A longitudinal analysis of electronic cigarette forum participation

Understanding e-Cigarette Addictiveness: Triangulation of Focus Group and Netnographic Data

BACKGROUND

Numerous studies have shown that e-cigarettes are addictive. For example, we previously showed that users of e-cigarette online forums discuss experiences of addiction in a netnographic analysis. However, it is unclear what makes e-cigarettes addictive apart from nicotine. In a focus group analysis, we recently identified 3 unique features of e-cigarettes that users linked to experiences of addiction: the pleasant taste, unobtrusiveness, and unlimited usability of e-cigarettes.

OBJECTIVE

This study aimed to validate the previously identified features of e-cigarette addictive potential by triangulating data from the netnographic analysis and focus group discussions.

METHODS

Drawing on a netnographic analysis of 3 popular, German-language e-cigarette forums, we studied whether experiences of addiction were linked to specific e-cigarette features. We included 451 threads in the analysis that had been coded for addictive experiences in a previous study by our team. First, we conducted a deductive analysis with preregistered codes to determine whether the features of pleasant taste, unobtrusiveness, and unlimited usability were mentioned in relation to the addictive potential of e-cigarettes in the online forums. Second, an inductive approach was chosen to identify further possible addictive features of e-cigarettes.

RESULTS

Our deductive analysis confirmed that the features highlighted in our previous focus group study (pleasant taste, unobtrusiveness, and unlimited usability) were also frequently discussed in online forums in connection to addictive symptoms. In addition, our inductive analysis identified nicotine dosage as a significant feature linked to addiction. Users reported varying their nicotine doses for different reasons, leading to the identification of four distinct user types based on dosing patterns: (1) high doses for intermittent, (2) high doses for constant use, (3) low doses for constant use, and (4) switching between high and low doses depending on the situation.

CONCLUSIONS

Our comprehensive analysis of online forum threads revealed that users' experiences of addiction are linked to 4 specific features unique to e-cigarettes: pleasant taste, unobtrusiveness, unlimited usability, and nicotine dosage. Recognizing these addictive features of e-cigarettes is crucial for designing cessation programs and informing public health policies to reduce the addictiveness of e-cigarettes.

Addictive Potential of e-Cigarettes as Reported in e-Cigarette Online Forums: Netnographic Analysis of Subjective Experiences

BACKGROUND

While e-cigarettes usually contain nicotine, their addictive potential is not yet fully understood. We hypothesized that if e-cigarettes are addictive, users will experience typical symptoms of addiction.

OBJECTIVE

The aim of our study was to investigate whether and how e-cigarette users report signs of addiction.

METHODS

We identified 3 large German-language e-cigarette online forums via a systematic Google search. Based on a netnographic approach, we used deductive content analysis to investigate relevant posts in these forums. Netnography has the advantage of limiting the social desirability bias that prevails in face-to-face research, such as focus groups. The data were coded according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria for tobacco use disorder, adapted for e-cigarettes. The DSM-5 criteria were used to portray a broad spectrum of possible experiences of addiction.

RESULTS

Overall, 5337 threads in 3 forums were screened, and 451 threads containing relevant information were included in the analysis. Users reported experiences consistent with the DSM-5 criteria, such as craving e-cigarettes, excessive time spent vaping, and health issues related to e-cigarette use. However, our analysis also showed that users reported the absence of typical tobacco use disorder criteria, such as successful attempts to reduce the nicotine dosage. For most themes, reports of their absence were more frequent than of their presence. The absence of perceived addiction was mostly reported in contrast to prior tobacco smoking.

CONCLUSIONS

This is the first study to use a netnographic approach to explore unfiltered self-reports of experiences of e-cigarette addiction by users in online forums. As hypothesized, some but not all users reported subjective experiences that corresponded to the criteria of tobacco use disorder as defined by the DSM-5. Nevertheless, subjective reports also indicated that many e-cigarette users felt in control of their behavior, especially in contrast to their prior use of tobacco cigarettes. The finding that some e-cigarette users subjectively experience addiction highlights the need for effective cessation programs to support users who experience their e-cigarette use as burdensome. This research can guide the refinement of instruments to assess e-cigarette addiction and guide cessation programs.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s40359-021-00682-8.

Assessing toxicant emissions from e-liquids with DIY additives used in response to a potential flavour ban in e-cigarettes

SIGNIFICANCE

Electronic cigarettes (e-cigarettes) aerosolise liquids that contain nicotine, propylene glycol, glycerol and appealing flavours. In the USA, regulations have limited the availability of flavoured e-cigarettes in pod-based systems, and further tightening is expected. In response, some e-cigarette users may attempt to make their e-liquids (do-it-yourself, DIY). This study examined toxicant emissions from several aerosolised DIY e-liquids.

METHODS

DIY additives were identified by reviewing users' responses to a hypothetical flavour ban, e-cigarette internet forums and DIY mixing internet websites. They include essential oils, cannabidiol, sucralose and ethyl maltol. E-liquids with varying concentrations and combinations of additives and tobacco and menthol flavours were prepared and were used to assess reactive oxygen species (ROS), carbonyl and phenol emissions in machine-generated aerosols.

RESULTS

Data showed that adding DIY additives to unflavoured, menthol-flavoured or tobacco-flavoured e-liquids increases toxicant emissions to levels comparable with those from commercial flavoured e-liquids. Varying additive concentrations in e-liquids did not have a consistently significant effect on the tested emissions, yet increasing power yielded significantly higher ROS, carbonyl and phenol emissions for the same additive concentration. Adding nicotine to DIY e-liquids with sucralose yielded increase in some emissions and decrease in others, with freebase nicotine-containing e-liquid giving higher ROS emissions than that with nicotine salt.

CONCLUSION

This study showed that DIY additives can impact aerosol toxicant emissions from e-cigarettes and should be considered by policymakers when restricting commercially available flavoured e-liquids.

Answering questions about electronic cigarettes using a multidisciplinary model

Electronic cigarettes (ECIGs) are a relatively new class of tobacco products and a subject of much debate for scientists and policymakers worldwide. Objective data that address the ECIG risk-benefit ratio for individual and public health are needed, and addressing this need requires a multidisciplinary approach that spans several areas of psychology as well as chemistry, toxicant inhalation, and physiology. This multidisciplinary approach would benefit from methods that are reliable, valid, and swift. For this reason, we formed a multidisciplinary team to develop methods that could answer questions about ECIGs and other potential modified risk tobacco products. Our team includes scientists with expertise in psychology (clinical, community, and experimental) and other disciplines, including aerosol research, analytical chemistry, biostatistics, engineering, internal medicine, and public health. The psychologists on our team keep other members focused on factors that influence individual behavior, and other team members keep the psychologists aware of other issues, such as product design. Critically, all team members are willing to extend their interests beyond the boundaries of their discipline to collaborate effectively with the shared goal of producing the rigorous science needed to inform empirically based tobacco policy. In addition, our trainees gain valuable knowledge from these collaborations and learn that other disciplines are accessible, exciting, and can enhance their own research. Multidisciplinary work presents challenges: learning other scientists' languages and staying focused on our core mission. Overall, our multidisciplinary team has led to several major findings that inform the scientific, regulatory, and public health communities about ECIGs and their effects. (PsycINFO Database Record (c) 2019 APA, all rights reserved).