Elevated Nicotine Dependence Scores among Electronic Cigarette Users at an Electronic Cigarette Convention

Abstract

Electronic cigarette (e-cigarette) conventions are trade shows held across the globe to promote e-cigarette products and provide a venue for users to socialize. E-cigarette users that attend these events likely represent the most intensive e-cigarette user group. No study has characterized addiction and behavior characteristics in this population. We surveyed 131 e-cigarette users attending a large Southeastern e-cigarette convention in Fall 2015. All questions from the Fagerstrom Test for Nicotine Dependence (FTND), select questions from the Penn State Electronic Cigarette Dependence Index, and novel user behavior questions were included. In total, 25 questions were included in the survey. FTND scores were calculated for each respondent who answered all six FTND questions (n = 117). Fisher's Exact Chi square test was used to assess the relationship between addiction and behavior characteristics and FTND scores. Most respondents were classified as moderately dependent (score 5-7, 45.3% of respondents). Length of use, waking at night to use an e-cigarette, strength of cravings, strength of urges over the past week, and frequency of visiting e-cigarette blogs were significantly associated with FTND scores. E-cigarettes users have average FTND scores higher than tobacco smokers. Scores were not significantly associated with prior tobacco cigarette use. Characteristics associated with tobacco smokers' nicotine addiction, such as waking at night to smoke and strength of cravings experienced, are relevant to e-cigarette users. E-cigarettes do not contain the magnitude of toxicants in tobacco cigarettes, but e-cigarettes may produce new chemical exposures evidenced by the adverse health effects reported by some respondents.

Influence of Electronic Cigarette Characteristics on Susceptibility, Perceptions, and Abuse Liability Indices among Combustible Tobacco Cigarette Smokers and Non-Smokers

“…Relatedly, some ECIGs are capable of delivering and exceeding CTC-like doses of nicotine [12,13]. ECIG nicotine content and delivery profiles are concerning because of nicotine’s ability to promote dependence following experimentation and progression to chronic use [14,15]. ECIGs are also highly customizable, as users may adjust their nicotine levels and device wattage and choose different ECIG liquid flavors [16].…”

Short-term abstinence effects in experienced electronic cigarette users

“…In this model, older participants, higher nicotine concentrations, daily ECIG use, longer durations of use, and higher device wattages predicted higher ECIG dependence scores, though smoking status and volume of liquid/day did not. This pattern is consistent with previous work documenting positive associations between these same variables and ECIG dependence scores as measured by PSECDI (Foulds et al, 2015;Piper, Baker, Benowitz, Smith, & Jorenby, 2019) or other measures (Johnson et al, 2018;Morean et al, 2018;Piper et al, 2019). Higher PSECDI scores have also been associated with the use of more advanced generation ECIGs (i.e., 2 nd and maybe 3 rd generation devices; Foulds et al, 2015;Yingst et al, 2015), and these devices typically have higher wattages.…”

“…Higher wattages (Kosmider, Spindle et al, 2018) and higher nicotine concentrations (Hiler et al, 2017;Ramôa et al, 2016) are associated with increased nicotine delivery, which may promote greater dependence. No relationship was found between cigarette smoking and ECIG dependence, a finding supported by some work (Johnson et al, 2018) but not others (Morean et al, 2019). Daily volume of liquid used also was not a significant predictor (similar to Browne & Todd, 2018), though ECIG consumption patterns are difficult to characterize (Blank et al, 2016;Pearson et al, 2018).…”

“…This idea is also supported by other work that includes current ECIG users who formerly used cigarettes; dependence scores were shown to be lower, time to first product use in the morning was shown to be longer (i.e., the duration of product abstinence was longer), and ratings of nicotine/tobacco withdrawal and craving were shown to be lower for ECIGs relative to cigarettes (Farsalinos, Romagna, Tsiapras, Kyrzopoulos, & Voudris, 2013b;Foulds et al, 2015). Only one available study has suggested that ECIGs may produce higher levels of dependence than cigarettes (Johnson et al, 2018), though the large majority of the sample reported previous cigarette use (86.2%). The best evidence of dependence on ECIGs, and the phenomenon of ECIG withdrawal, requires evaluation of ECIG users with no history of cigarette or other tobacco use.…”

“…Use characteristics such as longer durations of ECIG use (Foulds et al, 2015;Johnson et al, 2018), as well as daily ECIG use (Morean, Kirshnan-Sarin, & O'Malley, 2018), are associated with increased ECIG dependence. Additionally, frequency of ECIG use increased in an adolescent sample over 12 months along with increased dependence, which may be suggest that users are gaining tolerance (Vogel, Prochaska, Ramo, Andres, & Rubinstein, 2019).…”