Electronic cigarette experimentation in the Malaysian city of Kuantan: Was there an association with the smoking status?

et al. Relation of demographic and lifestyle factors to symptoms in a multi‑racial/ethnic population of women 40‑55 years of age. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. W e read with particular interest the study by Elkalmi et al. about electronic cigarette experimentation in the general public of Kuantan in Malaysia. [1] We think some important information was not presented in the manuscript, and the authors need to provide some clarifications. The authors examined factors that could be associated with electronic cigarette experimentation and use, such as sociodemographic factors and perceptions of harm. Technically, the authors present differences in the frequencies measured by Chi-square tests. To measure associations, it would have been more appropriate to perform logistic regression analyses and present the odds ratios. Furthermore, considering that electronic cigarettes were developed as smoking substitutes, it is expected that use is mainly observed among smokers. However, the authors made no attempt to examine the association between electronic cigarette use and smoking status. Preferably, the latter should be classified as current, former and never smokers. A recent analysis of the Eurobarometer 2014 survey showed that being current or former smoker were the strongest correlates of electronic cigarette use even after adjusting for other factors in the multivariate analysis. [2] In addition, adoption of use by never smokers was minimal; [2] this is important in terms of identifying potential harm due to use by nonintended subpopulation (i.e., never smokers). The authors report that electronic cigarette experimentation was more frequent in males compared to females. However, it is obvious from Table 2 of the manuscript by Elkalmi et al. that smoking was also by far more prevalent in males. Thus, there is a significant collinearity between gender and smoking status. In that context, evaluating the association between electronic cigarette use and smoking status is even more important because it could reject the hypothesis that gender is a major determinant of electronic cigarette use. The authors interpreted the study findings by stating that electronic cigarette use is a problem for the Malaysian society, and this should alert healthcare providers and policy makers. It is a paradox that they identified electronic cigarettes as the problem (with only …