Awareness of electronic cigarettes in India: Findings from the 2016-2017 Global Adult Tobacco Survey (GATS).

Introduction: Electronic nicotine delivery systems (ENDS) have recently emerged as a public health threat globally. Despite the low proportion of e-cigarette users (1.22%) reported in the Global Adult Tobacco Survey-2, the Government of India enacted the Prohibition of E-cigarettes Act 2019 (PECA), prohibiting all forms of ENDS/ENNDS. The current analysis presents nationally representative findings on the level of awareness of e-cigarettes in India and its correlates and characteristics of those aware of e-cigarettes.

Methods: The current secondary analysis from GATS-2 among adults aged ≥15 years from all states and Union Territories of India used a standard protocol for data collection and management. A multi-stage cluster sampling design was used. The respondents who were aware of e-cigarettes were included (n=2524). Binomial logistic regression analysis was conducted, and adjusted odds ratios (AORs) with 95% CI, were calculated to measure the associations between independent and dependent variables.

Results: Only 3.4% of the respondents were aware (either heard or seen) of e-cigarettes and their awareness was found significantly higher among males (AOR=2.07; 95% CI: 1.90-2.24), urban population (AOR=2.83; 95% CI: 2.61-3.07), and higher education (AOR=0.41; 95% CI: 0.38-0.45).

Conclusions: Public awareness campaigns about the harms of e-cigarettes and the law (PECA) need to be rolled out in urban and rural areas. Capacity-building exercises of implementers and enforcers at the grassroots level could also support communicating the harms to hard-to-reach groups. Further, regular compliance monitoring of the legislation and prosecution of violators would facilitate its effective implementation at the national and sub-national levels.