Electronic Cigarette Users’ Reactions and Responses to a Hypothetical Nicotine Concentration Reduction in Electronic Cigarette Liquids

Abstract

Background: Regulations limiting nicotine in electronic cigarettes (e-cigarettes) have been proposed or implemented. Little is known about e-cigarette users’ reactions to reducing e-cigarette liquid nicotine concentration. Methods: We used concept mapping to describe e-cigarette users’ reactions to a 50% reduction in the nicotine concentration of their e-cigarette liquids. In 2019, current e-cigarette users who used e-cigarette liquid with greater than 0 mg/ml nicotine concentration completed an online study. Participants (n = 71, mean age = 34.9 (SD = 11.0), 50.7% women), brainstormed statements completing a prompt: “If the e-liquid that I use now in my e-cigarette/vaping device was only available in half the nicotine concentration or amount that I use now, a specific action I would take or a specific reaction I would have is…”, Participants then sorted a final list of 67 statements into piles of similar content and rated statements on how true the statements would be for them. Multidimensional scaling and hierarchical cluster analyses identified thematic clusters. Results: Eight clusters were identified: (1) Replacement Product Seeking, (2) Mental Preparations and Expectations, (3) Use the New Liquid, (4) Information Seeking, (5) Compensation Behaviors, (6) Opportunity for E-Cigarette Reduction, (7) Physical and Psychological Effects, and (8) Replacement with non-E-Cigarette Products and Behaviors. Cluster ratings suggested many participants would search for other e-cigarette products/liquids to replace their current liquids, but using other tobacco products (e.g., cigarettes) may be less likely. Conclusions: If nicotine concentrations were decreased in e-cigarette liquids, e-cigarette users may attempt to purchase different e-cigarette products or modify their products to achieve desired effects.

Keywords:

• Electronic nicotine delivery devices
• non-cigarette tobacco product
• public policy
• nicotine
• nicotine reduction

Authors’ contributions

ES, AB, MG, and PF conceptualized the study. ES led planning and conduct of the study. ES, SM, and WS contributed to data collection and analysis. ES wrote the first draft of the manuscript and all authors provided critical review of the manuscript.

Declaration of interest

ES is named on a patent application for a smartphone app that determines electronic cigarette device and liquid characteristics. All other authors have no conflicts to report.

Data availability statement

Deidentified data available upon reasonable request.

Additional information

Funding

This work was supported by grant number U54DA036105 from the National Institute on Drug Abuse of the National Institutes of Health and the Center for Tobacco Products of the U.S. Food and Drug Administration. Eric Soule, Mignonne Guy, and Pebbles Fagan’s effort is also supported by grant number grant number P50MD017319 of the National Institute on Minority Health and Health Disparities. Eric Soule’s effort is also supported by grant number R15ES032138 of the National Institute of Environmental Health Sciences.