The Impact of E-cigarette Usage on Cognitive Performance Level among University Students in Malaysia: A case-controlled study

Introduction: The electronic cigarette (e-cigarette) is an electronic device containing a cartridge filled with liquid nicotine and other chemicals, producing inhalable smoke. Malaysia is known to be one of the biggest markets for e-cigarettes due to the highest recorded number of young consumers. E-cigarette cause multiple pulmonary complications or direct injury secondary to the device explosion. Little is known about its effects on cognitive performance, and its potential hazard to the brain. Given a different sociodemographic background and e-cigarette profile compared to the other country, it is paramount to explore its potential effect on cognitive function among the young population in Malaysia. Method: This is a case-controlled study to explore the cognitive performance differences between e-cigarette users and non-users among university students in Malaysia. We performed a face-to-face cognitive evaluation using WHO Auditory Verbal Learning Tests (WHO-AVLT), Trail Making test (TMT), and Digit Span Test (DST). We assessed the knowledge and attitude towards e-cigarettes using a self-reported questionnaire and explored their association with the behaviour. Results: DST has shown a significant difference, with the e-cigarette users demonstrated a higher score compared to non-cigarette users with scores of 21.75 and 20.17, p < 0.05, respectively. There were no significant differences between the e-cigarette users and non-users for WHO-AVLT and TMT. E-cigarette users demonstrate a lower level of knowledge and attitude than users, showing a significant association with e-cigarette behavior. Conclusion: E-cigarette does not cause a cognitive performance decline among university students. This study provides the initial evidence of whether there is any potential for e-cigarette effect on cognitive function among our local young population. The finding may serve as a reference for a more robust related study in the future.