FIRST CITY PROVIDENTIAL COLLEGE

First City Providential College

Brgy. Narra, Francisco Homes Subdivision, City of San Jose del Monte, Bulacan

E-Cigarette Awareness, Use, and Effects Among

Teenagers in Selected Barangays in San Jose Del
Monte, Bulacan

A Research Paper presented to

College of Allied and Medical Sciences of
First City Providential College

In Fulfilment of the
Requirement for the subject
Nursing Research 1

Research conducted by
Jasmine Agustin
Jasmin Gener
Lovely Pablico
3rd Year - BSN

Submitted to
Nelson Maglanque, DMD
Research Instructor

Academic Year 2021-2022

2nd Semester

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CHAPTER I
THE PROBLEM AND ITS SETTING

This chapter presents the background of the study,

objectives, significance of the study, and the scope and
delimitation.

Background of the Study

Electronic cigarettes also referred to as e-hookahs, vaporizer
cigarettes, vapes, and vape pens, are battery-powered devices
that emit a vaporized solution for inhalation whose goal is to
simulate breathing tobacco smoke without really inhaling it.
(Brazier, 2020). There are various substances that were identified
in both aerosols and vape liquids which include nicotine, solvent
carriers and other compounds. (Eaton, Kwan & Stratton, 2018).
The majority of e-cigarettes' main active component, nicotine,
damages the brain's memory, attention, and learning centers.
(Hedger, 2020). E-cigarettes and vaporizers are still not
recommended for adolescents who do not currently smoke since
nicotine in any form is very addictive. Those who do not currently
routinely use nicotine may use liquid nicotine as a gateway to
traditional cigarettes (Felman, 2018).
Currently, e-cigarette sales are unregulated, making them
accessible to children and teenagers and for those who are
quitting smoking, vaping is neither obviously more nor less
successful than regulated nicotine replacement treatments or
standard care, and existing evidence shows that it is likely

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equivalent to or slightly better than nicotine patches.

(Montemayor, Jr., 2020) although the Food and Drug
Administration (FDA) and Department of Health (DOH) have
already warned the public that the current research indicates
that the composite components of these devices and its emissions
are not entirely harmless. Moreover, according to Republic Act
11467, the use, sales, and distribution of electronic cigarettes are
prohibited among teenagers. Although the official legal age to
vape is 21, there are minors who still have access to electronic
cigarettes.
Furthermore, since e-cigarettes have become one of the
hottest trends among teenagers, they are less likely to utilize e-
cigarettes to quit smoking, having their sole purpose of being in
trend or to feel the pleasure given by it. (Perikleous, Steiropoulos,
Paraskakis, Constantinidis & Nena, 2018) and although it may
have fewer side effects than traditional cigarettes, the safety of e-
cigarette use and its potential as a smoking cessation strategy is
still debated due to a lack of data and study regarding its
harmful effects. (Marques et al., 2021).
Hence, researchers seek to understand the factors
influencing the use of e-cigarettes among teens and assess their
level of awareness of the possible holistic effects of their long-
term use. This also includes the factors affecting teenagers’
preference between e-cigarettes rather than traditional cigarettes.

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Research Objectives
This study aims to determine the following:
1) The usage of vaping or electronic cigarettes (e-cigarettes) and
the level of awareness of teenage users.
2) General knowledge of vaping or e-cigarette usage.
3)Smoking/vaping prevention program and prevalence of vape
smoking among teenagers.
4) Education about the possible dangers of prolonged e-cigarette
use.

Statement of the Problem

The study seeks to determine the e-cigarette awareness, use,
and effects among teenagers in San Jose Del Monte, Bulacan
1. What is the profile of the respondents in terms of the following:
a. Age
b. Gender
c. Highest educational attainment
2. How do teens understand the use of e-cigarettes?
3. How well-informed are teens in San Jose Del Monte, Bulacan,
on the possible effects of long-term use of e-cigarettes?
4. What factors influence teenagers' decision to use e-cigarettes
rather than regular or traditional cigarettes
5. Should e-cigarette use be marketed on Philippine mass media?
6. What are the most common flavors used by teenagers?
7. What are the factors affecting their flavor preference?

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Significance of the Study

This study aims to provide crucial information and
knowledge on teenagers regarding the awareness, use, and effects
of how e-cigarettes affect their health. The result of this study
will be of great benefit to the following:
Users - This study will raise awareness of the possible dangers of
smoking e-cigarettes among participants and provide them with
the knowledge, attitude, and skills to overcome peer pressure to
smoke e-cigarettes. Therefore, the participants would be able to
avoid the numerous health and social issues connected with e-
cigarette use.
Parents - This study will provide parents with a better
understanding of their children’s perception regarding e-cigarette
use and the potential severe consequences of their smoking
habit. The knowledge provided will enable them to devise
preventive measures to keep their children from smoking e-
cigarettes.
Nursing Students - The results will enable them to act
accordingly about the possible changes they may encounter and
the hazards linked with e-cigarette use.
Nurses - The data will allow them to develop effective prevention
strategies to broaden knowledge, promote a negative attitude
toward smoking e-cigarettes, and improve adolescents' smoking
refusal skills. If proven effective, the intervention under
consideration might be duplicated in comparable settings and
adapted to different locations to prevent and control adolescent e-
cigarette use.

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Educational Institution- The result of this study can help them

take concrete steps toward promoting policies that can help
regulate the use of e-cigarettes among adolescents.
Future researchers - The results of this study could become a
basis for further studies that will provide context or an overview
in testing the validity of other related findings.

Scope and Delimitation

This study will be conducted at the selected barangay in San
Jose Del Monte, Bulacan. Furthermore, this study aims to
determine the awareness and effects of using e-cigarettes among
teenagers. Thus, the selection of respondents is only the
teenagers (13-19 years old) who use e-cigarettes for at least one
month from the year 2021 to 2022

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CHAPTER II
REVIEW OF RELATED LITERATURE AND
CONCEPTUAL FRAMEWORK

This chapter contains local and foreign studies and literature

related to the current research. It focuses on the methodology
used, findings, and recommendations relevant to the current
study.

Foreign Literature
According to Susan & Walley (2021), In the 1960s, 43% of
adolescents in the United States and smoking was prevalent in
airplanes, restaurants, and even hospitals. While the current
adult smoking rate remains unsatisfactory, it is predicted to fall
to 13% by 2020. Simultaneously, teenagers' tobacco use has
skyrocketed, owing mainly to the introduction of a new type of
tobacco product, e-cigarettes, and vape devices. According to the
National Youth Tobacco Survey 2020 (pre-epidemic data), 19.6 %
of high school students smoked e-cigarettes in the previous 30
days. In order to understand the impact of e-cigarette use on
individual and population health, it is crucial to understand more
about these products and the factors that have resulted in the
rapid increase in awareness and usage.
There is no question that e-cigarettes have harmful health
consequences for both tobacco and nicotine users and non-users.
There is substantial evidence that e-cigarettes have negative
short-term health impacts, while the long-term health

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implications, particularly on the growing body and mind, may not

be wholly recognized for decades. The influence of e-cigarettes on
public health has been more challenging to assess. E-cigarettes
as a smoking cessation device do not support their usage over
FDA-approved tobacco cessation medication.
One of the most important facts is that, as of this time, no e-
cigarette company had applied to the FDA as a smoking cessation
device. Meanwhile, millions of young people use e-cigarettes
regularly, yet there is limited research and resources to combat
teenage nicotine addiction. There has never been a critical period
to focus on tobacco use prevention and treatment, especially
given the known and potential health risks of e-cigarette use
among our youth. Tobacco usage is a social determinant of
health, contributing to the population's considerable and
unacceptable health inequities.

The Types of E-cigarettes

According to Truth Initiative (2021) when e-cigarettes first
became popular, these devices were in the market around 2007
intended to look like ordinary cigarettes, others resembled cigars,
pipes, pens, and other writing implements. USB flash drives,
too.1,8 to account for product design diversity, E-cigarettes have
been categorized by some studies as devices of the first, second,
or third generation. A first-generation electronic cigarette looks
and feels like a disposable cigarette. A second-generation e-
cigarette is a larger, more powerful device. Typically, a pen-
shaped gadget that can be recharged. Devices classified as third
generation e-cigarettes that don't resemble a flammable cigarette

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and frequently have huge and sometimes batteries that can be

customized, Some parts may be damaged. They are
interchangeable, which is why they are occasionally. These
refillable gadgets are known as "mods."
E-cigarettes with a clean, modern design have recently become
popular. design that is high-tech and easily recharged. The
market for batteries has opened up. JUice USB Lighting (JUUL),
the most popular, debuted in 2015 and soon rose to prominence
as a market leader e-cigarette product, which consists of roughly
73.4 percent of electronic cigarette users by July of next year 10
Suorin Drop, for example, is a "copycat" product. Following
JUUL's lead, myblu and Vuse Alto high nicotine delivery and
high-tech design e-liquids containing nicotine salts formulations.
All of these devices are often used. Known as "JUUL" because of
its widespread availability brand, but they're also known as
"pods." Because the e-liquid is supplied in self-contained
disposable pods, it's referred to as "mods." JUUL's phenomenal
popularity has supported the use of knockoff devices JUUL-
specific compatibility, including Eonsmoke and Vapor4Life are
two companies that provide comparable high nicotine levels in
sleek, gadgets that are either discrete or that employ JUUL pods
or pods that can be used in JUUL pods JUUL gadgets

Risks of E-cigarettes Versus Cigarettes

The National Academies of Sciences, Engineering, and
Medicine (NASEM 2018) issued a report demonstrating
considerable evidence that e-cigarettes expose users to less
dangerous substances than combustible cigarettes. While some

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studies have shown that smokers who switch completely to e-

cigarettes are exposed to lower levels of some carcinogens and
other toxicants, potentially lowering the risk of several tobacco-
related diseases, others have shown that smokers who switch
completely to e-cigarettes are exposed to higher levels of some
carcinogens and other toxicants (Helen et al,. 2020).
It is uncertain whether or not cigarette smokers want to quit
using e-cigarettes exclusively. The FDA has not yet approved e-
cigarettes as a smoking cessation aid (CDCP 2020). There's a
piece of evidence to support the use of e-cigarettes to help people
quit smoking mostly teenagers (Gaiha & Felsher 2021). There is
mounting data that using e-cigarettes is no better than taking
FDA-approved nicotine replacement treatment or doing nothing
to help smokers quit. (Pierce et al,. 2020). Most e-cigarette users
continue to smoke cigarettes and use both cigarettes and e-
cigarettes (a practice known as "dual usage"). As e-cigarettes and
regular cigarettes are combined, the risk of lung and heart
disease increases when compared to smoking cigarettes alone.
(Alzahrani et al,. 2019) and e-cigarettes do not reduce smoking
rates and instead encourage adolescents to use tobacco products,
rather than assisting adult smokers in converting from
traditional cigarettes to ostensibly less harmful e-cigarettes or
quitting entirely. (Glantz & Bareham 2018)
The use of e-cigarettes has highlighted that vaping can cause
nicotine addiction in young people and lead to some becoming
dependent cigarette smokers, potentially "renormalizing"
smoking. Some believe that vaping poses significant health risks,
and others question whether vaping reduces smoking cessation.

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Therefore, e-cigarette use is likely far less hazardous than

smoking. (Balfour et al., 2021). The NASEM (2018) report
acknowledged that even if e-cigarettes are less harmful than
combustible cigarettes, that does not mean they are safe or
without risk.

Rates of adolescents on e-cigarette use

According to the 2019 National Youth Tobacco Survey
(NYTS), 5.8% of high school students and 2.3% of middle school
students used conventional combustible cigarettes in the past 30
days. It is important to note that decreases in traditional cigarette
usage predated the increase in e-cigarette use, and smoking
prevalence among high school students has been dropping since
2011 (Gentzke et al., 2019). High school students reporting
recent e-cigarette use increased from 1.5% in 2011 to 38.9% in
2020 according to the 2020 NYTS data, and 22.5% reported daily
e-cigarette use (Wang et al,. 2020) Further, the increase in
adolescent e-cigarette use explains why adolescents’ overall use
of tobacco has increased, with 53.3% of high school students
(eight million) and 24.3% of middle school students (2.9 million)
reporting having ever used any tobacco product (Cullen et al.,
2019). Of further concern is that numerous studies have found
that teenagers who use e-cigarettes are two to seven times more
likely to consume traditional cigarettes later, depending on the
dataset (Berry et al,. 2019) The 2018 report by the NASEM found
a causal connection between e-cigarette use and conventional
cigarette smoking initiation and concluded that there is

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“substantial evidence that e-cigarette use increases risk of ever

using combustible tobacco cigarettes among teenagers”.

Why do adolescents use e-cigarettes?

There are many factors that have been ascribed to the
growth in e-cigarette usage among adolescents, including
tempting flavors, aggressive marketing, appealing designs,
misperceptions, and highly addictive nicotine compositions.
(Hamberger & Felsher 2020; Chaffee et al., 2020).

Flavors in e-cigarettes attract adolescents

Flavors are the most widely reported reason for teenage e-
cigarette use, and they are the primary method adolescents, and
young people, initiate and consume all tobacco products.
(McKelvey et al., 2018). The 2020 National Youth Tobacco Survey
(NYTS) found that the proportion of adolescent e-cigarette users
who reported using flavored products increased from 68.8% in
2019 to 82.9% in 2020, and the most favored flavors among high
school users were fruit, mint, menthol, candy, desserts, or other
sweets. Most youth e-cigarette users say they use e-cigarettes
“because they come in flavors I like”. Although cigarettes with
flavors (except menthol) have been prohibited in the US,
According to the US Food and Drug Administration (FDA 2020)
authority over tobacco products, this flavor restriction was not
extended to e-cigarettes when they and all other tobacco products
were brought under FDA’s tobacco authority with the 2016
enactment of the Deeming Rule Also, the law does not outright
prohibit “flavors” per se, but instead restricts products from

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containing “characterizing flavors,” without defining what this

term means. Tobacco companies have understood for decades
that flavored tobacco products appeal to teenagers.
A 2018 study found that more than 15,500 unique e-
cigarette flavors were available online. Companies have taken
advantage of the government’s failure to extend flavor restrictions
to e-cigarettes and have introduced thousands of flavored e-
cigarette products into the marketplace (Zhu et al., 2018). and an
earlier study found that more than 80% of the 450 e-cigarette
brands offered were available in fruit, candy, and dessert flavors.
Fruit tastes like cherry and watermelon, candy flavors like
chocolate and gummy bear, and conventional mint and menthol
flavors are all available in e-cigarettes. Additionally, companies
are marketing e-cigarettes and e-liquids in kid-enticing flavors
such as cotton candy, strawberry shortcake, and even dozens of
unicorn flavors. Vape shops that sell e-cigarettes and e-liquids
offer a wide assortment of flavors and often allow customers to
mix their flavors (King 2020).
Flavors are appealing to adolescents because they mask the
harsh taste and even smell of tobacco. Further, adolescents
indicate that advertisements for flavored e-cigarettes target
people their age, younger or just a little older. Studies also show
that adolescents who use flavored e-cigarettes are more
susceptible to using conventional cigarettes (McKelvey et al,.
2018). The FDA announced in January 2020 that it would
prioritize enforcement against unauthorized flavored cartridge-
based e-cigarettes (e.g., JUUL pods). Still, it exempted tobacco-
and menthol-flavored products, flavored e-liquids (e.g., those sold

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in vape shops for tank and mod systems), and flavored

disposable e-cigarettes (e.g., Puff Bar). Following the FDA
pronouncement, adolescents shifted to menthol products,
disposable e-cigarettes, and flavor boosters (e.g., Puff Krush) in
all of the alluring flavors limited in pods. Disposable e-cigarette
use surged more than 1000% among high school e-cigarette
users and 400% among middle school e-cigarette users, with
menthol-flavored items accounting for more than half of all e-
cigarette sales.

Nicotine in e-cigarettes perpetuates adolescents use

E-cigarettes, e-liquids, and other innovative nicotine
products (such as flavored nicotine lozenges and toothpicks
marketed to young people) have varied nicotine doses and ways of
administration. The newest formulations use nicotine salts,
which allow higher quantities of nicotine to be inhaled more
efficiently and with more minor irritation than the traditional
free-base nicotine form. However, nicotine levels in e-cigarettes
and e-liquids vary widely, as does nicotine exposure from e-
cigarettes, depending on product parameters (including device
and e-liquid features) and how the device is used. It is difficult for
customers to determine how much nicotine is in an e-cigarette,
and numerous e-cigarettes marketed as having no nicotine have
been shown to contain nicotine (Adams, 2018). Younger
individuals are more susceptible to nicotine's negative
consequences, which include addiction, facilitation of the use of
other addictive drugs, decreased impulse control, attention and
cognitive deficiencies, and mood problems (Hedger, 2020).

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Adolescents do not understand the implications of nicotine

dependency and addiction, and many are perplexed about how
much nicotine they use and the nicotine content of their Juuls
and other e-cigarettes. They do not understand the meaning of
“addiction.” It will be difficult for teenagers to quit using e-
cigarettes and other nicotine products after experimentation or
use for a few years. For this reason, the current federally
mandated warning label for e-cigarettes, “WARNING: This
product contains nicotine. Nicotine is an addictive substance,” is
not adequate. It suggests that educational and clinical settings
should provide comprehensive education and message about
nicotine addiction, and federal, state and local regulations should
be enacted that requires disclosure of the amount and delivery of
nicotine and effective product warning labels (McKelvey & Felsher
2020)
One of the most frequently cited explanations for using e-
cigarettes is the ability to conceal easily and vape these products,
called “stealth vaping.” The FDA should use its mandate to
protect adolescents and its authority from enforcing against
companies that make and sell products that are targeted to or
likely to promote use by youth by cracking down on easily
concealable e-cigarettes and other nicotine products.
Additionally, the FDA has the authority to regulate the design of
e-cigarettes so that they are less concealable (Gaiha et al., 2020).
Peer pressure and experimentation are vital social effects on e-
cigarette usage among teenagers and young adults. Although
some studies imply that adolescents understand that JUUL and
other e-cigarettes are potentially harmful and may lead to

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increased substance use, adolescents continue to use e-cigarettes

at an alarming pace. Some experts believe that campaigns and
educational programs that focus solely on the dangers of JUUL
and other e-cigarette use may be ineffective in reducing the youth
epidemic. Instead, they should acknowledge and address the
social realities and other underlying reasons for e-cigarette use.
Further research, on the other hand, demonstrates that
education can be beneficial in lowering teenage tobacco use
(Wood et al., 2020).
The adolescent e-cigarette epidemic has eroded successful
efforts to reduce adolescent, young adult, and adult tobacco use
over the past few decades. Tobacco control strategies that have
proven effective must be implemented, including targeted
education campaigns and regulations at the state, federal and
local levels. We must constantly strategize several steps ahead to
ensure that these efforts will apply not only to the product
currently available on the market but also to new products in the
pipeline that will be enticing to adolescents and young adults to
avoid a vicious cycle of recapitulation and epidemics.

Local Literature
The Department of Health and the Food and Drug
Administration (2019) are warning the public about the negative
health impacts and safety risks linked with the use of electronic
cigarettes, also known as ENDS/ENNDS. According to the Global
Adult Tobacco Survey (GATS), the total prevalence of e-cigarette
users in the Philippines was 2.8 percent and 0.8 percent,
respectively, in 2015. Due to the fast-growing global market for

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this new class of devices, local e-cigarette users are likely to have
increased as well. The DOH and FDA would like to present the
following information on the status of current science on
electronic cigarettes in the interest of informed policy making. E-
cigarettes or vapes are tobacco-free e-liquids or refills combined
with an electronic delivery mechanism. Users inhale aerosol,
mist, or vapor produced by these systems, which resemble the
act of smoking. According to current research, the composite
ingredients and emissions from these gadgets are not fully
harmless. The American College of Obstetricians and
Gynecologists, the American College of Physicians, the American
Academy of Pediatrics, the American Academy of Family
Physicians, and the American College of Surgeons have all stated
that these devices are dangerous to people's health. The
Philippine Pediatric Society has also spoken out against its highly
addictive and cancer-causing properties. Nicotine, ultra-fine
particles, carcinogens, heavy metals, and volatile organic
compounds are among the dangerous components found in these
devices, according to the Department. According to peer-reviewed
research, e-cigarette fluids contain high quantities of addictive
nicotine, which can cause acute or even deadly poisoning
through ingestion and other methods. In addition to nicotine
addiction, incidences of epidemic-scale nicotine toxicity in
youngsters have been observed in other nations where e-cigarette
usage is on the rise. E-cigarette aerosol contains toxic and
possibly harmful compounds, including second-hand aerosols,
which users and bystanders inhale and exhale (SHA). Because of
the ubiquity of flavored varieties and their unusual construction,

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these items have a unique allure to youth, according to the DOH

and FDA.
DOH secretary stated that to demonstrate that e-cigarettes
are less hazardous than traditional smoking, a series of long-
term epidemiological studies are necessary. He also stated that
there is inadequate evidence-based research to support the use of
e-cigarettes as a smoking cessation aid, contrary to common
assumption. Currently, The Food and Drug Administration (FDA)
regulates e-cigarettes and heated tobacco products (HTPs) under
Republic Act No. 11467, which modifies and expands the 1997
National Internal Revenue Code. Aside from increasing the excise
tax of alcohol products, electronic cigarettes and heated tobacco
products, selling vapor goods to people under the age of twenty-
one (21) under this act is also prohibited and punishable by a
fine and thirty days in jail. Further, vapor items containing
flavors other than plain tobacco or plain menthol are illegal from
being manufactured, imported, sold, or distributed. On the
contrary, vape bill was passed on its third reading which lowers
the legal smoking age from 21 to 18 and allows for numerous
tastes. It will also move regulatory control over the product from
the Food and Drug Administration (FDA) to the Department of
Trade and Industry (DTI) (Zablan, 2022).

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Foreign Studies
The UB researchers conducted interviews with adolescent e-
cigarette users and non-users in the Western New York area to
learn about their views on vaping. While many people use vaping
to help them quit smoking traditional cigarettes, the majority of
teenagers have never done so, According to Park (2019).
Participants exhibited a more favourable attitude toward e-
cigarettes than they did other illegal substances, and they
acknowledged the prevalence and acceptance of vaping among
their peers. Participants who vaped, on the other hand, thought
e-cigarettes were harmless, but non-users thought the product
was less harmful than cigarettes but still dangerous and
addicting. The majority of participants had a hazy awareness of
the possible consequences of e-cigarette usage, despite the fact
that the problems associated with cigarettes were well-known
among adolescents. Participants who vaped were drawn to the
diversity of flavours offered for e-cigarettes because they despised
the taste of cigarettes. The only people who saw e-cigarettes as a
gateway to other drugs and dangerous behaviours were non-
users. "The fact that non-users were especially worried about
gateway effects might be used in preventative initiatives to deter
them from starting to use e-cigarettes," Park added. "However,
once adolescents have used e-cigarettes, the most crucial
components to target in interventions may need to be pleasant
and enticing qualities, such as flavours." As sources of
information regarding e-cigarettes, participants mentioned family,
advertisements, peers, the internet, and social media sites like
Instagram.

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Parents who disapproved of vaping were more likely to be

non-users. Participants who used e-cigarettes, on the other hand,
said they had older siblings who used the devices to stop
smoking, which Park believes influenced their image of e-
cigarettes as good and potentially facilitated access to vaping
products.
Current e-cigarette use appears to be a separate risk factor
for respiratory disease. Although switching to e-cigarettes from
combustible tobacco should potentially lower the risk of
respiratory disease, current evidence shows a significant
incidence of dual usage, which is linked to an elevated risk above
combustible tobacco use. E-cigarette use should not be
encouraged because it is also linked to a decreased chance of
effectively quitting smoking for the majority of smokers. (Bhatta
& Glantz, 2019)
Based on the study conducted by Fairman et al. (2021), the
negative outcome expectancies for discouraging the use of e-
cigarettes are social repercussions and health outcomes. In the
same study, positive and negative social, psychoactive or sensory,
and health-related outcome expectations were indicated by
adolescents where they described stress and anxiety relief and
looking mature or older as positive outcome expectancies.
According to Perikleous et al., (2018) vaping promotion
among teens is aided by marketing, particularly through social
media; nonetheless, retail stores remain a key source of e-
cigarette display. A possible worry has surfaced as a result of the
placement of e-cigarettes in 36 percent of retailers near products
popular with youngsters, according to a recent observational

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research involving four Scottish communities. E-cigarettes are

frequently sold and placed in checkout lines and next to products
that appeal to children and teenagers; this may lead to e-
cigarettes becoming a widely used and accepted product. Several
US states, however, have approved legislation raising the
minimum age of purchase for all tobacco products, including e-
cigarettes, to 21 years old.
According to Hanafin et al., (2020) less is known about how
young adults perceive the harmful effects of e-cigarette use.
Teenagers have been found to lack knowledge about the risks
associated with e-cigarette usage, being able to describe the
detrimental effects of smoking cigarettes but being considerably
less sure about the dangers of e-cigarette use. On the other hand,
it was discovered that they listed many advantages of using e-
cigarettes but few benefits of smoking cigarettes. Young
individuals may develop favorable perceptions of e-cigarettes
since they are not informed about their respective risks.

Local Studies
According to Palmes, Trajera & Sajnani (2021) with an
increase in product awareness, an increase in online search
searches, and an increase in sales, e-cigarettes have exploded in
popularity around the world. Endorsing renowned personalities
and branding e-cigarettes with diverse flavours have increased
the appeal of e-cigarettes through media marketing tactics such
as print, television, radio, and the internet. From July 2008 to
February 2010, searches for e-cigarettes surged in all countries,
and were hundreds of times higher than searches for smoking

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alternatives in the United Kingdom, according to a real-time

surveillance system based on Google internet search query data.
However, the widespread use of unproven marketing claims is a
major driver to these goods' increased sales. These claims
include, among others, that e-cigarettes are healthier and cleaner
than traditional cigarettes, that e-cigarettes are smoking
cessation aids, and that the aerosols emitted are safe for those
who are exposed. Although some tobacco harm reduction
activists tout the product as a viable alternative to smoking, little
scientific understanding about the product's possible negative
health impacts has caused debate and alarm among healthcare
officials. Decades of tobacco control initiatives have reduced daily
cigarette smoking prevalence in numerous countries throughout
the world. Any renormalization of tobacco through new products
like e-cigarettes would jeopardise or undo the gains gained thus
far.
Another study conducted by Jaramillo, et al., (2017) the
biggest motivation for consumers to use electronic cigarettes is to
quit smoking tobacco cigarettes. It also comes in a variety of
electronic juice flavors, followed by their delight. Other factors
have had minimal impact on why people use electronic cigarettes.
The statistics demonstrate that there is no significant
relationship between the elements influencing their buying
behavior in terms of nicotine, vapor, juice flavor, frequency of
purchasing juice, and amount spent on purchasing juice.
Esteban-Ipac (2022), in their study, concluded that the usage of
electronic cigarettes is becoming more prevalent among teenagers
and, as a result, psychological risk assessment and preventive

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health advice should include electronic cigarettes, not just

traditional smoking. In the same study, they found out that
adolescents are aware of the dangers of smoking and have a
negative perspective about it; yet, other variables influence their
decision to begin smoking.

Conceptual Framework
The Input-Process-Output (IPO) model is the foundation for
this research paradigm. It displays the Input, which comprises
the researchers' objectives, the demographic profile of the
respondents, the processes by which the researchers will conduct
the research, and the expected Outputs of this study will be the
study's outcome or result.
For the input, these are the independent variables
deliberately manipulated to cause a change such as, the of the
respondents, respondent’s knowledge regarding electronic
cigarette, the possible dangers of long-term use of e-cigarettes,
factors influencing teenagers' decision of using e-cigarettes rather
than regular cigarettes, should e-cigarette use be marketed on
Philippine mass media, and flavor preference of the respondents.
The processes are: data collection of respondents’ profiles,
administering questionnaires, organizational of teenagers
responses and statistical analysis of data. The process is
designed to come up with an output or outcome of the study.
The output or outcome, which is the dependent variable, will
assess the level of perception of teenagers in the use of e-
cigarettes in the selected barangay in San Jose Del Monte
Bulacan.

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INPUT PROCESS OUTPUT

1. The profile of
the respondents
a. Age
Data collection
b. Gender
c. Highest of teenagers
educational profiles
attainment
2. Teenagers’
knowledge Administering
regarding e- questionnaires
cigarette use
3. The possible Assessed level
effects of long- Organizational
of perception of
term use of e- of teenager's
cigarettes teenagers who
responses
4 Factors use E-cigarettes
influencing
teenagers' decision Statistical
to use e-cigarettes analysis of data
rather traditional
cigarettes
5 E-cigarette can
be marketed on
Philippine mass
media
6. The most
common flavors
used by teenagers
and the factors
affecting their
flavor preference

FEEDBACK

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Definition of terms
E-cigarettes - is an electronic device with the shape of a
cigarette, cigar, or pen and does not contain tobacco. It uses a
battery, a heating element, and a place to hold a liquid and
contains a solution of nicotine, flavorings, and other chemicals.
Nicotine - a colorless, oily, acidic, toxic liquid that becomes
yellowish-brown in the presence of air and light that is highly
addictive.
Carcinogens - a carcinogen is a substance that can cause
damage and inflammation, causing cells to divide more quickly
and disrupting the normal process of growth and cell division.
Combustible cigarettes- cigarettes that require burning of that
product such as traditional cigarettes or cigars and tobacco
cigarettes.
JUUL - a specific type of electronic cigarette uses a regulated
temperature control.
ENDS/ENNDS- Electronic Nicotine Delivery Systems are also
known as electronic cigarettes which contain nicotine while
Electronic Non-Nicotine Delivery Systems do not contain nicotine.
Aerosol- composed of microscopic particles, some of which may
contain harmful compounds produced when the e-liquid in
electronic cigarettes is heated. The aerosol and the drugs can
then be breathed deeply into the lungs and expelled.
Gateway effect- an effect which causes one to stop smoking;
smoking cessation due to a certain practice such as using
electronic cigarette

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Psychoactive- changes in mood, consciousness, thoughts,

feelings, or behavior as a result of effects on how the brain
functions.
Sensory- involves how one sensory stimulates, sensory data, or
having to do with sensation or the senses such as hearing,
seeing, smelling, taste as well as sense of touch
Adolescents- teenagers; from thirteen to nineteen years old who
uses vape or e-cigarettes
Marketing- an act or way an e-cigarette is advertised and
promote the sales of electronic cigarettes among the general
public
Cognitive- involves using one's intellect to do something, like
thinking or remembering.
First-generation electronic cigarette- the same size as
standard tobacco cigarettes which may be disposable or
rechargeable
Second generation electronic cigarettes- resemble a pen or
laser, and you must manually inhale while pressing the button.
Third generation e-cigarettes- manual e-cigarette that come in
various sizes and shapes which are bigger than the first and
second generation.

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CHAPTER III
METHODOLOGY

This chapter presents the type of method used in the

research, the respondents, research locale and sampling method,
and the research instruments that have been used. It also shows
the type of statistical treatment that is applied in order to analyze
and interpret the data gathered.

Research Design
In this research, a descriptive survey quantitative research
design was used to evaluate the e-cigarette awareness, use, and
effects among teenagers in San Jose Del Monte, Bulacan. This is
the most appropriate method of inquiry about the present status
and condition of a particular phenomenon.
The descriptive quantitative research design is used to
organise, interpret and report the status of a group which
includes observing and describing a subject's activity without
interfering with it in any manner.

Research Locale
The research study will be done in selected barangay in San
Jose Del Monte, Bulacan and the respondents will be adolescents
who are users of electronic cigarettes

Respondents
The study’s target respondents will be 100 who are all
residents of San Jose Del Monte, Bulacan . The data gathered will

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greatly benefit the result of the research. The criteria for the
selection of the respondents are according to the users of e-
cigarettes..

Sampling Technique
This research will use simple random sampling. It is a
technique for choosing a sample from a statistical population in
which each feasible sample has a preset chance of being chosen.
This allows unbiased representation of the population.

Data Collection Procedures

The data will be gathered in San Jose Del Monte, Bulacan
and will come from the teenagers who are residents of San Jose
Del Monte, Bulacan. This research method will be used to gather
data from the respondents to gain information regarding the E-
Cigarette Awareness, Use, and Effects Among Teenagers in San
Jose Del Monte, Bulacan

Instrumentation
The researcher will be conducting this study using a survey
as the research instrument. These will make it easier to collect
information from a specific population. Both online and printed
survey questionnaires methods provide a fast, efficient, and
moderate way of acquiring significant amounts of data from large
sample volumes.
The survey will include the demographic profile of the
respondents as well as the research questions. An expert in the

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subject will validate the research instrument. This is done to

ensure that the material is examined and appropriately changed.

Statistical Treatment of Data

The data will be analyzed and interpreted through the
following statistical tools. The respondent’s profile was treated
using the frequency counts and percentage.
Frequency Count. The number of respondents will be counted to
determine the percentage of the occurrence.
Simple Percentage. The number of responses of the respondents
in the personal data will be treated. The number of responses in
each item was divided by the total population multiplied by 100.
The formula is:
R
P= ---- x 100
N
Where: P – is the percentage
R – is the number of responses
N – is the total number of respondents
Weighted Mean:
The formula was:
(WM = ∑fx)
N
Where: fx – weighted frequency of response obtained by
multiplying x or weight for each item in the choices
∑fx - summation of the obtained fx on each item.
N – number of respondents

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