A consistent approach using standardised items to assess e-cigarette use in both youth and adult populations will aid cross-survey and cross-national comparisons of the effect of e-cigarette (and tobacco) policies and improve our understanding of the population health impact of e-cigarette use. Focusing on adult behaviour, we propose a set of e-cigarette use items, discuss their utility and potential adaptation, and highlight e-cigarette constructs that researchers should avoid without further item development. Reliable and valid items will strengthen the emerging science and inform knowledge synthesis for policy-making. Building on informal discussions at a series of international meetings of 65 experts from 15 countries, the authors provide recommendations for assessing e-cigarette use behaviour, relative perceived harm, device type, presence of nicotine, flavours and reasons for use. We recommend items assessing eight core constructs: e-cigarette ever use, frequency of use and former daily use; relative perceived harm; device type; primary flavour preference; presence of nicotine; and primary reason for use. These items should be standardised or minimally adapted for the policy context and target population. Researchers should be prepared to update items as e-cigarette device characteristics change. A minimum set of e-cigarette items is proposed to encourage consensus around items to allow for cross-survey and cross-jurisdictional comparisons of e-cigarette use behaviour. These proposed items are a starting point. We recognise room for continued improvement, and welcome input from e-cigarette users and scientific colleagues.
- Electronic nicotine delivery devices
- Public policy
- Surveillance and monitoring
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Contributors All authors conceived the manuscript topic. JLP wrote the first draft of the paper and led the writing team. SCH, LSB, LB, AMG, ACV, AM, DBA and JEC contributed to manuscript writing. JEC and DBA were project leads on 'Harvesting Global Learning on Alternative Nicotine Delivery Systems (ANDS) to Inform U.S. Policy Action, Policy Research, and Surveillance'.
Funding LSB is funded by a Cancer Research UK (CRUK)/BUPA Foundation Cancer Prevention Fellowship (C52999/A19748). LSB, SCH and AM are members of the UK Centre for Tobacco and Alcohol Studies, a UK Clinical Research Collaboration Public Health Research: Centre of Excellence with funding from the Medical Research Council, British Heart Foundation, Cancer Research UK, Economic and Social Research Council and the National Institute for Health Research under the auspices of the UK Clinical Research Collaboration (MR/K023195/1). Effort on this manuscript for AMG, ACV and DBA was also supported by Truth Initiative. JLP’s time was supported by the National Institute On Drug Abuse of the National Institutes of Health under Award Number K01DA037950.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with 'BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.
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