A RESEARCH ON SMOKERS AWARENESS OF ELECTRONIC CIGARETTES AS A LESS HARMFUL ALTERNATIVE TO SMOKING

A Research Paper Submitted In Partial Fulfillment of the requirements in ENG103

Submitted to: DR. TARA DONOZO Faculty, Department of English College of Arts and Sciences University of Asia and the Pacific

Submitted by: GABRIEL ANGEL V. DE VERA October 8, 2012

Abstract This study aims to discover the awareness level of smokers on electronic cigarettes as a healthier alternative to smoking traditional cigarettes. Smoking cigarettes is a harmful vice that can often lead to death. Electronic cigarettes are a battery powered device that produce vapor instead of smoke. There is a need to see how aware smokers are to this alternative, so they may be able to smoke in a less harmful way. Chapter 1 describes the basic terms, significance of the study and review of related literature. Chapter 2 illustrates how the researcher gathered his data and tabulated his results, as well as who the respondents were. Chapter 3 presents the findings of the researcher and his interpretation. Chapter 4 gives the over-all summary of the research, the researchers conclusions and his recommendations for the study.

TABLE OF CONTENTS Chapter 1 THE PROBLEM AND A REVIEW OF RELATED LITERATURE Introduction.5 Review of Related Literature...8 On Cigarettes..8 On Electronic Cigarettes14 Conceptual Framework16 Statement of the Problem.16 Scope and Limitation of the Study..16 Significance of the Study.16 Definition of Terms...17

Chapter 2 METHOD Research Design...19 Research Participants and Other Sources of Data....19 Research Instruments....20 Data-Gathering Procedure.....20

Chapter

4 3 PRESENTATION AND INTERPRETATION OF FINDINGS Age of Respondents..21 Number of Years the Respondents have been Smoking21 Age when Respondents Started Smoking..23 Why Respondents Started Smoking...24 Estimate on How Much Respondents have Spent on Smoking..24 Belief of Negative Effects of Respondents on their Health25 Desire to Indulge Habit in a Healthier Way25 Awareness of Alternatives to Smoking...26 Preferred Alternative of Choice..27

Chapter 4 SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS Summary...29 Conclusions...31 Recommendations.32

REFERENCES APPENDICES

Chapter 1 THE PROBLEM AND A REVIEW OF RELATED LITERATURE Introduction Smoking has been a part of mans life since it was discovered. People smoke for many reasons, among them are peer pressure, to look cool, to relieve stress and to help in the digestive process. Due to these reasons, people have formed the habit of smoking, and, as we know, habits are very hard to break. Unfortunately smoking is a very bad habit, and is very dangerous not only for the smoker; but for those around him/her.

Studies have shown that the chemicals used in cigarettes can cause different kinds of cancer. It is interesting to note that despite warnings from doctors and health organizations, people continue to smoke. However there are alternatives now, to help people either reduce the amount of cigarettes they smoke in a day; or help them quit altogether. These inventions are the nicotine patch, tobacco gum, nicotine pills, therapy; and the latest being electronic cigarettes.

The researcher was very interested in this study because he was a smoker and had been smoking two packs a day for eleven years. After much consideration and a few computations, the researcher discovered that he had already spent three hundred thousand pesos at the very least. The reasons why he developed this bad habit are: to look cool, peer pressure and to socialize with others. Most people start out the same way.

6 The researcher realized at some point that this could not go on. He was wasting money and time and destroying his health in the process. Even those around him were affected by the second and third hand smoke that he emitted. He wanted a healthier lifestyle, but he had a hard time quitting. He did not want to try other smoking cessation methods because he knew that none of them would address the oral fixation that he had developed over the years with smoking.

Then the researcher discovered electronic cigarettes being sold in Greenhills and Megamall. He thought that this product might be able to help him smoke in a less harmful manner, if not totally quit. He know did not know much about the great health differences of ecigs and regular cigarettes at that time. In fact, after only two weeks of smoking, the researchers dentist already saw the difference and asked him if he had quit smoking because his teeth had reduced nicotine stains. This experience motivated the researcher to focus on the e-cigs as a less harmful alternative to smoking regular cigarettes. Hence, he decided to do his paper on this new invention.

Before anything else, we need to define the word. Electronic cigarettes resemble traditional cigarettes or cigars. They are battery-powered devices designed to convert liquid to vapor, emit and deliver the vapor to the user. The user can opt to have flavored vapor, or traditional tobacco brands. The prices range from one thousand five hundred to twenty thousand pesos, depending on the model. While it is initially expensive, the long-term benefits are numerous.

7 After two weeks of using e-cigs, the researcher noticed that he felt better and could do more exercise. Aside from that he also slept better at night, food tasted so much better, and he didnt reek of the smell of cigarettes. The people around him were not disturbed by the vapor he emitted.

The reason the researcher chose this topic is because he believes that the electronic cigarette can become a less harmful alternative for those who cannot let go of smoking, but who want to be healthy. While it is something relatively new and needs further study, the results of the current studies show a lot of promise. It is therefore worthwhile to find out how aware smokers are that electronic cigarettes are a less harmful alternative to smoking.

REVIEW OF RELATED LITERATURE

This is a review of related literature in the following: (A) On Cigarettes, and (B) On Electronic Cigarettes. On Cigarettes Cigarette smoking is known to be the most potent nicotine delivery device of tobacco addiction. Tobacco is the worlds deadliest drug, and it is highly addictive. In the United States alone about four hundred forty three thousand (443,000) die annually from tobacco related diseases that can be prevented (Kushner, Sunaya, Nidhi & Paintal, 2011). Cigarettes are made of about four thousand chemicals, fifty-one of them are known carcinogens (Kushner et al., 2011).

According to The National Institute of Drug Abuse (NIDA)The cigarette is a very efficient and highly-engineered drug delivery system. (Tobacco Addiction, 2009.) The most addictive substance in a cigarette is nicotine. But what makes the cigarette deadly, are all the other chemicals that it is composed of. Some of the other chemicals found in a cigarette as according to Jacobs (1995) are tar and carbon monoxide.

It is also important to note that 24.2 percent of Americans have started smoking within their teenage years, as early as 12 years old (NIDA, 2009). In 2007, NIDA conducted a survey of more than 3 million American adolescents (aged 12-17) who were reported to have been using a

9 tobacco product the month before the survey. Studies have shown that cigarette smoking with teens is a result of psychosocial influences like peer pressure (NIDA, 2009).

Nicotine, in its purest form, can kill a person with one drop. It is commonly found in bug sprays as well. Nicotine is also a highly addictive substance that stimulates the brain (Jacobs, 1995; NIDA, 2009.).

Jacobs (1995) research explains that, Tar is the oily material which remains after tobacco passes through the filter. When a smoker inhales, a lot of the tar sticks to and blackens the lungs.

Carbon monoxide on the other hand is a gas that is emitted by cars and interferes with respiratory functions (Jacobs, 1995). These are only three of the four thousand plus chemicals that constitute a cigarette. From a birds eye view, it is difficult to understand why a person would smoke. Taking a quick look at how smoking delivers its effects would paint a better picture.

NIDA (2009) has explained that By inhaling tobacco smoke, the average smoker takes in 1-2 mg of nicotine per cigarette. When tobacco is smoked, nicotine rapidly reaches peak levels in the bloodstream and enters the brain. A typical smoker will take 10 puffs on a cigarette over a period of 5 minutes that the cigarette is lit. Thus, a person who smokes about 1 packs (30 cigarettes) daily gets 300 hits of nicotine to the brain each day. NIDA (2009) further explains that immediately after exposure to nicotine, there is a kick caused in part by the drugs

10 stimulation of the adrenal glands and resulting discharge of epinephrine (adrenaline). The rush of adrenaline stimulates the body and causes an increase in blood pressure, respiration, and heart rate.. The problem with smoking is that, not only is the smoker getting the positive and negative effects, but so are those around him/her.

There are enormous health risks to the smoker, those who inhale the smoke through secondhand smoke, and those who come in contact with third-hand smoke (Kuschner et al., 2011). A brief definition of second and third -hand smoke will give us a better understanding of what they are.

Goldman et al. (2010) argues that secondhand smoke is the complex aerosol of which 85% comes from the burning tip of a cigarette and 15% from the smokers who exhale it This smoke is passed on to those who are within the immediate vicinity of the smoker.

Third-hand smoke, on the other hand, is the long lasting effect in an area where smoking occurred, but has not had any cigarette smoking for a long time. Third-hand smoke is the cause of the negative effects considered on long-term scale (Kuschner et al., 2011). There are a wide range of hazards, diseases and chronic illnesses available to those who smoke as well as those who are victims of second and third-hand smoke.

According to Stanley Pontiere (n.d.) Cigarette smoke is dangerous to both smokers and non-smokers. Cigarette smoking causes many types of cancer. It can also affect the

11 reproductive system of the woman according to the American Cancer Society (2011). Smoking is commonly known to also cause emphysema, lack of respiratory function and loss of taste.

Most smokers know that tobacco is harmful and want to either reduce or quit. The difficulties are enormous, due to the withdrawals and the cravings. However, there are means that smokers can use to quit smoking. Some of these are: nicotine patch, nicotine pill and tobacco gum (NIDA, 2009.)

The consequences of smoking are common knowledge, but there is a constant need to reiterate them. NIDA (2009) claims that: Cigarette smoking harms nearly every organ in the body. It has been conclusively linked to cataracts and pneumonia, and accounts for about one-third of cancer deaths. The overall rates of death from cancer are twice as high among smokers as nonsmokers, with heavy smokers having rates that are four times as high as nonsmokers. Foremost among the cancers caused by tobacco use is lung caner-cigarette smoking has been linked to about 90 percent of all cases of lung cancer, the number one cancer killer of both men and women. Smoking is also associated with cancers of the mouth, pharynx, larynx, esophagus, stomach, pancreas, cervix, kidney, bladder, and acute myeloid leukemia. (p. 78) There are available alternatives or cessation tools for smokers that are currently approved by the FDA. Some of these are: nicotine patches, nicotine pills and tobacco or nicotine gum (NIDA, 2009). A nicotine patch is attached to a part of the body to deliver nicotine via the skin pores. The pills are ingested so as to curb cravings and make smoking distasteful. The gum tries to soothe the cravings at the same time deliver nicotine (NIDA, 2009).

12

On Electronic Cigarettes The Electronic Cigarette or e-cig is a battery-powered device, designed to deliver nicotine to the human respiratory system via vapor (Caponetto, Polosa, Russo, Leotta & Campagna, 2011). According to a group of researchers (Kuschner et al., 2011) it has also been termed as Electronic Nicotine Delivery System (ENDS) by the World Health Organization . Instead of using tobacco, the e-cig uses a e-liquid that is converted into vapor.

According to Foulds et al. (2011), the e-cig was invented by the Chinese pharmacist Hon Lik in 2003. He wanted to provide a healthier option for smokers, as well as save his father from lung cancer in the process. Patents are currently held by the Ruyan company. The e-liquid is mainly composed of propylene glycol (PG). But there are other additives that can change the thickness and flavor of the vapor. Due to the nature of what is being emitted, people who use e-cigs are not called smokers.

For Foulds, Veldheer and Berg (2011), people who use electronic cigarettes are called vapers. They do not want to be associated with smokers and smoking, so they have called themselves as vapers. This has given rise to the more advance e-cigs known as Personal Vaporizer or PV.

13 PVs are a more customizable e-cigs that are larger in size with varying battery sizes to produce higher voltage. In a study conducted, the researchers (Foulds et al., 2011) found out that those who use the PVs are usually long time (at least 10 months) e-cig users. There are many advantages to e-cigs, and there are also some disadvantages. A quick look should present the general idea.

Some of the immediate advantages of the e-cigs are that they emit vapor and not smoke. It disappears rapidly and does not cling onto clothes or other substances, making sure that there is no secondhand and third-hand smoke. There are a variety of flavors and the nicotine levels can be customized. It can also address the oral fixation, which other tobacco or nicotine alternatives dont.

There are also disadvantages. First of all, it is initially expensive. Secondly, there have been no long-term studies. Lastly, if the vaper or an infant were to ingest the e-liquid containing nicotine, it could prove fatal.

14

Conceptual Framework

The researcher, through a survey questionnaire, decided to look into the personal factors of the respondents such as the age they started smoking, the number of years they have been smoking and how much money these respondents have already spent over the number of years they have been smoking.

It would be safe to conclude that if a person started smoking at a young age, he would not only become addicted to it but he may also begin to feel the negative effects of smoking like severe coughing, asthma attacks, weak respiratory system, predisposition to respiratory ailments, and even cardiac problems. If smoking has become a habit, then it would be one that will be difficult to break. The many years of smoking does take its toll on a smokers health. And this can result in even more fatal diseases such as cancer, heart attacks etc. and, ultimately, death.

While a pack of cigarettes may not be as cheap as they used to be, they are still, more or less, affordable. In a country where they can be bought by the piece or stick, the availability of the product is never a problem. Hence, precisely because the item is affordable or within ones budget, a person never truly realizes just how much he has spent until he takes the time to compute how much money he has spent on this bad habit over the years.

15 Aside from wanting to know if the respondents were aware of the negative effects of smoking on their health, the researcher wanted to know if they were willing to try out other less harmful alternatives. Since smoking is a lucrative industry and because many business-minded individuals would like to take advantage of the situation, there are many products in the market that are presented as less harmful alternatives to smoking regular cigarettes. There are also products that were created to help the smoker either curb or totally break the habit. Some well known examples are nicotine patches and pills, tobacco gum and the electronic cigarettes. The latter appear to be the latest invention now available in the market.

The researcher wanted to find out if the awareness of the respondent to these products would induce him to try any one of them as well as his reasons for doing so.

Conceptual Paradigm

16

Statement of the Problem This research paper aims to find out if smokers are aware that electronic cigarettes are a less harmful alternative to smoking regular cigarettes. Specifically it seeks to answer the following questions: 1. Do most smokers know the harmful effects of smoking on their health? 2. How aware or familiar are they with electronic cigarettes? 3. How aware are they that electronic cigarettes are a less harmful alternative to smoking regular cigarettes?

Scope and Limitations of the Study The respondents of this study were 50 individuals ranging from ages younger than 16 years old and over 60 years old. A researcher-made questionnaire was distributed for the respondents to answer. Some of the respondents are students of a prestigious university in Ortigas, Pasig across all year levels. Other respondents are call-center agents from a wellknown multinational company. All data was tallied by a computer program designed by the researcher.

Significance of the Study The results of the study may be beneficial to the following: To all smokers. Smoking is a bad and harmful habit, and we know that habits are very hard to break. Many of the negative effects of smoking are lethal therefore, there is a need to

17 look for a less harmful alternative if indeed it is difficult to break the habit. The researcher hopes that smokers will explore these alternatives.

To parents who smoke. Children tend to imitate what their elders do, most especially their parents. For their sake, there should be awareness of lethal effects of second and third-hand smoke. Hence, electronic cigarettes may just be the answer to the problem of the harm that regular cigarettes deliver.

To the public in general. The effects of second and third-hand smoke cannot be underestimated, since this has been proven to be just as harmful or if not more lethal than first-hand smoke.

To the future researchers. That they will be interested to do a long term cigarette to confirm the validity of electronic cigarettes as being less harmful, and its non-lethal effects, whether on a long or short term basis.

Definition of Terms For the purpose of clarity and a better understanding of concepts and terms used in this study, the following are defined in their conceptual and operational use: Cigarettes. Are rolled from tobacco leaves and contain more than 4000 chemicals, 51 of which are known carcinogens (Jacobs, 1995). Cigarette Smoking. The act of smoking cigarettes Tobacco addiction. An addiction of a tobacco product such as cigarettes, cigars etc..

18 Nicotine addiction. The psychological effect of being addicted to any form of nicotine. Prolonged use or an urge to use a nicotine product that cannot be resisted (National Institute of Drug Addiction [NIDA], 2009). First-hand smoke. The smoke that the smoker inhales. Second-hand smoke. The smoke that the smoker emits, which is also harmful to those around him or her (Goldman et al., 2010). Third-hand smoke. The substance that remains in an area, piece of clothing of any material substance that can pass on the harmful effects of cigarettes or tobacco. These effects can be evaluated or observed on a long term basis (Kuschner et al., 2011). Nicotine patch. A patch that is stuck on any part of the body to deliver nicotine only (NIDA, 2009). Tobacco gum. A chewing gum with tobacco or nicotine only. Nicotine is delivered by chewing and then the gum is spat out after (NIDA, 2009). Nicotine pill. A pill that is ingested to replace nicotine and/or curb the cravings for traditional tobacco products (NIDA, 2009). Electronic cigarettes. The Electronic Cigarette or e-cig is a battery-powered device, designed to deliver nicotine to the human respiratory system via vapor (Caponetto, Polosa, Russo, Leotta & Campagna, 2011).

19 Chapter 2 METHOD Research Design

The research design that was used was a quantitative one. A questionnaire, which was constructed by the researcher, was reviewed and approved by his professor before it was distributed to a cross section of society. This method was used to be able to find out how many smokers were aware of the different alternatives that are currently in the market which may be less harmful than regular cigarettes.

Research Participants and Other Sources of Data

The researcher distributed eighty ( 80 ) questionnaires at random to two sources namely: students from the University of Asia and the Pacific, Ortigas Center, Pasig City from all year levels and programs and call center agents and supervisors from IBM-CRM located at Hanston Square, Pasig City. Before filling out the questionnaire, the respondents were first asked if they smoke. Out of the eighty ( 80 ) questionnaires that were distributed, the researcher was able to retrieve fifty ( 50 ).

20

Research Instrument

As mentioned earlier, a survey questionnaire ( see appendix

_ ) was constructed then

submitted to the researchers professor for possible revisions and approval. There were nine questions which the respondents had to answer. The first seven focused on the following : the respondents age, the number of years they were smoking, how old they were when they first began to smoke, the reasons for smoking, how much they have spent on the habit over the years, how aware they are about its negative effects on their health and, if given a chance, would they want to be able to continue smoking in a less harmful way. The last two questions focused on the following : if the respondents have heard of alternatives to smoking regular cigarettes and which of the four alternatives listed on the survey sheet were they willing to try. They were also asked their reasons for the choice/s that they made.

Data Gathering

The researcher distributed and managed half of the questionnaires himself and requested trusted friends and classmates to distribute and manage the other half. More than half of the survey sheets were retrieved a week after they were distributed which was on August 20, 2012. The rest were retrieved by the end of September 2012. After gathering the questionnaires, the researcher created a computer program using the JAVA programming language to double check hand tallied results thereby ruling out human error. After the data was tallied and processed, it was interpreted.

21 CHAPTER 3 PRESENTATION AND INTERPRETATION OF FINDINGS

Research Problem: How aware are smokers that electronic cigarettes are a less harmful alternative to smoking? People are aware that there are less harmful alternatives to cigarette smoking. Cigarette smoking is nothing more than a tobacco and/or a nicotine addiction. Therefore, people are open to the possibility of trying out alternatives to either curb or break the habit of smoking traditional cigarettes. But most would prefer to continue smoking in a healthier fashion. Among the four alternatives presented, the most prominent choice is the electronic cigarettes hereafter after referred to as e-cigs. From 50 respondents, 36 have said that they are willing to try the electronic cigarettes. Age of Respondents The first question the respondents were asked was their age. Most of the respondents were between 16-60, as 38 of them claimed as such. Only 6 were below 16, and only 6 were above 60. This would suggest that those under 16 years of age have just begun to smoke, while those who are between 16-60 have been smoking for either just a few years or decades. While those above 60 must have been smoking for close to half a century. The National Institute of Drug Abuse (NIDA) confirms that smoking starts 90% of the time during the adolescent years and can continue well into old age (National Institute of Drug Abuse [NIDA], 2009). Number of Years the Respondents have been Smoking Out of 50 respondents, 20 have said that they have been smoking from between 1-9 years. This would mean their addiction can still be broken, or re-directed to something less

22 harmful. Another 10 respondents claimed to have been smoking for less than a year. Which means that they are not yet even past the dizziness of smoking. The researcher claims to have forced himself to smoke for at least 1 year. During that time, he had to bear with nausea that comes from smoking. This is normal for those who are still developing the habit. Another 14 respondents admitted that they have been smoking between 10-20 years, while another 6 said that they have been smoking for over 20 years. In comparison to those who have been smoking less than 10 years, those who have been smoking for a longer time may have either a harder or easier time shifting. It may be harder because their bodies have already developed dependency not only on nicotine, but also the psychological facets of smoking. The cravings and withdrawal effects could also be much greater because of the prolonged dependency of the body on nicotine (NIDA, 2009). It could also be easier in the researchers opinion in the sense that those who have been smoking for a longer period might want something healthier since they have noticed the negative effects on their health.

23 Age when Respondents Started Smoking When asked how old the respondents were when they started smoking, the respondents had varied answers. The researcher felt it would be better illustrate his findings. See Figure 1.

Figure 1: Age of respondents when they started smoking

24 Those who started smoking may have either entered high school early or found the influence of smoking to be appealing at such an early age. The bulk of the respondents were 15 when they started smoking. It could suggest that these respondents were either caught by peer pressure, or simply found that this was a habit that could help them in some aspect of their life. For those who started at 16-8, it may be assumed that they were just about to enter college, and had not yet come across cigarettes. The respondents who started at the age of 20 and above, were clearly adults who must have found a great need to start smoking. As compared to those who were younger and more experimental, these respondents most likely made an informed decision, or a badly informed decision. Why Respondents Started Smoking When asked why they started the habit, 14 respondents wrote that they started to smoke in order to relieve stress. 17 claimed that smoking just developed into a habit, 3 became addicted to nicotine and 2 began the habit to look cool. It is interesting to note that only 6 respondents claimed that it was peer pressure that made him start smoking, and another 5 claimed that they did it out of curiosity. It is interesting to note once again that the majority of the respondents admitted that it just developed as a habit and that the next largest group of respondents said that stress was the cause of their smoking habit. Prior to this research, the writer of this paper presumed that the majority of respondents would claim that the reason they started to smoke was due to peer pressure. The fact that the majority of the respondents answered it became a developed habit and stress reliever, is something the researcher found thought provoking. Because in his experience it was more stressful to develop the habit of smoking. Smoking only became a stress reliever after the habit had developed. It could be possible that these respondents were told that smoking relieves stress, and thus they based their reasoning for developing this

25 habit on that presumption. It was also quite strange to note that the respondents who claimed that smoking developed into a habit did not bother to reflect on why smoking became a habit. To simply claim that something develops into a habit, may suggest that one does not understand his or her reason for the habit itself. Because as NIDA has shown in their studies, almost all teenage smoking cases begin with psychosocial issues such as peer pressure or curiosity (NIDA, 2009). It can be observed that only 7 respondents started smoking after their adolescent years. Estimate on How Much Respondents have Spent on Smoking When asked to estimate how much they had already spent on the habit of smoking through the years, the range was quite large. Since it spanned from Php 1000 to Php 3,000,000. But the majority were in a tie with regard to the amount. Six of them say Php5000 while another six said Php100,000. It is obvious that the ones who have just started smoking have not spent that much. However, those who have been smoking for many years have a greater expenditure on the vice. The reason this question was posed is because the researcher wanted to ascertain if the respondents were aware of the great amount of money gradually spent over the years. Belief of Negative Effects of Respondents on their Health When the respondents were asked if they believed that smoking cigarettes that has had negative effects on their health, 42 respondents have said that they are aware of some form of negative effects on their health, while only 8 said no. It is clear that the majority of the respondents are fully aware of the dangers and potentially harmful effects of smoking. The 8 who said no, are either individuals who may be in denial or are not engaged in any physical activity that requires strenuous cardiovascular or pulmonary functions. Most respondents who affirmed belief of the negative effects of their habits stated that their belief was physically confirmed by mostly respiratory problems like: bad lungs, persistent cough and cold, bad breath,

26 loss of appetite, pain in the lungs, difficulty of breathing, asthma attacks etc. It is not uncommon for smokers to be aware to the negativity of their habits and persist in smoking. NIDA has shown statistically that almost all, if not all smokers are aware of the risks and potentially lethal repercussions of the habit (NIDA, 2009). The researchers initial presumption that smokers are aware of the negative effects of smoking cigarettes was confirmed. Desire to Indulge Habit in a Healthier Way The majority of 50 respondents (45 of them) stated that they would like to be able to indulge in their habit in a less harmful way. While again, only five respondents specified that they would like to continue smoking regularly. Desire to Indulge Habit in a Healthier Way When asked why they would like to look for a less harmful alternative, it is interesting to note that none of the respondents mentioned the desire to limit the negative effects of second and third-hand smoke. It may be safe to conclude that the respondents are not yet aware of the new phenomenon of third-hand smoke (Kuschner et al., 2011) .We may also safely conclude that the respondents either underestimate the negative effects of second-hand smoke or disregard them completely (NIDA, 2009). This sort of behavior would suggest that smokers are less concerned with those who are affected by their vice. This behavior is a common trait seen in any form of addiction (NIDA, 2009). However, for the reasons of the respondents as to why they would like to seek a less harmful alternative, the common reasons that were stated are: they would like to have a better lifestyle, so they can keep smoking, they would like to regain their stamina and get rid of their persistent cough and cold. Some of those who have claimed to want to choose a healthier alternative have also expressed their desire to prevent diseases that can lead to death, such as cancer. This would once again confirms what NIDA (2009) said about smokers; that they

27 are aware that cigarettes can cause cancer and other harmful and lethal diseases. It would be safe to conclude that those who prefer a less harmful alternative would like to have a healthy lifestyle as well as continue their vice. Awareness of Alternatives to Smoking Thirty-six (36) respondents have said that they are aware of healthier alternatives to smoking regular cigarettes, while 14 have said no. Among the 36 who said yes, the alternatives they were aware of were quite varied and strange. Most of the answers were, eating pork, eating chips, chewing gum and many more which were not actual suggested or approved alternatives by the FDA. Very few of the answers were, gum, patches and electronic cigarettes. This would suggest that very few smokers are actually aware of electronic cigarettes. Although more electronic cigarettes stores have opened recently based on the researchers observation, it is quite distressing to note that smokers have not taken time to research or even read a simple article on what ecigs are. However, the fact that not very many smokers are aware of electronic cigarettes is not surprising, because they are relatively new and started only in 2003 (Foulds et al., 2011). While the 14 who said no, appear oblivious to what alternatives are in the market. Like the nicotine patch, which has been in the market for quite a few decades. Preferred Alternative of Choice The respondents were given 4 alternatives to choose from. These are: tobacco gum which is a chewing gum designed to deliver tobacco and nicotine to the human body (NIDA, 2009); nicotine patches which are patches that are stuck on the skin to deliver nicotine to the human body (NIDA, 2009); nicotine pills which are ingested and which deliver nicotine to the human body (NIDA, 2009); and finally electronic cigarettes which is like a cigarette but instead of smoke, vapor is emitted and levels of nicotine are customizable (Foulds et al., 2011). Thirty-six

28 (36) respondents have expressed the desire to try the electronic cigarettes for quite a few reasons. Some of these are: adjustability of the nicotine level, flavors, no smoke but vapor, classy looking, true smoking sensation and the oral fixation is addressed. 2 respondents chose tobacco gum out of curiosity, while 4 chose nicotine patches because they were more famous for them, 1 chose the nicotine pill because he was also curious and 7 who said that they do not want to try anything. The obvious preferred alternative is the e-cig, because it offers the smoker a lot of options, which were already mentioned earlier.

To sum up all of the results, the researcher concludes that the habit of smoking usually begins at the early stages of adolescence and can continue to until the late stages of life. Furthermore, it is a habit that is developed over the years; whether the respondent started out of curiosity, peer pressure or as a stress reliever. It is a developed habit that is very difficult to break. It is also interesting to note that respondents are aware that smoking is an expensive vice, which has negative and even fatal effects on health. The majority of the respondents were receptive to the alternatives presented to them and they preferred alternative was the ecig, although majority of them did not about e-cigs.

29

Chapter 4 SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

Summary The following are the summarized findings of this research: 1. Clearly, the number of products available in the market to either curb or stop the

habit of smoking appears to increase every year. The latest is the electronic cigarette, which was invented in 2008. Since smoking is a bad habit or a vice, unfortunately, not everyone can cut the habit immediately. Many find great difficulty getting rid of it because of the nicotine addiction. Hence, the invention of the alternatives to smoking regular cigarettes such as tobacco gum, nicotine pills and patches and the e-cigs.

2.

As mentioned earlier, the mere fact that someone manages to come up with

something new to address this age old habit shows that people are aware of how difficult it is to cut and cut clean when it comes to smoking. Despite the fact that this vice has claimed the lives

30 of so many millions across time, race and culture, people continue to smoke and spend so much money either to continue to indulge in the addiction or to try to wean themselves from it. What makes it even more challenging for the smoker is the numerous stressful situations he has to deal with either in his professional or personal life. It is a fact that many people smoke because they claim that cigarettes are a good stress reliever.

3.

Studies have shown the negative effects of smoking not only on the smoker but to

all those around him due to second and third - hand smoke. In fact, experts have said that second and third hand smoke are even more fatal than first-hand smoke. It is truly unfortunate, considering the long history of smoking that the information that we have of this phenomena was made available only in the twentieth century. Furthermore, it is difficult not to think of the many lives that were lost because of this lack of information and awareness about the true nature and health hazards of smoking.

4.

While looking back with much regret, people can also look forward with more

hope since more and more people are convinced of the lethal health problems that this vice brings to mankind in general. With this awareness, comes measures or alternatives to help those who have made smoking a habit that is very hard to break. Society, in general, is more aware of the negative effects of smoking through second and third-hand smoke and, therefore, have become more vigilant. There are now designated areas for smokers or, in some major establishments, there is a strictly enforced no smoking policy.

31 As mentioned earlier, the smoker has quite a few alternatives to choose from which will help him to: (a). get his dose of nicotine without inhaling and exhaling lethal smoke, (b). help him curb his habit and, hopefully, break it, and (c). continue with the habit but in a less harmful way specifically through the e-cigarette. The e-cigs seem to have become a popular alternative because they address the oral fixation that many smokers appear to need; they can be customized to address the smokers needs ( e.g., nicotine level etc.); they do not emit toxic smoke but vapor which is made from fruit essences; they do not contain the numerous toxic elements found in regular cigarettes.

Conclusions On the basis of the study the researcher therefore concludes: 1. The electronic cigarette is a relatively new product, which was invented to help the smoker either curb or cut his addiction to nicotine as well as to other highly toxic materials found in regular cigarettes. While it is true that there are no conclusive studies that state that this product is the best and the healthiest alternative, data from the studies that have been done so far are very promising.

2. The researcher, who has been using the e-cig for almost a year has been able to successfully stop his addiction to nicotine. He no longer uses it but has replaced the substance with fruit essences instead. Therefore, when he feels the need to vape (this is the term used because vapor and not smoke comes out of the e-cig.) due to stress,

32 he does not inhale or exhale any toxic materials. In fact, the fruit essences are quite fragrant. Furthermore, there are a number of former smokers who, because they switched to e-cigs, have been able to successfully quit smoking altogether. They have said that the e-cig is effective. 3. There is unfortunately a lack of awareness among smokers when it comes to electronic cigarettes. The fact that they are not up to date with new developments with smoking alternatives may suggest that their vice has either put them in a state of denial, or they are simply not interested to learn more about their vice. It was very encouraging to know that smokers who want to smoke in a less harmful way are open to try the electronic cigarette, which is showing a lot of promise.

4. While it is true that the e-cigs are quite expensive since they range from Php 2,000Php20,000 depending on the model, they do come out cheaper in the end when we consider the health benefits they can give to the smoker. For instance, those who have switched from smoking to vaping have said that they feel healthy and are able to keep up with strenuous exercises at the gym.

There can be no doubt that the best solution for a smoker is to stop smoking altogether. However, we do need to realize that breaking the habit is not as simple as it may seem to be. While nicotine patches and pills nay have their own success stories, many smokers still feel the need to put something in between their lips. The e-cigs seem to be able to address this problem.

Recommendations

33 After having read the responses of the respondents, the researcher would like to make the following recommendations: 1. The youth will always be drawn to things/activities that are taboo. They are generally curious and the more adventurous ones will take the initiative to find out more about the thing /activity that they have been told to stay away from. Likewise, many young people give in to peer pressure. Hence, because they want to feel they belong, they engage in activities that their friends are involved in. Smoking happens to be one of them. Parents, guardians and caregivers need to be fully aware that the best way to keep young people in check is to be completely involved in all their activities. Nothing can take the place of good parenting and good parenting means being a hands-on parent. A childs character is formed at home and the strengthening of the will through virtues and good habits will prepare the child to resist peer pressure in the future. Parents, guardians and caregivers also need to remember that they are the childs role model. It is difficult to tell a child not to smoke if the parent smokes.

The researcher would also like to suggest to parents and guardians not to give big allowances to their children since, many times, they use this money to buy cigarettes. 2. Young people should be made aware of all the dangers of smoking. The researcher believes that since the youth spend more time in the academic environment, school authorities should implement a vigorous no smoking campaign in all schools. Furthermore, students should be exposed to periodic school sponsored talks by medical experts on the lethal effects of this vice. Hopefully, constant reminders will encourage

34 students to stay away from cigarettes especially since studies have shown that young people begin smoking between the ages of 12-16 years. This means that they are either in high school or just graduating from grade school. Vigilance on the part of both the home and the school may bring down the number of young people who might start smoking at a very young age. 3. The researcher believes that the public, in general, should make the effort to know more about the dangers not only of second but third-hand smoke since studies have shown just how lethal it is. Many non-smokers have died because of second and third-hand smoke and, while we may be aware of this, we might not be fully aware of the nature of second and third-hand smoke. Studies have shown how fatal third-hand smoke can be. 4. It is hoped that this research will encourage others to do a more detailed and extensive study of the electronic cigarettes to determine just how safe and harmless they are. 5. The researcher also believes that it would be very beneficial to current smokers if more information campaigns about ecigs could be made. This would allow smokers to either learn about ecigs and their benefits, or at least increase in their awareness of its existence. Despite the fact that ecigs are relatively new and require more study, the current findings, which are scientifically accurate, should suffice to promote information campaigns. 6. Tobacco companies should (in the researchers opinion) begin to look into the field of ecigs. The reason for this is so that their views on ecigs are not limited to possible financial loses. Tobacco companies should be willing to market the product as well for 2 reasons. The first in the interest of corporate social responsibility. Second, there is a greater chance of innovation if they were to do more research on ecigs and make better ones. They would also have an opportunity to make more money.

35

36

REFERENCES:

Ayers, A.W., Ribisl, K.M., & Brownstein, J.S. (2011). Tracking the Rise in Popularity of Electronic Nicotine Delivery Systems (Electronic Cigarettes) Using Search Query Surveillance. American Journal of Preventive Medicine, 40, 448-453.

Caponnetto, C., Polosa, R., Russo C., Leotta C., & Campagna, D. (2001). Successful smoking cessation with electronic cigarettes in smokers with a documented history of recurring relapses: a case series. Journal of Medical Case Reports, 585, 1-5.

Foulds, J., Veldheer S., & Berg, A. (2011) Electronic Cigarettes (e-cigs): Views of aficionados and Clinical/Public Health Perspectives. The International Journal of Clinical Practice. 65, 1037-1042.

Goldman, L.R, Benowitz, N., Bhatnagar, A., Dominici, F., Fienberg, S., Friedman, G.D., et al., (2010). Seconhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence. National Institute of Medicine

Kuschner, W.G., Reddy, S., Mehrotra, N., & Paintal H.S. (2011). Electronic Cigarettes and Third-hand Tobacco Smoke: Two Emerging Health Care Challenges for the Primary Care Giver. International Journal of General Medicine, 4, 115-120.

37 National Institution of Drug Abuse (2009). Tobacco Addiction

Pontiere, S.R., (n.d.) The Electronic Cigarette Alternative to Death by Cigarette

Siegel, M.B., Tanwar K.L., & Wood, K.S. (2011). Electronic Cigarettes as a Smoking-Cessation Tool: Results from an Online Survey. American Journal of Preventive Medicine, 40, 472-475.

38

APPENDICES Appendix A: Survey Questionaire English Research Survey Electronic Ciga English Research Survey Gabriel Angel V. de Vera 11-2407
Gabriel Angel V. de Vera

11-2407 Electronic Cigarettes as a healthier alternative to smoking 1. How old are you? _ less than16 __ between 16-60 __ above 60

2. How long have you been smoking? _ less than 1 year

__ 1-9 years _ _ 10-20 years more than 20 years

3. How old were you when you started smoking?

4. Why did you start smoking? __ Stress reliever _ _ It became a developed habit _ _ _ It became a nicotine addiction To look cool Others (Please Specify) : Peer pressure, curiosity

5. How much do you estimate you have spent on smoking?

6. Do you believe that smoking has had negative effects on your health?

39
Why?

What Negative effects have you observed if any?

7. If given the chance would you like to be able to indulge your habit in a healthier way? Why?

8. Have you heard of any healthier alternatives to smoking? Yes If yes, what are these?

No

9. Which of these would you like to try as a healthier alternative? _ _ _ Tobacco gum (A chewing gum designed to deliver tobacco to the system.) Nicotine Patches (A patch that is put on a part of the body to deliver nicotine to the human body.) Nicotine Pills (Ingested pills that are designed to deliver nicotine to the human body.)

__ Electronic Cigarettes (Like a cigarette, but instead of smoke vapor is emitted and levels of nicotine are customizable.)

Why?

rettes as a healthier alternative to smoking 1. How old are you? _ less than16 __ between 16-60 __ above 60 2. How long have you been smoking? _ less than 1 year __ 1-9 years

40 _ _ 10-20 years more than 20 years

3. How old were you when you started smoking? 4. Why did you start smoking? __ Stress reliever _ _ It became a developed habit _ It became a nicotine addiction _ To look cool _ Others (Please Specify) : Peer pressure, curiosity 5. How much do you estimate you have spent on smoking? 6. Do you believe that smoking has had negative effects on your health? Why? What Negative effects have you observed if any? 7. If given the chance would you like to be able to indulge your habit in a healthier way? Why? 8. Have you heard of any healthier alternatives to smoking? Yes If yes, what are these? No 9. Which of these would you like to try as a healthier alternative? _ Tobacco gum (A chewing gum designed to deliver tobacco to the system.) _ Nicotine Patches (A patch that is put on a part of the body to deliver nicotine to the human body.) _ Nicotine Pills (Ingested pills that are designed to deliver nicotine to the human body.) __ Electronic Cigarettes (Like a cigarette, but instead of smoke vapor is emitted and levels of nicotine are customizable.) Why?

41

Appendix B: Computer Code for Tally Checker import java.util.*; import java.io.*; public class Question{ private static int size = 3; private static Scanner input = new Scanner(System.in); private static BufferedReader input2 = new BufferedReader(new InputStreamReader(System.in)); private String Q; private static int ans,lessthan16,between,above60,lessthan1year,years1to9,years10to20,morethan20years; private static int stress,habit,addiction,cool,peer,curiosity; private static int amount; private static int [] ageSmoke = new int [size]; private static int [] totalAmount = new int [size]; private static int yNum; private static int nNum; private static String [] whatNeg = new String [size]; private static String [] whyN = new String [size]; private static String [] whyY2 = new String [size]; private static String [] whyN2 = new String [size]; private static int healthyTotaly; private static int healthyTotaln;

42 private static int totalHeard; private static int totalNot; private static String [] whatY = new String [size]; private static String [] why = new String [size]; private static int tobaccoGum,nicotinePatch,nicotinePill,ecig;

public static void Q1(){ System.out.println("1. How old are you?\n[1] less than 16\n[2] between 1660\n[3] above 60"); ans = input.nextInt();

switch (ans) { case 1: lessthan16++;break; case 2: between++;break; case 3: above60++;break; default: System.out.println("Error");Q1(); } }

43 public static void Q2(){

System.out.println("2. How long have you been smoking?"); System.out.println("[1] less than a year"); System.out.println("[2] 1-9 years"); System.out.println("[3] 10-20 years"); System.out.println("[4] more than 20 years"); ans = input.nextInt();

switch (ans) { case 1: lessthan1year++;break; case 2: years1to9++;break; case 3: years10to20++;break; case 4: morethan20years++;break; default: System.out.println("Error");Q2(); } }

public static void Q3(int i){ System.out.println("3.How old were you when you started smoking? "); ans = input.nextInt(); ageSmoke[i] = ans;

44 }

public static void Q4(){

System.out.println("4. Why did you start smoking?"); System.out.println("[1] Stress Reliever"); System.out.println("[2] It became a developed habit"); System.out.println("[3] It became a nicotine addiction"); System.out.println("[4] To look cool"); System.out.println("[5] Peer Pressure"); System.out.println("[6] Curiosity"); ans = input.nextInt();

switch (ans) { case 1: stress++;break; case 2: habit++;break; case 3: addiction++;break; case 4: cool++;break; case 5: peer++;break; case 6: curiosity++;break; default: System.out.println("Error");Q4(); }

45

public static void Q5(int i){

System.out.println("How much do you estimate you have spent on smoking?"); amount = input.nextInt(); totalAmount[i] = amount; }

public static void Q6(int i)throws Exception{ System.out.println("6.Do you believe that smoking has had negative effects on your health? [y][n]");

String answer = input.next(); char ans = answer.charAt(0);

//ans.toUpperCase();

switch (ans) {

46

case 'Y' : case 'y': yNum++;System.out.println("What negative effects have you observed if any?"); whatNeg[i] = input2.readLine(); whyN[i] = "";break;

case 'N' : case 'n': nNum++; System.out.println("Why?"); whyN[i] = input2.readLine();whatNeg[i] =""; break;

default: System.out.println("ERROR"); Q6(i);

public static void Q7(int i)throws Exception{

System.out.println("7.Would you like to be able to indulge your habit in a healthier way?[y][n]"); String healthy = input.next(); char ans = healthy.charAt(0); //whyN2[i] = ""; //whyY2[i] = "";

47 switch (ans) {

case 'Y' : case 'y': healthyTotaly++;System.out.println("Why?"); whyY2[i] = input2.readLine(); whyN2[i] = "";break;

case 'N' : case 'n': healthyTotaln++; System.out.println("Why?"); whyN2[i] = input2.readLine();whyY2[i] =""; break;

default: System.out.println("ERROR"); Q7(i);

public static void Q8(int i)throws Exception{

System.out.println("8. Have you heard of any healthier alternatives to smoking? [y][n]"); String answer = input.next(); char ans = answer.charAt(0); //whyN2[i] = "";

48 //whyY2[i] = ""; switch (ans) {

case 'Y' : case 'y': totalHeard++;System.out.println("What?"); whatY[i] = input2.readLine();break;

case 'N' : case 'n': totalNot++; whyY2[i] =""; break;

default: System.out.println("ERROR"); Q8(i);

public static void Q9(int i)throws Exception{

System.out.println("9. Which of these would you like to try as a healthier alternative?"); System.out.println("[1] Tobacco gum (a chewing gum designed to deliver tobacco to the system)");

49 System.out.println("[2] Nicotine Patches(A patch that is put on a part of the body to deliver nicotine to the human body)"); System.out.println("[3] Nicotine Pills(Ingested pills that are designed to deliver nicotine to the human body)"); System.out.println("[4] Electronic Cigarettes(Like a cigarette, but instead of smoke, vapor is emitted and levels of nicotine are customizable"); ans = input.nextInt();

switch (ans) { case 1: tobaccoGum++;break; case 2: nicotinePatch++;break; case 3: nicotinePill++;break; case 4: ecig++;break; default: System.out.println("Error");Q9(i); }

System.out.println("Why?"); why[i] = input2.readLine(); }

public static void A1(){ System.out.println("\n\nTotal less than 16 = "+lessthan16); System.out.println("Total between 16-60 = "+between);

50 System.out.println("Total above 60 = "+above60); }

public static void A2(){ System.out.println("Total less than 1 year = "+lessthan1year); System.out.println("Total 1-9 years = "+years1to9); System.out.println("Total 10-20 years = "+years10to20); System.out.println("Total more than 20 years = "+morethan20years); }

public static void A3(){ int sum = 0; for(int i =0;i<size;i++) { sum = sum + ageSmoke[i]; System.out.println("Ages when started "+ageSmoke[i]+" "); } int average = sum/size; System.out.println("Average age when started smoking = "+average); }

public static void A4(){

51 System.out.println("Total Stress Reliever = "+stress); System.out.println("Total It became a developed habit = "+habit); System.out.println("Total It became a nicotine addiction = "+addiction); System.out.println("Total To look cool = "+cool); System.out.println("Total Peer Pressure = "+peer); System.out.println("Total Curiosity = "+curiosity); }

public static void A5(){ int sum = 0; for(int i =0;i<size;i++) { sum = sum + totalAmount[i]; System.out.println("Amounts spent:" +totalAmount[i]+" "); } int average = sum/size; System.out.println("Average expense on cigarettes = "+average); }

public static void A6(){

System.out.println("Total Yes on negative effects = "+yNum);

52 System.out.println("Total No on negative effects = "+nNum);

System.out.print("Reasons why they believe there are no negative effects: "); for(int i=0;i<size;i++) { System.out.println(whyN[i]+" "); }

System.out.print("What Negative effects have they observed: "); for(int i=0;i<size;i++) { System.out.println(whatNeg[i]+" "); }

public static void A7(){

System.out.println("Total Yes on healthier way = "+healthyTotaly); System.out.println("Total No on healthier way = "+healthyTotaln);

53

System.out.print("Reasons why they want healthier way: "); for(int i=0;i<size;i++) { System.out.println(whyY2[i]+" "); }

System.out.print("Reasons why they dont want a healthier way: "); for(int i=0;i<size;i++) { System.out.println(whyN2[i]+" "); }

public static void A8(){

System.out.println("Total Yes on heard = "+totalHeard); System.out.println("Total No on not heard = "+totalNot);

54 System.out.print("Alternatives heard of: "); for(int i=0;i<size;i++) { System.out.println(whatY[i]+" "); } }

public static void A9(){ System.out.println("Tobacco gum = "+tobaccoGum); System.out.println("Nicotine Patch= "+nicotinePatch); System.out.println("Nicotine Pills = "+nicotinePill); System.out.println("Electronic Cigarettes = "+ecig);

System.out.print("Why these alternatives "); for(int i=0;i<size;i++) { System.out.println(why[i]+" "); }

55 public static void main(String args[])throws Exception {

Scanner keyIn = new Scanner(System.in);

System.out.println("Please enter number of respondents: "); size = keyIn.nextInt(); for(int i = 0;i<size;i++) { Q1(); Q2(); Q3(i); Q4(); Q5(i); Q6(i); Q7(i); Q8(i); Q9(i); }

A1(); A2();

56 A3(); A4(); A5(); A6(); A7(); A8(); A9();