Elsevier

Addictive Behaviors

Volume 39, Issue 2, February 2014, Pages 491-494
Addictive Behaviors

Short Communication
A longitudinal study of electronic cigarette users

https://doi.org/10.1016/j.addbeh.2013.10.028Get rights and content

Highlights

  • Little is known about change in the behaviour of users of electronic cigarettes over time.

  • We followed 477 users of electronic cigarettes during one month and 367 users over one year.

  • We found that electronic cigarette use had no deleterious effects on smoking behaviour.

Abstract

Objective

To assess behavior change over 12 months in users of e-cigarettes (“vapers”).

Methods

Longitudinal Internet survey, 2011 to 2013. Participants were enrolled on websites dedicated to e-cigarettes and smoking cessation. We assessed use of e-cigarettes and tobacco among the same cohort at baseline, after one month (n = 477) and one year (n = 367).

Results

Most participants (72%) were former smokers, and 76% were using e-cigarettes daily. At baseline, current users had been using e-cigarettes for 3 months, took 150 puffs/day on their e-cigarette and used refill liquids containing 16 mg/ml of nicotine, on average. Almost all the daily vapers at baseline were still vaping daily after one month (98%) and one year (89%). Of those who had been vaping daily for less than one month at baseline, 93% were still vaping daily after one month, and 81% after one year. In daily vapers, the number of puffs/day on e-cigarettes remained unchanged between baseline and one year. Among former smokers who were vaping daily at baseline, 6% had relapsed to smoking after one month and also 6% after one year. Among dual users (smokers who were vaping daily at baseline), 22% had stopped smoking after one month and 46% after one year. In dual users who were still smoking at follow-up, cigarette consumption decreased by 5.3 cig/day after one month (from 11.3 to 6.0 cig./day, p = 0.006), but remained unchanged between baseline and 1-year follow-up.

Conclusions

E-cigarettes may contribute to relapse prevention in former smokers and smoking cessation in current smokers.

Introduction

Electronic cigarettes (e-cigarettes) are increasingly popular and the prevalence of e-cigarette use increases sharply every year (ASH, 2013). Sales of e-cigarettes have tripled every year since 2007 in the U.S. (Koch, 2012) and part of the recent decrease in cigarette sales in the U.S. is attributable to smokers switching to e-cigarettes (Kell, 2013). Some analysts even predict that within a decade, sales of electronic cigarettes will surpass sales of tobacco cigarettes (Wells, 2013). The spectacular success of e-cigarettes is a game-changing event in the field of tobacco control. Yet, relatively little research has been published on e-cigarettes and on “vapers” (e-cigarette users). Several observational studies (Caponnetto et al., 2011, Farsalinos and Romagna, 2013, Schneiderhan, 2012) and two randomized trials suggest that e-cigarettes help smokers quit or reduce smoking (Bullen et al., 2013, Caponnetto, Campagna, et al., 2013). Outside these clinical studies, only a few longitudinal studies of vapers have been published (Adkison et al., 2013, Vickerman et al., 2013), and it is still unclear how the behavior of vapers evolves over time. This is important information to obtain because the effects of e-cigarettes on health and on smoking behavior will be more evident if vaping is an ongoing, rather than temporary behavior. The safety and toxicity of e-cigarettes will also largely depend on how long vapers use these products. Vapers' behavior may also change over time, in particular because this technology evolves rapidly, and because with time, they acquire more experience or may otherwise modify their behavior. Thus, the objective of this study was to assess change over time in the behavior of e-cigarette users.

Section snippets

Material and methods

Because e-cigarettes are purchased largely on the Internet, online registration is an appropriate method to recruit vapers. We posted a questionnaire in English and French on the smoking cessation website Stop-Tabac.ch, and asked websites informing about e-cigarettes or selling them and specialized discussion forums to publish links to the questionnaire. Starting in 2010, the baseline questionnaire included a detailed assessment of vaping and smoking behaviors, which has been previously

Results

The baseline survey was answered by 1329 participants, of whom 773 provided an e-mail address (58%). Of these 773 people, 477 answered the follow-up survey after one month, a 62% response rate (36% of 1329) and 367 after one year, a 47% response rate (28% of 1329). Table 1 shows that participants in the follow-up surveys were more likely than non-respondents to be daily users of e-cigarettes and former smokers, were older than non-respondents and their income was slightly higher, and among

Discussion

Our study provides the most detailed information to date on the ‘natural behavior’ of an international cohort of vapers over 12 months outside clinical settings or efficacy trials (Adkison et al., 2013, Vickerman et al., 2013). Most e-cigarette users were former smokers, who used e-cigarettes much like nicotine medications, to assist quitting, but with a longer duration of use. During the course of one year, use of e-cigarettes was remarkably stable in this group, even in those who had recently

Role of funding sources

Funding for this study was provided by Swiss Tobacco Prevention Fund (TPF), grant 12.000489. The TPF had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.

Contributors

JFE and CB designed the study and wrote the protocol. JFE collected the data and conducted the statistical analysis. JFE wrote the first draft of the manuscript and all authors contributed to and have approved the final manuscript.

Conflict of interest

JFE's salary is paid by the University of Geneva. He was reimbursed by a manufacturer of e-liquids for traveling to London and to China.

CB's salary is paid by the University of Auckland. CB has no financial or non-financial interests relevant to the submitted work. He has previously undertaken research funded by HealthNew Zealand Ltd via an arrangement with Ruyan (an e-cigarette manufacturer) and has previously undertaken research on behalf of NicoNovum prior to the purchase of the company by

Acknowledgment

Vincent Baujard, from the HON Foundation, Geneva, Switzerland (www.hon.ch) developed the software for data collection.

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