'Vaping' profiles and preferences: an online survey of electronic cigarette users.

TL;DR: 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.

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 between September 2011 to May 2012. Measurements Online questionnaire. Participants 1347 respondents from 33 countries (72% European), mean age 43 years, 70% male, 96% Causacian, 44% educated to degree level or above. Findings 74% reported not smoking for at least a few weeks since using the e-cigarette and 70% reported reduced urge to smoke. 72% 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 (0mg) 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 to 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). Conclusions E-cigarettes tend to be used for smoking cessation but for a longer duration than NRT and were generally regarded as efficacious. Future research should focus on possible long-term health risks, abuse liability and cessation efficacy.

Summary

Introduction

• Electronic cigarettes are battery-operated devices that deliver nicotine via inhaled vapour.
• 'Smoking' an electronic cigarette (e-cigarette) mimics the act of smoking and is often referred to as 'vaping'.
• Users can mix their own 'liquid' choosing from a range of flavours and strengths to refill cartridges.
• This suggests the use of more sophisticated devices and/or experienced use is necessary for achieving effective nicotine delivery.
• The first survey of e-cigarette users (N = 3587; 62% from US) has recently been published and has helped to answer some of these questions [11] .

Method

• The questionnaire was hosted on the University of East London (UEL) website with links from TECC and TWEL websites.
• D) Use of the e-cigarette, including length of use, product and cartridge type, strength and preferred flavours, amount used , reasons for use (e.g. as a complete or partial alternative to smoking.
• Other 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) vs. current smokers (N = 218) under each category heading.
• Sample sizes vary by variable due to missing data.
• T-tests are used to compare means for continuous variables and frequency data are analysed using cross-tabulation with chi-square statistics.
• 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).

Participant information

• Of the total 1376 responses, 27 were removed: 13 were blank; 10 were double entries, and 4 had considerable missing data.
• 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 exsmokers reported that they had stopped smoking for more than one year; 19% had stopped for between 6 and 11 months and 43% for less than 6 months.

E-cigarette patterns of use

• Duration of e-cigarette use was significantly longer in current than ex-smokers whilst exsmokers reported using the e-cigarette sooner after waking than did current smokers.
• Table 2 also provides frequencies and percentages for strengths and flavours used.
• 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 alternative 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.
• Endorsement of this response was also significantly greater in ex than current smokers (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 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

• Females, however, were just as likely as males to report using custom made devices.
• 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.

Discussion

• The present study aimed to characterize e-cigarette use, users, and effects, in a sample of visitors to TECC and TWEL websites.
• Females opted more for chocolate/sweet flavours whereas males preferred tobacco flavoured liquids and tank systems.
• Only 1% of the sample reported exclusive use of non-nicotine (0mg).
• 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.
• 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.

Figures

Table 5: Side effects associated with e-cigarette use (%)

Table 4: Effects of the Electronic Cigarette (%)

Table 3: E-cigarette use and effects on tobacco smoking

Table 1: Participant demographic and smoking-related information

Table 2: E-cigarette patterns of use

Full text

1
‘Vaping’ profiles and preferences: an
online survey of electronic cigarette
users
Lynne Dawkins
1
, John Turner, Amanda Roberts and Kirstie Soar
School of Psychology
University of East London
Water Lane
Stratford
London E15 4LZ
1
Correponding author: tel.: 020 8223 4421
e-mail: l.e.dawkins@uel.ac.uk
Running Head: Vaping profiles and preferences
Word Count: 4,499
Declaration of Interest
No funding was received for this study. The first author has a collaborative
relationship with the Electronic Cigarette Company (TECC) and Totally Wicked
E-Liquids (TWEL). TECC and TWEL reviewed and approved the content of the
questionnaire and set up links from their web-sites to the host site at UEL.

2
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
between September 2011 to May 2012. Measurements Online questionnaire. Participants
1347 respondents from 33 countries (72% European), mean age 43 years, 70% male, 96%
Causacian, 44% educated to degree level or above. Findings 74% reported not smoking for
at least a few weeks since using the e-cigarette and 70% reported reduced urge to smoke.
72% 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 (0mg) 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’ (t
1104
=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 (χ
2
1
=133.66, P<0.0007) although few other differences emerged between these groups.
Compared to males, females opted more for chocolate/sweet flavours (χ
2
1
=16.16, P< 0.001)
and liked the e-cigarette because it resembles a cigarette(χ
2
3
= 42.65, P< 0.001). Conclusions
E-cigarettes tend to be used for smoking cessation but for a longer duration than NRT and
were generally regarded as efficacious. Future research should focus on possible long-term
health risks, abuse liability and cessation efficacy.

3
Introduction
Electronic cigarettes are battery-operated devices that deliver nicotine via inhaled vapour.
Removable cartridges contain glycerol or propylene glycol, flavouring, and varying amounts
of nicotine (including 0mg). 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 rapidly growing and highly fragmented with over 100 different brands. Its estimated
revenue at retail in the US in May 2012 was over $250 million and is expected to double by
the end of 2012 [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'
choosing from a range of flavours and strengths to refill cartridges. Some e-cigarettes (e.g.
the Super & Mini kits from TECC) are moving to 'cartomizers' in which the cartridge and
atomizer are combined, allegedly resulting in a more efficient and tastier vape. Finally, since
different voltages affect the vaping experience, variable voltage 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.
In a recent, online population survey of 2649 adults in the US [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]. Nevertheless in the

4
absence of data supporting these cessation claims, the World Health Organization (WHO)
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 withdrawal symptoms
[5,6,7]. Reports regarding delivery to the blood stream are inconsistent; three human
studies reported very low blood nicotine levels in naive users [5,6,8] whilst 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 potential. The
first survey of e-cigarette users (N = 3587; 62% from US) has recently been published and
has helped to answer some of these questions [11]. Sixty-one percent of the sample were
men, 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
The Electronic Cigarette Company (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.

5
Method
The questionnaire was hosted on the University of East London (UEL) website with links
from TECC and TWEL 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:
A) Demographic information (age, gender, ethnicity, education 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.
C) Tobacco Smoking Information, including the Fagerström Test of Cigarette Dependence
(FTCD; [12]), a six-item scale to assess cigarette dependence. Question 1 (commonly
considered the strongest single-item predictor of dependence) asks: 'how soon after
waking do you/did you smoke your first cigarette'? Participants indicate: 'within 5 minutes'
(scored 3), 'between 6-30 minutes' (scored 2), '31-60 minutes' (scored 1) or 'after 60
minutes' (scored 0). Total scores are calculated 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 one year, more than 2 years).
D) Use of the e-cigarette, including length of use, product and cartridge type, strength and
preferred flavours, amount used (in ml and puffs; where participants indicated a range, we
took the top figure and refer to ‘maximum daily use’), reasons for use (e.g. as a complete 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.
E) Effects of the e-cigarette including satisfaction, hit, acceptability, taste, urge to smoke,
impact on smoking behaviour and respiratory effects, all rated on a 4-point Likert Scale from
'not at all' to 'very much so'.