Knowledge and attitudes toward electronic cigarettes among healthcare providers and health professional students: implications for patient counseling - A systematic review

BACKGROUND: Electronic cigarettes are widely used, and healthcare providers play an important role in advising patients about their safety and possible use in smoking cessation. However, differences in knowledge, attitudes, and confidence may affect the consistency and quality of counseling. AIM: This systematic review examined evidence on knowledge, attitudes, confidence, and information sources related to electronic cigarettes among healthcare providers and medical students. METHODS: A search of PubMed and Scopus was conducted for English-language studies published within the past 10 years. Quantitative, qualitative, and mixed-methods observational studies were included, and findings were synthesized narratively due to methodological differences across studies. RESULTS: Fourteen studies met the inclusion criteria. Although awareness was generally high (up to 79.3%), detailed knowledge was often limited. In Europe, about half of physicians rated their understanding as moderate, and 96.5% of Polish physicians considered e-cigarettes harmful, with only 11.5% supporting their use for smoking cessation. In the Middle East, fewer than 15% viewed them as safer than conventional cigarettes. Among students, 30-36% selected "don't know" when asked about safety. CONCLUSION: Confidence in counseling varied and was typically lower among students. Media and social networks were the most common sources of information. Despite high awareness, important knowledge gaps remain, highlighting the need for structured education and clearer clinical guidance.