E-Cigarettes Use Behavior and Experience of Adults: Qualitative Research Findings to Inform E-Cigarette Use Measure Development

Abstract

Objectives: To gain a better understanding of electronic cigarette (e-cigarette) use behavior and experience among adult e-cigarette users, with the goal of informing development of future e-cigarette use measures. Methods: Between August and October 2014 six focus groups were conducted in Seattle. Participants (63% male; 60% >35 years old; 60% White): e-cigarette users who used combustible tobacco products either currently or in the past. E-cigarette discussion topics covered: their daily use pattern (eg, frequency), product-related characteristics (eg, nicotine levels), and perceptions about health risks and benefits. Results: Participants' descriptions of daily use were so varied that no common "unit" of a "session" easily summarized frequency or quantity of typical e-cigarette use. Most users had difficulty in tracking their own use. Participants reported nicotine craving relief when using e-cigarettes, but described e-cigarettes use as less satisfying than combustible cigarettes. Valued characteristics included "ready availability" and the possibility of using indoors. A unique aspect of the e-cigarette use experience is the option of adding flavors and having the ability to exhale "big clouds" of vapor/aerosol. Most perceived e-cigarettes as a better and safer alternative to conventional cigarettes, yet still sought further information about health consequences and safety of e-cigarettes from trusted sources. Conclusions: E-cigarettes users are far from homogeneous in their behavior and motivation for adopting e-cigarettes. A range of use patterns arising from both hedonic and utilitarian factors, along with product characteristics (eg, variable nicotine levels and flavors) extending beyond those of conventional cigarettes, suggest that new, specific e-cigarette use measures must be developed. Implications: The current study provides timely information on adult e-cigarette use behavior, which is a crucial step in measuring this new phenomenon and assessing the risks associated with using e-cigarette products. Our findings reveal that vaping is not a mere replacement for combustible cigarette smoking and that many users of e-cigarettes enjoy product characteristics such as flavors and "clouds" that are unavailable in combustible cigarettes. Therefore, commonly available cigarette smoking measures are not well suited to measurement of e-cigarette use behavior, and indication that new measures need to be developed to accurately track e-cigarette use.

Twenty‐four‐hour subjective and pharmacological effects of ad‐libitum electronic and combustible cigarette use among dual users

“…‘dizziness’ and ‘nausea’ items comprising the ‘aversion’ subscale of the mCEQ) relative to e‐cigarettes. Similarly, other research has shown that rewarding subjective effects are greater from cigarettes relative to e‐cigarettes following ad‐libitum use and in qualitative interviews . Although nicotine exposure was greater from cigarettes, there was no difference in overall withdrawal symptoms measured by the MNWS.…”

Associations of Electronic Cigarette Nicotine Concentration With Subsequent Cigarette Smoking and Vaping Levels in Adolescents

“…The survey included two questions to characterize vaping intensity: (1) the number of vaping episodes per day, assessed with the question, “On the days you vaped, how many times did you usually pick up your e-cigarette device to vape?” (response options: 1 time, 2 times, 3–5 times, 6–9 times, 10–14 times, 15–20 times, or ≥ 20 times); and (2) the number of puffs taken during each vaping episode, assessed with the question, “Each time you picked up your e-cigarette to vape, how many puffs did you usually take before putting it away?” (response options: 0 puffs, 1 puff, 2 puffs, 3–5 puffs, 6–9 puffs, 10–14 puffs, 15–20 puffs, or ≥ 20 puffs). 17, 18 These response categories were recoded into quantitative count variables by taking the lowest value of each ordinal smoking (i.e., 0, 1, 2, 6, 11, 16, 20 cigarettes/day) and vaping (i.e., 0, 1, 2, 3, 6, 10, 15, 20 puffs or episodes) category for use in the intensity analyses.…”

“Essentially, All Models Are Wrong, but Some Are Useful”: A Preliminary Conceptual Model of Co-occurring E-cig and Alcohol Use

“…Further, e-cig refill liquids vary considerably between products, and even within products, with refills containing various additives and flavorings, and often unconfirmed amounts of nicotine, all of which make the assessment of nicotine exposure difficult. Qualitative findings have demonstrated that, due to the heterogeneity associated with e-cig use behavior, it is difficult to identify a single means of measuring quantity and frequency of e-cig use, and further, e-cig users demonstrate difficulty in recording their e-cig use behavior [61]. Second, individual behaviors of e-cig use, such as puff velocity, also present a challenge in measuring e-cig use.…”