Then and now: Consumption and dependence in e-cigarette users who formerly smoked cigarettes

Abstract

Electronic cigarette use, or vaping, continues to be a focus for regulators and policy makers in public health, particularly since it can compete with or be a substitute for smoking. This study investigated characteristics of nicotine dependence and consumption in a sample of vapers who formerly smoked cigarettes. We recruited 436 (80% male) vapers from several internet discussion forums; 95% of whom previously smoked, but ceased after commencing vaping. These participants completed a retrospective version of the Fagerström Test for Nicotine Dependence (FTND-R), as well as a version modified to suit current vaping (FTND-V), along with measures of consumption. Nicotine dependence appears to reduce markedly when smokers transition to vaping. However, ‘decoupling’ is observed in the relationship between consumption and dependence in vaping, and the FTND-V showed inadequate psychometric properties. Older and female vapers tend to employ a low-power, higher nicotine-concentration style of vaping. Overall, nicotine concentration tended to increase over time, although this effect was moderated by users' intentions to reduce their intake. Indicators of smoking addiction do not appear to be applicable to vaping, with respect to both internal consistency and relationship to consumption. This suggests that motivations for vaping are less dominated by nicotine delivery (negative reinforcement), and may be driven more by positive reinforcement factors. Nevertheless, e-liquid nicotine concentration was associated, albeit weakly, with dependence among e-cigarette users. Finally, vapers are heterogeneous group with respect to style of consumption, with a high-power/lower nicotine set-up more common among younger men.