a

significantly weak, positive correlation between the two variables, r = 0.256, p = 0.002.

Table 4.16 Pearson product moment correlation between percentage of knowledge level on e-
cigarette and overall perception towards e-cigarette among nursing personnel (N=150)

28
 Strength of Correlation Probability
Pearson (r) (p)

Percentage of knowledge Overall perception 0.256 0.002*

level on e-cigarette towards e-cigarette
Note: Correlation is significant at the level 0.01 (2-tailed)

4.8 Summary

In short, we had received 198 sets of questionnaires were analysed by using Statistical

Package Social Science (SPSS) version 23. Normality test was done on the dependent variables

which were percentage of knowledge level on e-cigarette and overall perception towards e-

cigarette, and all the data was normally distributed.

Independent t-test, Mann-Whitney U test, One-way ANOVA, Welch ANOVA,

Spearman’s correlation, and Pearson’s correlation test were conducted to determine the

association between dependent variables and nursing personnel’s sociodemographic

characteristics. Most of the characteristics was not significantly associated with percentage of

knowledge level on e-cigarette and overall perception towards e-cigarette, except for

educational level and ever heard of e-cigarette. There was a significantly weak, positive

correlation between the percentage of knowledge level on e-cigarette and overall perception

towards e-cigarette.

29