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To characterize e-cigarette use, users and effects in a sample of Electronic Cigarette Company (TECC) and Totally Wicked E-Liquid (TWEL) users. Online survey hosted at the University of East London with links from TECC/TWEL websites from September 2011 to May 2012. Online questionnaire. One thousand three hundred and forty-seven respondents from 33 countries (72% European), mean age 43 years, 70% male, 96% Causacian, 44% educated to degree level or above. Seventy-four percent of participants reported not smoking for at least a few weeks since using the e-cigarette and 70% reported reduced urge to smoke. Seventy-two percent of participants used a ‘tank’ system, most commonly, the eGo-C (23%). Mean duration of use was 10 months. Only 1% reported exclusive use of non-nicotine (0 mg) containing liquid. E-cigarettes were generally considered to be satisfying to use; elicit few side effects; be healthier than smoking; improve cough/breathing; and be associated with low levels of craving. Among ex-smokers, ‘time to first vape’ was significantly longer than ‘time to first cigarette’ (t1104 = 11.16, P < 0.001) suggesting a lower level of dependence to e-cigarettes. Ex-smokers reported significantly greater reduction in craving than current smokers (χ21 = 133.66, P < 0.0007) although few other differences emerged between these groups. Compared with males, females opted more for chocolate/sweet flavours (χ21 = 16.16, P < 0.001) and liked the e-cigarette because it resembles a cigarette (χ23 = 42.65, P < 0.001). E-cigarettes are used primarily for smoking cessation, but for a longer duration than nicotine replacement therapy, and users believe them to be safer than smoking.
Content may be subject to copyright.
‘Vaping’ profiles and preferences: an online survey of
electronic cigarette users
Lynne Dawkins, John Turner, Amanda Roberts & Kirstie Soar
School of Psychology, University of East London, London, UK
ABSTRACT
Aims To characterize e-cigarette use, users and effects in a sample of Electronic Cigarette Company (TECC) and
Totally Wicked E-Liquid (TWEL) users. Design and setting Online survey hosted at the University of East London with
links from TECC/TWEL websites from September 2011 to May 2012. Measurements Online questionnaire.
Participants One thousand three hundred and forty-seven respondents from 33 countries (72% European), mean age
43 years, 70% male, 96% Causacian, 44% educated to degree level or above. Findings Seventy-four percent of
participants reported not smoking for at least a few weeks since using the e-cigarette and 70% reported reduced urge
to smoke. Seventy-two percent of participants used a ‘tank’ system, most commonly, the eGo-C (23%). Mean duration
of use was 10 months. Only 1% reported exclusive use of non-nicotine (0 mg) containing liquid. E-cigarettes were
generally considered to be satisfying to use; elicit few side effects; be healthier than smoking; improve cough/breathing;
and be associated with low levels of craving. Among ex-smokers, ‘time to first vape’ was significantly longer than ‘time
to first cigarette’ (t1104 =11.16, P<0.001) suggesting a lower level of dependence to e-cigarettes. Ex-smokers reported
significantly greater reduction in craving than current smokers (c21=133.66, P<0.0007) although few other differ-
ences emerged between these groups. Compared with males, females opted more for chocolate/sweet flavours
(c21=16.16, P<0.001) and liked the e-cigarette because it resembles a cigarette (c23=42.65, P<0.001).
Conclusions E-cigarettes are used primarily for smoking cessation, but for a longer duration than nicotine
replacement therapy, and users believe them to be safer than smoking.
Keywords E-cigarette, electronic cigarette, nicotine, smoking, survey, vaping.
Correspondence to: Lynne Dawkins, School of Psychology, University of East London, Water Lane, Stratford, London E15 4LZ, UK.
E-mail: l.e.dawkins@uel.ac.uk
Submitted 5 October 2012; initial review completed 13 November 2012; final version accepted 8 February 2013
INTRODUCTION
Electronic cigarettes are battery-operated devices that
deliver nicotine via inhaled vapour. Removable car-
tridges contain glycerol or propylene glycol, flavouring,
and varying amounts of nicotine (including 0 mg). The
nicotine solution is vaporized by an atomizer, which is
activated by ‘drawing’ on the device or pressing a
button. ‘Smoking’ an electronic cigarette (e-cigarette)
mimics the act of smoking and is often referred to as
‘vaping’.
Since their introduction into the market in 2004 by
the Ruyan Group (later re-named Dragonite) in China,
e-cigarettes have gained popularity worldwide. The
e-cigarette market is growing rapidly and highly frag-
mented, with over 100 different brands. In 2010,
750,000 e-cigarettes were sold; sales more than doubled
to 2.5 million in 2011 and further increased to 3.5
million in 2012 with no signs of slowing down [1,2].
Product sophistication has also improved during this
time, arguably augmenting nicotine delivery. ‘Tank’
systems have been introduced which contain a fluid-filled
reservoir rather than a saturated foam (traditional non-
tank cartridges). Users can mix their own ‘liquid’ choos-
ing from a range of flavours and strengths to refill
cartridges. Some e-cigarettes [e.g. the Super & Mini kits
from The Electronic Cigarette Company (TECC)] are
moving to ‘cartomizers’ in which the cartridge and atom-
izer are combined, allegedly resulting in a more efficient
and tastier vape. Finally, as different voltages affect the
vaping experience, variable voltages are a recent power
control device that allow users to connect a range of
atomizing devices and control the voltage that is applied
to the atomizer.
RESEARCH REPORT
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doi:10.1111/add.12150
© 2013 Society for the Study of Addiction Addiction,108, 1115–1125
In a recent, online population survey of 2649 adults
in the USA [3] 40.2% of respondents had heard of
e-cigarettes, and 11.4% of smokers, 2% of ex-smokers
and 0.5% of never-smokers had used them. In another
survey of US individuals (n=222) who had purchased an
e-cigarette, 67% of respondents reported that they had
reduced their cigarette consumption and 49% had quit
smoking completely (period of time unspecified) [4]. Nev-
ertheless, in the absence of data supporting these cessa-
tion claims, the World Health Organization have banned
therapeutic claims by manufacturers.
Although there is an absence of clinical trial data for
e-cigarettes, three published empirical studies suggest
they can provide moderate relief of craving and with-
drawal symptoms [5–7]. Reports regarding delivery to
the bloodstream are inconsistent; three human studies
reported very low blood nicotine levels in naive users
[5,6,8], while significant increases in salivary cotinine
(a nicotine metabolite) [9] and blood nicotine levels
[10] have been shown in regular users. This suggests the
use of more sophisticated devices and/or experienced use
is necessary for achieving effective nicotine delivery.
More still needs to be determined about the nature of
e-cigarette use, namely who uses them, their effectiveness
for quitting/harm reduction, safety and addictive poten-
tial. The first survey of e-cigarette users (n=3587; 62%
from USA) has been published recently and has helped to
answer some of these questions [11]. Sixty-one percent of
the sample was male, 70% ex-smokers and 92% agreed
that the e-cigarette had helped them to quit or reduce
their smoking. Most (84%) perceived the e-cigarette to be
less toxic than smoking and reported using it to deal with
tobacco craving (79%) and withdrawal symptoms (67%),
or to quit smoking or avoid relapsing (77%).
This study aims to add to the current knowledge of the
nature of e-cigarette users, its use, and its effects. To
ensure validity and generalizability, we used a more
restricted sample of TECC and Totally Wicked E-Liquid
(TWEL) users (the two most widely-used brands in the
UK; [11]) recruited via their websites. We aimed to
capture information regarding the characteristics of
e-cigarette users (e.g. age, gender, educational status and
why they choose to use the e-cigarette); the nature of
e-cigarette use (e.g. length and frequency of use, amount
used, preferred flavours and devices, possible dependency
and attempts to cut down); and positive (e.g. satisfaction,
acceptability, effects on craving and smoking-behaviour)
and negative effects (e.g. nausea, dizziness, throat/mouth
irritation) of e-cigarette use.
METHOD
The questionnaire was hosted on the University of East
London website with links from TECC andTWEL websites.
Data were collected between September 2011 and May
2012. The survey was fully approved by the University of
East London’s ethics committee.
The questionnaire took approximately 15–20 minutes
to complete, and comprised 6 sections assessing the
following.
1Demographic information (age, gender, ethnicity, edu-
cation and country) and smoking status: current
smoker, ex-smoker or never-smokers (fewer than 20
cigarettes in your lifetime). Participants were directed
to different sections depending on their smoking
status.
2Tobacco smoking information, including the Fager-
ström Test of Cigarette Dependence (FTCD; [12]), a six-
item scale to assess cigarette dependence. Question 1
(commonly considered the strongest single-item pre-
dictor of dependence) asks: ‘How soon after waking do
you/did you smoke your first cigarette?’. Participants
indicate: ‘within 5 minutes’ (scored 3), ‘between 6 and
30 minutes’ (scored 2), ‘31–60 minutes’ (scored 1) or
‘after 60 minutes’ (scored 0). Total scores are calcu-
lated on the 6 items and scores range from 0 (low
dependence) to 10 (high dependence). An adapted
version with wording in the past tense was used if
participants indicated that they were ex-smokers.
Ex-smokers were also asked ‘How long has it been since
you stopped smoking?’ (less than 6 months, 6 months
to 1 year, more than 1 year, more than 2 years).
3Use of the e-cigarette, including length of use, product
and cartridge type, strength and preferred flavours,
amount used (in mL and puffs; where participants indi-
cated a range, we took the top figure and refer to
‘maximum daily use’), reasons for use (e.g. as a com-
plete or partial alternative to smoking. Note: we did not
specifically ask about use for quitting smoking as we
did not want to prime respondents to endorse this
response), dependence on the e-cigarette and attempts
to cut down use.
4Effects of the e-cigarette including satisfaction, hit,
acceptability, taste, urge to smoke, impact on smoking
behaviour and respiratory effects, all rated on a four-
point Likert scale from ‘not at all’ to ‘very much so’.
5Side effects of the e-cigarette based on those used
previously [10] rated on a four-point Likert scale from
‘not at all’ to ‘all the time’.
6Other comments based on general patterns of use
(to be analysed and presented elsewhere).
Statistical analysis
Results are presented for the whole sample (including 4
never-smokers who reported using the e-cigarette) and
then for smoking group: ex-smokers (n=1123) versus
current smokers (n=218) under each category heading.
1116 Lynne Dawkins et al.
© 2013 Society for the Study of Addiction Addiction,108, 1115–1125
This smoking-group comparison was undertaken in
response to (i) the surprisingly high response rate from
ex-smokers (n=1123, 83%) and (ii) the observation that
almost 100% of ex-smokers, compared with 50% of
current smokers, stated that the e-cigarette had helped
them to stop smoking which triggered an interest in
exploring possible differences in user characteristics and
patterns of use between ex and current smokers. Given
that there is also increasing evidence that reinforcing
aspects of smoking/nicotine may differ by gender [7,13]
and that vaping is more common among males [11], we
also compared males (n=897) and females (n=390).
Sample sizes varied by variable owing to missing data.
T-tests were used to compare means for continuous vari-
ables and frequency data are analysed using cross-
tabulation with c2statistics. In some cases respondents
could endorse more than one option (i.e. strength of
liquid used, preferred flavour), whereas other variables
were forced-choice (different response options indicated
in tables). In the case of the former (more than one
response permitted), separate c2analyses were conducted
for each category; for the latter (forced-choice options)
overall c2tests are presented followed by pair-wise com-
parisons only where the overall effect was statistically sig-
nificant. Given the multiple comparisons conducted here
(70 for smokers versus ex-smokers and 50 for males
versus females) we used a Bonferroni correction; thus,
aP-value of 0.0007 was accepted as cut-off for statisti-
cal significance for smoker group comparisons and
P=0.001 for gender comparisons.
RESULTS
Participant information
Of the total 1376 responses, 27 were removed: 13 were
blank; 10 were double entries; and 4 had considerable
missing data. Of the remaining 1349 entries, 1123
(83%) described themselves as ex-smokers, 218 (16%) as
current smokers and 6 (4%) as never-smokers. Two
never-smokers provided no data for the majority of
e-cigarette questions, indicating that they were not actu-
ally using the device so their entries were removed,
leaving a sample size of 1347.
Table 1 presents demographic information for the
whole sample and for ex- versus current smokers. Partici-
pants responded from 33 different countries (72% Euro-
pean): UK (23%, n=315); USA (16%, n=210);
Germany (15%, n=205); France (5%, n=61); Brazil
(2%, n=22); Denmark (1%, n=12); Austria (1%, n=9);
Finland (1%, n=9); Switzerland (1%, n=8); others
[36%; n<4 (0.3%) from each of the 24 other countries].
There were no significant differences between ex- and
current smokers on any demographic variable or country
of origin.
Compared with current smokers, ex-smokers as a
group reported a higher level of cigarette dependence
(FTCD total, see Table 1) and reported smoking sooner
after waking (FTCD, Question 1), but age of starting
smoking did not differ by group. Thirty-eight percent of
ex-smokers reported that they had stopped smoking for
more than 1 year; 19% had stopped for between 6 and
11 months and 43% for less than 6 months.
E-cigarette patterns of use
Thirty-five percent (n=448) of respondents stated that
they had heard about the e-cigarette from a personal
contact; 41% (n=526) from the internet; 10% (n=134)
via other media; and 8% (n=100) saw it being used.
Table 2 presents information on e-cigarette patterns of
use for the whole sample and separately for ex- versus
current smokers. Twenty-three percent (n=302) stated
that they used their e-cigarette within 5 minutes of
waking and 49% (n=645) within 6–30 minutes of
waking [note: data presented in table are mean scores
(between 0 and 3)].
Duration of e-cigarette use was significantly longer in
current than ex-smokers, while ex-smokers reported
using the e-cigarette sooner after waking than did
current smokers. Ex-smokers also reported greater daily
use (in mL and puffs), although this difference did not
reach statistical significance at the adjusted alevel. In
ex-smokers, ‘time until first cigarette’ (based on retro-
spective reporting of former smoking habits) was signifi-
cantly shorter than ‘time until first vape’ (t1104 =11.16,
P<0.0007).
Fifty-six percent (n=744) of the whole sample
answered ‘yes’ to the question ‘Do you use the e-cigarette
in the same manner as cigarettes?’. Five hundred and
eighty-nine (44%) qualified their answer with comments:
6% (n=37) stated that they used it less and 29%
(n=177) used it more. Of the latter, 5% (n=30) stated
that they used it ‘constantly’ or ‘chain vaped’; 13.%
(n=79) used it more because vaping was permitted in
places where smoking was not allowed; 17% (n=99)
used the e-cigarette more frequently, but took fewer puffs
on each occasion. Two participants compared their use of
the e-cigarette to ‘snacking’ and one to ‘grazing’.
Unsurprisingly, 80% (n=1063) of stated products
were TECC/TWEL products (see Table 2 for a breakdown
of products used). There was a statistically significant
overall group difference for product type. Follow-up
analyses of individual product type by group revealed
that more ex-smokers than current smokers reported
using the Tornado Tank eGo-C and custom-made devices,
and more current smokers reported using the Titan 510
(non-tank) system, although these differences fell short of
the adjusted alevel adopted here. Table 2 also provides
Vaping profiles and preferences 1117
© 2013 Society for the Study of Addiction Addiction,108, 1115–1125
frequencies and percentages for strengths and flavours
used. The 18-mg fluid was the most popular (49%,
n=663) and tobacco was the most popular flavour
(53%, n=664). There were no differences between
current smokers and ex-smokers with respect to flavour
preference.
E-cigarette reasons for use and effects on tobacco
consumption
Survey respondents were asked why they started using
the e-cigarette (see Table 3). Seventy-six percent (1027)
of the whole sample reported wanting a ‘complete alter-
native to smoking’. Twenty-two percent stated ‘other
reasons’, including ‘to quit smoking’ (7%, n=87),
‘health reasons’ (6%, n=83), ‘cost’ (3%, n=36) and ‘to
get round smoking restrictions’ (3%, n=35). A higher
proportion of ex-smokers than current smokers endorsed
the ‘complete alternative to smoking’ item, while a higher
proportion of current smokers endorsed ‘partial alterna-
tive to smoking’.
In the whole sample, 74% (n=981) reported that
they had not smoked for several weeks to several months
since using the e-cigarette, and a further 14% (n=184)
reported that their cigarette consumption had decreased
dramatically. Not surprisingly, a greater proportion of
ex-smokers reported that they had not smoked for several
weeks or months, while significantly more current
smokers reported that their tobacco consumption had
decreased dramatically. E-cigarette use was also associ-
ated with a reduction in craving for tobacco cigarettes
with 91% (n=1208) stating that their craving had
‘decreased substantially’. Endorsement of this response
was also significantly greater in ex- than current smokers
(see Table 3). Thirty percent [31% (n=339) of
ex-smokers and 24% (n=24) of current smokers] stated
that they had attempted to cut down their e-cigarette use.
There were no group differences in terms of success in
this endeavour (see Table 3).
Positive effects of the e-cigarette
Table 4 presents the percentage of the whole sample, and
breakdown by smoking group, endorsing the ‘not at all’
and the ‘very much so’ responses relating to e-cigarette
effects. Overall this sample reported positive effects of
Table 1 Participant demographic and smoking-related information.
Whole sample Ex-smokers Current smokers
P Test statisticn Mean (SD) n Mean (SD) n Mean (SD)
Age (years) 1302 43.39 (11.99) 1084 43.34 (11.76) 212 43.54 (13.10) 0.84 t=-0.2
Age started smoking 1338 15.68 (3.66) 1121 15.6 (3.63) 218 16.13 (3.78) 0.047 t=-1.99
FTCD 1317 5.99 (2.41) 1107 6.20 (2.30) 210 4.93 (2.66) <0.0007 t=6.45
FTCD Q1: How soon after waking
do/did you smoke cigarettes?
1338 2.11 (0.91) 1121 2.17 (0.87) 217 1.79 (1.04) <0.0007 t=4.97
n%n%n%
Gender: 1287 0.78 c2=0.078
Male 897 70 749 70 144 69
Female 390 30 323 30 65 31
Ethnicity: 1272 0.79 c2=1.03
White 1225 96 1027 97 193 96
Black 6 <15111
Asian 15 1 12 1 2 1
Mixed 26 2 20 2 6 3
Highest level of education: 1274 0.56 c2=12.61
Masters degree/MBA/PhD or equiv. 180 14 154 15 25 12
Degree 380 30 308 29 71 35
Higher Teaching Qualification or
equiv.
127 10 103 10 23 11
A level/SCE Higher or equiv 166 13 142 13 23 11
O level/GCSE (Grade A–C) or equiv. 110 9 92 9 18 9
CSE Grade 2–5/O Levels (grades
D&E)/GCSE (grades D–G)/NVQ
level 1
40 3 29 3 11 5
CSE ungraded 11 1 9 1 2 1
Other 260 20 227 21 31 15
Items in bold are statistically significant at the adjusted Plevel of <0.0007. FTCD =Fagerström Test of Cigarette Dependence; SCE =Scottish Certificate
of Education; GCSE =General Certificate of Secondary Education; CSE =Certificate of Secondary Education; NVQ =National Vocational Qualification.
1118 Lynne Dawkins et al.
© 2013 Society for the Study of Addiction Addiction,108, 1115–1125
Table 2 E-cigarette patterns of use.
Whole sample Ex-smokers Current smokers
P Test statisticn Mean (SD) n Mean (SD) n Mean (SD)
Duration of use (days) 1334 315.67 (333.83) 1113 329.49 (342.83) 216 248.77 (276.46) <0.0007 t=3.77
Estimated maximum daily use (mL) 1197 3.36 (3.53) 1018 3.50 (3.68) 174 2.50 (2.37) 0.001 t=3.45
Estimated maximum daily number of puffs 983 235.72 (339.13) 812 249.38 (361.07) 166 172.14 (194.97) 0.008 t=2.68
How soon upon waking do you smoke your e-cig 1323 1.84 (0.89) 1106 1.89 (0.86) 211 1.59 (0.98) <0.0007 t=4.16
n%n%n%
Product typea: 1322 <0.0007 c2=73.26
Tank use (any) 678 out of 974 72 565 70 109 65 0.186 c2=2.37
Tornado Tank EGo-C 301 23 268 24 33 16 0.005 c2=7.81
Tornado Tank 197 15 157 14 38 18 0.173 c2=1.85
Tornado (non-tank) 105 8 82 7 23 11 0.096 c2=2.77
510 Titan tank 66 5 50 5 16 8 0.068 c2=3.34
510 Titan (non-tank) 87 7 62 6 25 12 0.001 c2=10.84
Joyetech eGo-C 96 7 75 7 20 9 0.180 c2=1.80
Screwdriver 50 4 47 4 3 1 0.046 c2=3.967
Mini (non-tank) 27 2 24 2 3 1 0.470 c2=0.521
Super (non-tank) 15 1 10 1 4 2 0.205 c2=1.604
Mircolite cartomizer 4 <0.5 2 <0.5 2 1 0.066 c2=3.386
Torpedo 1 <0.5 0 0 1 <0.5 0.023 c2=5.187
Custom made 113 9 107 10 6 3 0.001 c2=11.31
Other non-TEEC/TWEL product 143 11 123 11 19 9 0.339 c2=0.92
Unknown 116 9 96 9 20 9 0.744 c2=0.11
e-pipe 1 <0.5 1 <0.5 0 0 0.660 c2=0.193
Strengths usedb
0 mg (only) 14 1 13 1 1 0.5 0.35 c2=0.86
0 mg 148 11 136 12 10 5 0.001 c2=10.65
8 mg 246 18 216 19 25 12 0.006 c2=7.47
11 mg 447 33 385 34 58 27 0.028 c2=4.87
14 mg 200 15 167 15 32 15 0.95 c2=0.005
18 mg 663 49 546 49 116 53 0.21 c2=1.54
24 mg 260 19 209 19 51 23 0.10 c2=2.67
36 mg 189 14 152 14 37 17 0.18 c2=1.78
Mix own 286 21 248 22 36 17 0.07 c2=3.39
Preferred flavourb
Tobacco 664 53 542 51 121 61 0.012 c2=6.29
Fruit 421 33 360 34 58 29 0.180 c2=1.80
Mint/menthol 357 28 300 28 56 28 0.969 c2=0.001
Chocolate/sweet flavour 231 18 195 18 35 18 0.778 c2=0.08
Coffee 167 13 142 13 25 13 0.750 c2=0.10
Other 196 16 176 17 17 9 0.004 c2=8.41
Vanilla 156 12 130 12 25 13 0.903 c2=0.02
Alcohol related 49 4 40 4 7 4 0.863 c2=0.03
Flavourless 11 1 10 1 0 0 0.170 c2=1.89
Items in bold are statisically significant at the adjusted Pvalue <0.0007. e-cig =e-cigarette;TEEC =The Electronic Cigarette Company; TWEL =Totally Wicked E-Liquid. aForced-choice options. bRespondents could indicate more than one option.
Vaping profiles and preferences 1119
© 2013 Society for the Study of Addiction Addiction,108, 1115–1125
e-cigarette use, satisfaction levels were high and there
was little evidence that e-cigarette use induced strong
craving levels. A significantly higher proportion of
ex-smokers reported that e-cigarette use had helped them
to stop or cut down smoking; was extremely satisfying;
had reduced tobacco craving/urge to smoke; improved
their cough and breathing; and felt healthier than
smoking (see Table 4).
Negative effects of the e-cigarette
Very few adverse effects of e-cigarette use were reported
(see Table 5). The most common was throat irritation,
followed by mouth irritation. Of all the other side effects
listed, less than 16% (n<202) reported experiencing any
degree of effect and less than 3% (n<32) reported a high
level of side effects. There were no significant differences
with respect to reporting of adverse effects between
ex- and current smokers.
Gender differences
Female respondents were significantly older than
males [mean 45.82 (11.52) versus 42.14 (11.93);
t1271 =-4.89, P<0.001]. There were no other significant
gender differences for socio-demographic variables.
Females rated themselves as significantly more dependent
on cigarettes as measured by FTCD item one (t1277 =
-3.59 P<0.001) and FTCD total score (t1258 =-3.05,
P<0.01), although the latter was not statistically signifi-
cant. In relation to e-cigarette use, there were no signifi-
cant differences between males and females on ‘time to
first vape’, duration of use, or estimated amount used.
Although differences were not statistical significant,
fewer females reported using the Screwdriver (c21=8.21,
P<0.01) or a tank system (of any sort; c21=6.80,
P<0.01), and more females reported using the Mini
(c21=7.01, P<0.01) and Super (c21=7.78, P<0.01)
devices. Females, however, were just as likely as males to
report using custom-made devices. There were no gender
differences for strength of fluid used, although males pre-
ferred tobacco flavour (c21=17.67, P<0.001) and more
females reported using chocolate or other sweet flavours
(c21=16.16, P<0.001). In response to the question
‘Where did you hear about the e-cigarette?’, females were
more likely to endorse the ‘personal contact’ response
(c21=14.24, P<0.001). Tabular data are not presented
for gender; this is available on request.
There were no significant gender differences for any of
the items relating to reasons for use, effects on tobacco
consumption or craving, or attempt to cut down
e-cigarette use. Females were, however, significantly
more likely to agree that they ‘liked the taste of the
Table 3 E-cigarette use and effects on tobacco smoking.
Whole sample Ex-smokers Current smokers
Pc2
n%n%n%
Why start using e-cig?a
Wanted complete alternative to smoking 1027 76 880 78 144 66 <0.0007 15.32
Wanted partial alternative to smoking 257 19 169 15 88 40 <0.0007 75.54
Curiosity 356 26 280 25 73 34 0.009 6.89
Friends recommendation 245 18 204 18 40 18 0.949 0.004
Other 290 22 246 22 43 20 0.149 2.077
Since e-cig use, tobacco consumption use hasb: 1336 <0.0007 622.80
Increased dramatically 13 1 8 1 5 2 0.030 4.72
Stayed the same 12 1 7 1 5 2 0.017 5.70
Decreased dramatically 184 14 64 6 120 55 <0.0007 374.01
Not smoked for several weeks 221 17 204 18 16 7 <0.0007 15.79
Not smoked for several months 760 57 744 67 11 5 <0.0007 282.39
Since e-cig use craving for tobacco cigarettes hasb: 1331 <0.0007 161.49
Increased substantially 16 1 14 1 2 1 0.684 0.165
Stayed the same 38 3 14 1 21 10 <0.0007 50.67
Decreased substantially 1208 91 1054 95 151 70 <0.0007 133.66
Attempted to cut down e-cig use 392 out of 1330 30 339 31 51 24 0.05 3.89
Success at cutting downb: 389 0.006 16.52
Extremely successful 15 4 15 5 0 0
Not very successful 105 27 91 27 14 28
Very unsuccessful 3 1 2 1 3 1
Items in bold are statistically significant at the adjusted Plevel <0.0007. E-cig =e-cigarette. aRespondents could indicate more than one option.
bForced-choice options.
1120 Lynne Dawkins et al.
© 2013 Society for the Study of Addiction Addiction,108, 1115–1125
Table 4 Effects of the electronic cigarette (%).
Whole sample Ex-smokers Current smokers
Pc2
n
Not
at all
Very
much so n
Not
at all
Very
much So n
Not
at all
Very
much so
The e-cigarette has helped me to stop smoking 1333 1.5 89.4 1113 0.8 97.2 216 4.2 49.5 <0.0007 448.09
My breathing has improved since using the e-cigarette 1327 3.5 72.4 1109 2.4 77.5 214 8.9 45.8 <0.0007 102.80
I get a definite nicotine hit from the e-cigarette 1333 3.3 56.2 1113 3.0 56.3 216 5.1 56 0.100 6.28
I don’t like the taste of the e-cigarette 1330 83.2 2.6 1111 84 2.7 214 79.4 2.3 0.309 3.59
E-cigarette use is as satisfying as tobacco smoking 1335 1.2 68.0 1115 0.9 72.4 216 2.8 45.4 <0.0007 70.13
The e-cigarette irritates my airways more than cigarettes do/did 1328 86.2 0.8 1107 87.3 0.8 217 81.1 0.5 0.066 7.18
I crave e-cigarettes as much as I do/did tobacco 1322 13.3 18.4 1103 12.7 18.9 215 15.3 15.8 0.421 2.82
I like the e-cigarette because it looks and feels like a cigarette 1328 40.3 17.2 1108 40.9 16.1 216 36.1 23.1 0.062 7.34
I sometimes find it embarrassing using the e-cigarette in public places 1331 45.3 6.6 1110 45.5 5.9 217 45.2 10.6 0.019 9.93
E-cigarettes feel healthier than smoking 1325 0.5 81.4 1108 0.5 83.3 213 0.9 71.8 <0.0007 23.62
The e-cigarette has helped me to cut down tobacco smoking 1321 0.8 94.3 1107 0.5 98.3 213 1.9 74.1 <0.0007 204.09
I enjoy other people’s reactions to me using the e-cigarette 1330 11.7 32.2 1111 11.2 32.5 214 15 30.8 0.406 2.91
The e-cigarette allows me to use nicotine more 1327 47.6 11.1 1110 48.6 10.4 213 41.8 14.6 0.020 9.82
My cough has improved since using the e-cigarette 1310 9.0 70.3 1097 8.3 75.1 209 12.4 45 <0.0007 83.60
I don’t have the urge to smoke as much since using the e-cigarette 1319 3.8 69.7 1106 3.4 73.1 209 5.7 52.2 <0.0007 36.49
The e-cigarette is too heavy 1324 64.3 1.4 1107 65.7 1 212 28.8 57.1 0.011 11.05
I frequently use the e-cigarette in places where tobacco smoking is banned 1326 16 35.9 1110 15.6 35.5 211 18.5 38.4 0.368 3.16
Items in bold are statistically significant at the adjusted Pvalue <0.0007.
Vaping profiles and preferences 1121
© 2013 Society for the Study of Addiction Addiction,108, 1115–1125
e-cigarette’ (c23=16.56, P<0.001); they ‘liked the
e-cigarette because it looks and feels like a cigarette’
(c23=42.65, P<0.001); and ‘the e-cigarette dramati-
cally reduces my craving for nicotine’ (c23=13.94,
P<0.001). No gender differences emerged for reporting
of side effects.
DISCUSSION
The present study aimed to characterize e-cigarette use,
users and effects in a sample of visitors to TECC and
TWEL websites. Survey respondents were predominantly
ex-smokers who wanted a complete alternative to
smoking. The majority of respondents reported that
e-cigarette use (vaping) had dramatically reduced their
craving for cigarettes and helped them to stop or substan-
tially reduce their tobacco consumption. Very few
respondents reported using non-nicotine (0 mg) contain-
ing cartridges/liquid. E-cigarettes were generally consid-
ered to be satisfying to use, associated with very few side
effects, healthier than smoking, and responsible for
improved cough and breathing. Compared with current
smokers, significantly more ex-smokers reported that
vaping dramatically reduced their craving for tobacco
smoking and there was a trend for more ex-smokers to
report using a tank or custom-made device. No smoking
group differences were observed for adverse effects or
strengths or flavours used. Females opted more for
chocolate/sweet flavours, whereas males preferred
tobacco-flavoured liquids and tank systems. Compared to
tobacco smoking, vaping was associated with lower
craving and longer time until first use in the morning,
suggesting a lower level of dependence to e-cigarettes
than to smoking. Nevertheless, only a third of the sample
reported that they had attempted to cut down their
e-cigarette use with varying levels of success.
Although participants in the current sample repre-
sented 33 different countries (72% European), respond-
ents were predominantly Caucasian males. This gender
bias is consistent with previous observations [11] that
e-cigarettes appeal more to men than women. The mean
age of the sample (43 years) and the low percentage of
non-smoking respondents, also consistent with the pre-
vious survey [11], may either reflect the lower age limit
(18 years) for participation in both surveys or indicate
that e-cigarettes are not attracting large numbers of
young adults to a recreational nicotine habit. Eighty-
three percent of the current sample described themselves
as ex-smokers, 97% of whom reported that the
e-cigarette had helped them to stop smoking. Self-
reported (retrospective) nicotine dependency from
smoking (as assessed by the FTCD total score and ques-
tion 1) was higher for ex-smokers than current smokers.
This was an unexpected finding as one might expect
ex-smokers to be less dependent and thus better able to
quit, but it may reflect the retrospective nature of
responding in ex-smokers.
As participants responded to adverts via the TECC and
TWEL webpages, unsurprisingly, 80% of the sample
stated that they used TECC/TWEL products and 72% used
a tank system. Ex-smokers were more likely than current
smokers to use the Tornado Tank eGo-C or custom-made
devices. Although this difference fell short of the adjusted
level of statistical significance, it raises the possibility that
Table 5 Side effects associated with e-cigarette use (%).
Whole sample Ex-smokers Current smokers
Pc2
n
Not
at all
All
the time n
Not
at all
All
the time n
Not
at all
All
the time
Mouth irritation 1328 76.8 0.5 1110 76.3 0.5 214 79 0.5 0.714 1.36
Throat irritation 1329 63.1 0.5 1109 63.3 0.5 216 62 0.5 0.018 10.10
Aching jaws 1321 94.7 0.4 1103 95.6 0.4 214 90.2 0.5 0.012 11.01
Feeling sick 1317 90.8 0.3 1101 90.9 0.4 212 90.1 0 0.740 1.25
Vomiting 1307 98.8 0.3 1090 98.6 0.4 213 99.5 0 0.686 1.48
Flatulence/Bloating 1317 86.2 0.7 1103 85.6 0.7 210 89 0.5 0.617 1.79
Stomach ache 1327 93.2 0.5 1106 92.7 0.5 214 95.8 0.5 0.390 3.01
Heartburn 1321 85.6 0.4 1103 85.1 0.5 214 87.9 0 0.200 4.65
Diarrhoea 1318 94.3 0.2 1102 94.3 0.2 212 94.3 0 0.780 1.09
Hiccups 1316 89.9 0.2 1101 89.5 0.2 211 91.9 0 0.518 2.27
Feeling dizzy 1309 84.4 0.2 1100 84.5 0.2 213 83.3 0.5 0.808 0.97
Headache 1309 83.7 0.2 1095 83.4 0.2 210 85.1 0 0.836 0.86
Sweatiness 1317 94.1 0.3 1097 94.3 0.4 208 93.4 0 0.521 2.26
Cold hands/feet 1320 96.3 0.2 1100 96.4 0.2 213 95.8 0 0.663 1.58
Palpitations 1320 91.8 0.2 1104 92.1 0.2 212 90.1 0.5 0.714 1.36
1122 Lynne Dawkins et al.
© 2013 Society for the Study of Addiction Addiction,108, 1115–1125
tank systems are more effective for quitting smoking; an
area of research that merits further exploration. The
average maximum daily amount used was 3.36 mL of
fluid and 236 puffs—higher figures than reported previ-
ously [11]. Many respondents provided further details
about their e-cigarette use, which generally indicated that
e-cigarettes are used more frequently throughout the day
than cigarette smoking. This may reflect the fact that
vaping is permitted in places were cigarette smoking is
banned and/or that more puffs are required to achieve
adequate blood nicotine levels [6].
Only 1% of the sample reported exclusive use of non-
nicotine (0 mg). Contrary to the finding that use of the
0 mg e-cigarette in naive users can reduce craving and
withdrawal symptoms [7], these findings indicate that
the nicotine content is an important constituent for
regular users. This may be because more experienced
users are better able to detect the effects of nicotine,
and/or that the sensorimotor effects of non-nicotine con-
taining e-cigarettes on withdrawal and craving are only
short-lived. Alternatively, user expectations about the
importance of nicotine may lead to greater use of
nicotine-containing fluid. The most popular concentra-
tion of nicotine was 18 mg, and tobacco was the most
popular flavour, consistent with the previous report [11].
Seventy-four percent of the sample reported that they
had not smoked for at least several weeks since using the
e-cigarette and 57% reported that they had not smoked
for several months. Thus, respondents seem to be using
the e-cigarette as a quit-smoking tool with high self-
reported success rates. Nevertheless, whether e-cigarette
use itself is discontinued is unclear; participants in our
sample reported using the e-cigarette for an average of 10
months—much longer than the average duration of use
reported previously (5 months [11]). This may reflect the
recency of the present survey, thus allowing respondents
a longer time to vape, or it might reflect our sampling
method; advertisements on TECC and TWEL websites
would mean that only current e-cigarette users would
have known about the study. Either way, 10 months is
much longer than the recommended use of nicotine
replacement therapy (12 week [14]), suggesting that
people may be using e-cigarettes as a longer-term replace-
ment of the smoking habit rather than as a means of
quitting nicotine intake completely.
This raises the question that e-cigarettes themselves
could be addictive. Our findings concur with a recent
report suggesting that e-cigarettes have a lower abuse
potential than tobacco smoking [15]. Only 18% agreed
that craving for e-cigarettes was as strong as craving for
tobacco and ex-smokers indicated that time to first vape
was longer than time until first cigarette. Notwithstand-
ing that reports about former tobacco use may be subject
to distortion given the retrospective nature of responding,
these findings suggest a lower dependency on e-cigarettes
compared to tobacco smoking. Nevertheless, only a third
of our sample reported that they had tried to cut down
their e-cigarette use. This may reflect the nature of the
sample, a general reluctance or malaise among the
vaping community to stop using, or an inability or diffi-
culty to do so. Of those attempting to cut down, only 12%
reported that they had been ‘very’ or ‘extremely’ success-
ful. Abuse liability of the e-cigarette and effects of long-
term use on health are two under-explored areas that
clearly merit further attention.
The majority of the sample thought that e-cigarettes
were healthier than tobacco smoking (81%), and
reported an improvement in cough and breathing (70%).
E-cigarettes were generally rated to be satisfying to use,
associated with a dramatic reduction in tobacco craving,
and almost half of the sample agreed that the ‘hit’ was
comparable to that of tobacco smoking. Very few side
effects were endorsed (although negative effects would be
the variable least likely to score highly amongst this
cohort and would be better explored in a randomized con-
trolled trial). Ex-smokers reported a greater benefit to
their breathing, a stronger ‘hit’ and a greater reduction of
craving from e-cigarette use than current smokers.There
was also less reporting of aching jaws and throat irrita-
tion among ex-smokers. It is unclear whether these
effects reflect differences between ex- and current
smokers in product choice which contributed to greater
success in quitting smoking in the former or whether
quitting itself led to stronger perceived positive effects of
e-cigarette use. While an exploration of predictors of ces-
sation success using the e-cigarette was beyond the scope
of this paper, it would be interesting to explore such dif-
ferences in a controlled study using regression analysis
and confirmation of abstinence status.
Smoking status (ex- versus current) did not differ by
gender nor were there any gender differences on effects
of e-cigarette use on tobacco smoking, manner of
e-cigarette use, duration of use or amount used. Predict-
able flavour and product choice differences emerged with
a female preference for chocolate and sweet flavours, and
a preference trend for Super and Mini products that
resemble cigarettes. Indeed, significantly more females
than males endorsed the items ‘I like the e-cigarette
because it looks and feels like a cigarette’ and ‘I like the
taste of the e-cigarette’. Although females did not opt for
higher strength fluid, they were more likely to agree that
the e-cigarette reduced their cigarette cravings. These
observations resonate with the findings that, relative to
males, females are less sensitive to the interoceptive
effects of nicotine [16] and more responsive to non-
nicotine, sensorimotor aspects of smoking [7,13,17].
There are several limitations of this study, notably
the self-selected sample of TECC and TWEL users who
Vaping profiles and preferences 1123
© 2013 Society for the Study of Addiction Addiction,108, 1115–1125
responded to a link to the survey from the TECC/TWEL
websites, and whose smoking status and responses
cannot be validated. Such respondents are likely to be
current users with positive biases towards the e-cigarette,
thus it is likely that unsatisfied users and ex-users are
under-represented in this sample. There is also scope for
‘gaming’ here by individuals or organizations who might
have a vested interest in promoting the beneficial effects
of TECC/TWEL products or e-cigarettes in general against
the backdrop of regulatory uncertainty and possible
withdrawal of these products from the market [18,19].
This is particularly relevant to the current survey, which
was accessed by users of two leading UK e-cigarette retail-
er’s websites whereas participants in the previous survey
[11] were sampled from e-cigarette discussion forums
and more ‘neutral’ stop-smoking sites. Nevertheless,
reports regarding reasons for use, nature of use and posi-
tive and negative effects were similar across studies. Some
of the questions used here (i.e. those relating to former
tobacco smoking habits) required retrospective reporting.
This is often subject to bias/distortion which makes com-
parisons between former smoking habits and current
vaping less reliable. Overall then, while this study pro-
vides further insight into the nature of e-cigarette use, it
is likely that these data overestimate the efficacy of the
e-cigarette, thus findings should be interpreted with
caution.
Although these potential biases should be borne in
mind, taken together, the results of this study, and pre-
vious studies [4,11], suggest that e-cigarette users who
respond to online surveys vape as a complete or partial
alternative to smoking. There was little evidence for
dual use (smokers continuing to smoke at previous
levels and adding nicotine via e-cigarette) or addictive
potential in this sample. Although absolute safety and
product quality should be more thoroughly evaluated,
the implications of these findings for policy-makers,
regulators and health-care providers are clear: prohibit-
ing or discouraging the use of e-cigarettes could be det-
rimental to public health if smokers are deprived of a
highly endorsed and well-tolerated method of smoking
cessation.
To conclude, the findings from this survey of self-
selected, largely European TECC and TWEL e-cigarette
users are broadly consistent with a previous large-scale
survey [11] and suggest that e-cigarettes are used largely
by smokers to quit smoking, with a high degree of
success. Results reveal that e-cigarettes were satisfying to
use, reduced cravings for tobacco cigarettes, were associ-
ated with very few immediate side effects and tended to be
used for a longer duration than NRT. Future research
should concentrate on possible health risks associated
with long-term use, efficacy for smoking cessation (with
possible brand/product differences) and abuse potential.
Declaration of interest
No funding was received for this study. The first author
has a collaborative relationship with the Electronic Ciga-
rette Company (TECC) and Totally Wicked E-Liquids
(TWEL), and has received funds from these companies to
attend academic conferences. TECC and TWEL reviewed
and approved the content of the questionnaire and set up
links from their websites to the host site at UEL.
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Background E-cigarette aerosol containing aldehydes, including acetaldehyde, are metabolized by the enzyme aldehyde dehydrogenase 2 (ALDH2). However, little is known how aldehyde exposure from e-cigarettes, when coupled with an inactivating ALDH2 genetic variant, ALDH2*2 (present in 8% of the world population), affects cardiovascular oxidative stress. Objectives The study was to determine how e-cigarette aerosol exposure, coupled with genetics, impacts cardiovascular oxidative stress in wild type ALDH2 and ALDH2*2 knock-in mice. Methods Using selective ion flow mass spectrometry, we determined e-cigarette aerosol contains acetaldehyde levels 10-fold higher than formaldehyde or acrolein. Based on this finding, we tested how isolated ALDH2*2 primary cardiomyocytes respond to acetaldehyde and how intact ALDH2*2 knock-in rodents instrumented with telemeters respond physiologically and at the molecular level to 10 days of e-cigarette aerosol exposure relative to wild type ALDH2 rodents. Results For ALDH2*2 isolated cardiomyocytes, acetaldehyde (1 μM) caused a 4-fold greater peak calcium influx, 2-fold increase in ROS production and 2-fold increase in 4-HNE-induced protein adducts relative to wild-type ALDH2 cardiomyocytes. The heart rate in ALDH2*2 mice increased ∼300 beats/min, while, heart rate in ALDH2 mice increased ∼150 beats/min after 10 days of e-cigarette exposure, relative to air-exposed mice. E-cigarette aerosol exposure triggered ∼1.3 to 2-fold higher level of protein carbonylation, lipid peroxidation, and phosphorylation of NF-κB for both strains of mice, with this response exacerbated for ALDH2*2 mice. Conclusions Our findings indicate people carrying an ALDH2*2 genetic variant may be more susceptible to increases in cardiovascular oxidative stress from e-cigarette aerosol exposure.
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Amaç: Bu çalışma, YouTube üzerinden izleyiciyle buluşan elektronik sigara videolarında öne çıkan unsurları belirlemek amacıyla yürütülmüştür. Yöntem: Çalışma kapsamında Youtube’da Türkçe olarak yayımlanan elektronik sigara videoları söylem analizi tekniği ile incelenmiştir. Bu kapsamda video içeriklerde yer alan söylemler data olarak alınmıştır. Bu amaçla, çalışmaya uygun kriterde ulaşılan 60 video dahil edilmiştir. Bulgular: Çalışmada bulgular, “Cihazla İlgili Olumlamalar”, “Cihazla İlgili Uyarılar” ve “Sigara ile Karşılaştırma” başlıkları altında tematik olarak sunulmuştur. Sonuç: Bu sonuçlara göre dolaşımda bulunan elektronik sigara videolarının büyük oranda reklam ve tanıtım içeriği biçiminde kurgulandığı ve ürünün geleneksel sigaraya kıyasla daha etkili, ucuz ve zararsız bir ürün olarak tanıtıldığı görülmüştür. Diğer yandan geleneksel sigaranın zararlarını azaltmak ya da kullanımını sonlandırmak amacıyla kullanılabileceği yönündeki imaj öne çıkmıştır. Bir kısım videolarda cihazın kullanımına ilişkin teknik uyarılar söz konusu olmakla birlikte videolarda elektronik sigaraya ilişkin olumsuz bir algının aktarılmadığı belirlenmiştir. Ayrıca daha ucuz ve zararsız bir ürün olarak geleneksel sigaraya muadil bir tütün kullanım yöntemi olduğu ve bu yönüyle kullanımının teşvik edildiği belirlenmiştir. Anahtar kelimeler: Elektronik sigara, YouTube, söylem analizi Objective: This study was carried out to determine the prominent elements in electronic cigarette videos that meet the audience on YouTube. Method: In this study, electronic cigarette videos published in Turkish on Youtube were examined by discourse analysis technique. In this context, the discourses in the video contents were taken as data. For this purpose, 60 videos that were reached in the criteria suitable for the study were included. Results: The results are presented thematically under the headings of “Affirmations about the Device”, “Warnings about the Device” and “Comparison with Smoking”. Conclusion: According to these results, it is seen that the electronic cigarette videos in circulation are mostly designed in the form of advertisement and promotional content, and the product is promoted as a more effective, cheap and harmless product compared to traditional cigarettes. Also, the image that it can be used to reduce the harms of traditional cigarettes or to terminate its use has come to the fore. Although there are technical warnings about the use of the device in some videos, it has been determined that a negative perception of electronic cigarettes is not conveyed in the videos. In addition, it has been determined that it is a tobacco use method equivalent to traditional cigarettes as a cheaper and harmless product and its use is encouraged in this respect. Keywords: Electronic cigarette, YouTube, discourse analysis
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Background: Despite the steady rise in electronic cigarette (e-cigarette) uptake among young adults, increasingly more young people want to quit. Given the popularity of smartphones among young adults, mobile-based e-cigarette cessation interventions hold significant promise. Smartphone apps are particularly promising due to their varied and complex capabilities to engage end users. However, evidence around young adults' preferences and expectations from an e-cigarette cessation smartphone app remains unexplored. Objective: The purpose of this study was to take an initial step toward understanding young adults' preferences and perceptions on app-based e-cigarette cessation interventions. Methods: Using a qualitative descriptive approach, we interviewed 12 young adults who used e-cigarettes and wanted to quit. We inductively derived themes using the framework analysis approach and NVivo 12 qualitative data analysis software. Results: All participants agreed that a smartphone app for supporting cessation was desirable. In addition, we found 4 key themes related to their preferences for app components: (1) flexible personalization (being able to enter and modify goals); (2) e-cigarette behavior tracking (progress and benefits of quitting); (3) safely managed social support (moderated and anonymous); and (4) positively framed notifications (encouraging and motivational messages). Some gender-based differences indicate that women were more likely to use e-cigarettes to cope with stress, preferred more aesthetic tailoring in the app, and were less likely to quit cold turkey compared with men. Conclusions: The findings provide direction for the development and testing of app-based e-cigarette cessation interventions for young adults.
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We estimated e-cigarette (electronic nicotine delivery system) awareness, use, and harm perceptions among US adults. We drew data from 2 surveys conducted in 2010: a national online study (n = 2649) and the Legacy Longitudinal Smoker Cohort (n = 3658). We used multivariable models to examine e-cigarette awareness, use, and harm perceptions. In the online survey, 40.2% (95% confidence interval [CI] = 37.3, 43.1) had heard of e-cigarettes, with awareness highest among current smokers. Utilization was higher among current smokers (11.4%; 95% CI = 9.3, 14.0) than in the total population (3.4%; 95% CI = 2.6, 4.2), with 2.0% (95% CI = 1.0, 3.8) of former smokers and 0.8% (95% CI = 0.35, 1.7) of never-smokers ever using e-cigarettes. In both surveys, non-Hispanic Whites, current smokers, young adults, and those with at least a high-school diploma were most likely to perceive e-cigarettes as less harmful than regular cigarettes. Awareness of e-cigarettes is high, and use among current and former smokers is evident. We recommend product regulation and careful surveillance to monitor public health impact and emerging utilization patterns, and to ascertain why, how, and under what conditions e-cigarettes are being used.
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When the first version (the Tolerance Questionnaire, Fagerstrom, 1978) of the Fagerstrom Test for Nicotine Dependence (FTND; Heatherton, Kozlowski, Frecker, & Fagerstrom, 1991) was developed, tobacco smoking was not regarded as an addiction. Nevertheless, evidence that this might be the case was beginning to appear, and some researchers became increasingly interested in investigating the importance of nicotine in the smoking habit and educating the public about it. The research led to a profound change in the understanding of cigarette smoking, and in 1988, the U.S. Surgeon General, in the remarkable book Nicotine Addiction, established once and “forever” the importance of nicotine in tobacco smoking (U.S. Department of Health and Human Services [U.S. DHHS], 1988). However, as the role of nicotine was established, researchers lost sight of the possibility that other determinants might also be important. More recently, it has been found that, although nicotine is the most important addictive component of tobacco smoke, it is probably not the only substance involved in the development of tobacco dependence. In light of what is now known about what determines cigarette smoking, it seems timely to propose a renaming of the FTND to the Fagerstrom Test for Cigarette Dependence (FTCD). The background for this is discussed in this commentary.
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This report presents the conclusions reached and recommendations made by the members of the WHO Study Group on Tobacco Product Regulation at its fifth meeting, during which it reviewed two background papers specially commissioned for the meeting and which dealt, respectively, with the following two themes. 1. Devices designed for the purpose of nicotine delivery to the respiratory system in which tobacco is not necessary for their operation. 2. Setting regulatory limits for carcinogens in smokeless tobacco. The Study Group's recommendations in relation to each theme are set out at the end of the section dealing with that theme; its overall recommendations are summarized in section 4.
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Manual of Smoking Cessation provides the crucial knowledge required if you are involved in helping smokers to stop. The manual provides facts, figures, suggested interventions and sources of further information to assist in providing evidence-based treatment for smokers wishing to stop. This manual covers the core content areas and key learning outcomes described in the Standard for Training in Smoking Cessation (Health Development Agency, 2003). Manual of Smoking Cessation is structured in two concise parts: Part 1 provides essential information on smoking demographics, along with the risks of smoking and the benefits of stopping; Part 2 offers a range of practical advice to implement with clients. The Smoking Cessation Manual is an essential text for all those involved in the provision of smoking cessation services, including smoking cessation counsellors, nurses, pharmacists, doctors, health promotion officers, dental professionals, and other members of the health care team. The book is an invaluable resource for those learning about smoking cessation, and a succinct aide-memoire to those already practicing in the field. The authors represent the 'who's who' in the field of smoking cessation and are affiliated to University College London and Cancer Research UK (Andy McEwen and Robert West), St Bartholomew's & Royal London School of Medicine and Dentistry (Peter Hajek), and the University of Auckland (Hayden McRobbie).
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Electronic cigarettes (e-cigarettes) are battery operated devices that deliver nicotine via inhaled vapour. Few studies have evaluated acute effects on craving and mood, and none have explored effects on cognition. This study aimed to explore the effects of the White Super e-cigarette on desire to smoke, nicotine withdrawal symptoms, attention and working memory. Eighty-six smokers were randomly allocated to either: 18 mg nicotine e-cigarette (nicotine), 0mg e-cigarette (placebo), or just hold the e-cigarette (just hold) conditions. Participants rated their desire to smoke and withdrawal symptoms at baseline (T1), and five (T2) and twenty (T3) minutes after using the e-cigarette ad libitum for 5 min. A subset of participants completed the Letter Cancellation and Brown-Peterson Working Memory Tasks. After 20 min, compared with the just hold group, desire to smoke and some aspects of nicotine withdrawal were significantly reduced in the nicotine and placebo group; the nicotine e-cigarette was superior to placebo in males but not in females. The nicotine e-cigarette also improved working memory performance compared with placebo at the longer interference intervals. There was no effect of nicotine on Letter Cancellation performance. To conclude, the White Super e-cigarette alleviated desire to smoke and withdrawal symptoms 20 min after use although the nicotine content was more important for males. This study also demonstrated for the first time that the nicotine e-cigarette can enhance working memory performance. Further evaluation of the cognitive effects of the e-cigarette and its efficacy as a cessation tool is merited.
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Both nicotine and various non-nicotine smoking factors are believed to contribute to tobacco addiction but their relative roles remain incompletely understood. This study aimed to help clarify these roles by examining acute interactions between nicotine and denicotinized tobacco (DT). During two randomized blinded sessions, the effects of a quick-release 4 mg nicotine lozenge (NL) versus placebo lozenge (PL) on the subjective and behavioural responses to DT were examined in 27 (14 men) dependent, daily smokers. Participants were administered NL or PL for 30 min before receiving one initial DT cigarette. Participants could then earn additional DT cigarette puffs over the following 60 min. Subjective state was assessed using the Questionnaire of Smoking Urges-Brief and visual analogue scales at baseline, postlozenge and postinitial DT cigarette. Relative to PL, NL was associated with increased alertness as well as with reduced levels of DT self-administration (P<0.01). The administration of a single DT cigarette was followed by a reduction in craving under both lozenge conditions (P<0.001), an effect that was significantly greater in women (P<0.01). Moreover, DT administration was associated with increased ratings of 'pleasant', 'satisfied', 'stimulated' and 'relaxed', as well as with decreased ratings of 'anxious' (P's<0.01), independent of lozenge condition. The findings suggest that both nicotine and non-nicotine smoking factors may make important contributions towards the addictive properties of tobacco.
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Introduction: Electronic cigarettes (ECs) are marketed as nicotine delivery devices. Two studies with EC-naïve participants suggest that ECs deliver little or no nicotine. In those studies, standard-sized ECs were used, though experienced EC users often use larger devices that house higher voltage and/or longer lasting batteries. Whether user experience and device characteristics influence EC nicotine delivery is uncertain. The purpose of the present study was to examine the effects of ECs in experienced users who were using their preferred devices. Methods: Eight EC users (3 women) who had been using ECs for at least 3 months, completed one 5-hr session using devices they provided and the flavor/strength nicotine cartridges they selected. Sessions consisted of 4 phases: baseline, 10 puffs (30-s interpuff interval) from the device, 1-hr ad lib puffing period, and a 2-hr rest period (no puffing). Outcome measures in each phase included plasma nicotine concentration, heart rate, and subjective ratings of nicotine/product effects and abstinence symptoms. Results: Relative to baseline, plasma nicotine and heart rate increased significantly within 5 min of the first puff and remained elevated throughout the ad lib puffing period. Increases in ratings of direct effects of nicotine and product were observed as well as decreases in abstinence symptoms. Conclusions: User experience and/or device characteristics likely influence EC nicotine delivery and other effects. Systematic manipulation of these and other variables could elucidate conditions that produce intended effects.
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  To provide an initial abuse liability assessment of an electronic cigarette (EC) in current tobacco cigarette smokers.   The first of four within-subject sessions was an EC sampling session that involved six, 10-puff bouts (30 seconds inter-puff interval), each bout separated by 30 minutes. In the remaining three sessions participants made choices between 10 EC puffs and varying amounts of money, 10 EC puffs and a varying number of own brand cigarette (OB) puffs, or 10 OB puffs and varying amounts of money using the multiple-choice procedure (MCP). The MCP was completed six times at 30-minute intervals, and one choice was reinforced randomly at each trial.   Clinical laboratory.   Twenty current tobacco cigarette smokers.   Sampling session outcome measures included plasma nicotine, cardiovascular response and subjective effects. Choice session outcome was the cross-over value on the MCP.   EC use resulted in significant nicotine delivery, tobacco abstinence symptom suppression and increased product acceptability ratings. On the MCP, participants chose to receive 10 EC puffs over an average of $1.06 or three OB puffs and chose 10 OB puffs over an average of $1.50 (P < 0.003).   Electronic cigarettes can deliver clinically significant amounts of nicotine and reduce cigarette abstinence symptoms and appear to have lower potential for abuse relative to traditional tobacco cigarettes, at least under certain laboratory conditions.
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To the Editors: Electronic nicotine delivery systems (ENDS or electronic cigarettes) look like cigarettes but do not contain or burn tobacco. Instead, they comprise a battery-powered atomiser that produces a vapour for inhalation from cartridges containing humectants (propylene glycol or glycerol), flavours ( e.g. tobacco, mint or fruit) and nicotine. Many smokers report using ENDS to quit smoking or to substitute for tobacco in smoke-free places [1, 2]. ENDS do attenuate craving for tobacco, but appear to deliver little nicotine to the blood [3, 4]. Two studies have evaluated nicotine administration with different ENDS brands in ENDS-naive smokers [3, 4]. In one study, 32 smokers completed two 10-puff “vaping” bouts or smoked a cigarette [3]. In contrast to tobacco cigarettes, ENDS did not increase plasma nicotine reliably (plasma nicotine: 1.4 ng·mL−1 and 0.5 ng·mL−1, respectively, for two ENDS brands). In the other study, smokers used ENDS with a 16-mg nicotine cartridge for 5 min, a nicotine inhaler for 20 min or their usual cigarette for 5 min [4]. Nicotine concentration in plasma, measured after 60 min, was 1.3 ng·mL−1 for ENDS, 2.1 ng·mL−1 for inhalers and 13.4 ng·mL−1 for tobacco cigarettes, but one-third of participants showed no increase in blood nicotine while using the ENDS [4]. The time to maximum concentration of serum nicotine was shorter for ENDS (19.6 min) than for the nicotine inhaler (32.0 min), suggesting some absorption via the respiratory tract [4]. It is possible that serum nicotine levels would have been similar in ENDS and inhaler users, had ENDS users been allowed to use the devices for 20 min as for the inhaler. However, regular ENDS users may draw 120–175 puffs·day−1 on …
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To assess the profile, utilization patterns, satisfaction and perceived effects among users of electronic cigarettes ('e-cigarettes'). Internet survey in English and French in 2010. Online questionnaire. Visitors of websites and online discussion forums dedicated to e-cigarettes and to smoking cessation. There were 3587 participants (70% former tobacco smokers, 61% men, mean age 41 years). The median duration of electronic cigarette use was 3 months, users drew 120 puffs/day and used five refills/day. Almost all (97%) used e-cigarettes containing nicotine. Daily users spent $33 per month on these products. Most (96%) said the e-cigarette helped them to quit smoking or reduce their smoking (92%). Reasons for using the e-cigarette included the perception that it was less toxic than tobacco (84%), to deal with craving for tobacco (79%) and withdrawal symptoms (67%), to quit smoking or avoid relapsing (77%), because it was cheaper than smoking (57%) and to deal with situations where smoking was prohibited (39%). Most ex-smokers (79%) feared they might relapse to smoking if they stopped using the e-cigarette. Users of nicotine-containing e-cigarettes reported better relief of withdrawal and a greater effect on smoking cessation than those using non-nicotine e-cigarettes. E-cigarettes were used much as people would use nicotine replacement medications: by former smokers to avoid relapse or as an aid to cut down or quit smoking. Further research should evaluate the safety and efficacy of e-cigarettes for administration of nicotine and other substances, and for quitting and relapse prevention.