Etter / Bullen Survey Results Finally Published

[Vocalek]

Climb into the WayBack machine and recall when ECF readers were asked to participate in two surveys. One was put together by Kristin on behalf of CASAA, and the other was being run by a French researcher, Jean-François Etter

who published his first survey of 81 e-cigarette consumers back in May 2010 (Electronic cigarettes: a survey of users) and New Zealand researcher Chris Bullen, who has published several articles on e-cigarettes. We were told that they were looking for 1500 responses and that the survey would be completed in December 2010.

The results are now available. Postprint’; doi: 10.1111/j.1360-0443.2011.03505.x

Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy - ETTER - Addiction - Wiley Online Library

Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy

ABSTRACT

Aims. To assess the profile, utilization patterns, satisfaction and perceived effects among users of electronic cigarettes (“e-cigarettes”).

Design and Setting. Internet survey in English and French in 2010.

Participants. Visitors of websites and online discussion forums dedicated to e-cigarettes and to smoking cessation.

Findings. There were 3587 participants (70% former tobacco smokers, 61% men, mean age 41 years). The median duration of electronic cigarette use was 3 months, users drew 120 puffs/day and used 5 refills/day. Almost all (97%) used e-cigarettes containing nicotine. Daily users spent $33 per month on these products. Most (96%) said the e-cigarette helped them quit smoking or reduce their smoking (92%). Reasons for using the e-cigarette included the perception it was less toxic than tobacco (84%), to deal with craving for tobacco (79%) and withdrawal symptoms (67%), to quit smoking or avoid relapsing (77%), because it was cheaper than smoking (57%) and to deal with situations where smoking was prohibited (39%). Most ex-smokers (79%) feared they might relapse to smoking if they stopped using the e-cigarette. Users of nicotine-containing e-cigarettes reported better relief of withdrawal and a greater effect on smoking cessation than those using non-nicotine e-cigarettes.

Conclusions. E-cigarettes were used much as people would use nicotine replacement medications: by former smokers to avoid relapse or as an aid to cut down or quit smoking. Further research should evaluate the safety and efficacy of e-cigarettes for administration of nicotine and other substances, and for quitting and relapse prevention.

This paper has been accepted for publication in Addiction and is currently being edited and typeset. Readers should note that this paper has been fully refereed, but has not been through the copyediting and proof correction process.

 

[Tom09]

Great that this study provides further facts on a real popoulation (as opposed to the imaginary children).

A conference presentation that directly relates to the survey can be found here.

Interestingly, the presentation also reports saliva cotinine concentrations (cotinine is the most important metabolite of nicotine) determined for 30 daily e-cig users (median 200 puffs/day). Median saliva cotinine level is reported as 322 ng/ml. Obviously the topic of an additional publication, but level appears to me about what could be expected for regular analog smokers. Right?

 

[Papa Lazarou]

A presentation regarding the results is here - http://ectoh.org/documents/3B.5 Ett...ation satisfaction and perceived efficacy.pdf

The presentation also contains information regarding the results of cotinine saliva testing which I found interesting. Essentially the testing reveals that far from not delivering nicotine (as claimed in the past), e-cig users tested on average had higher cotinine levels (cotinine is a metabolite of nicotine) than people using NRT products, and a level consistent with cigarette smokers.

I was disappointed to see their view on e-liquid though. They state "the average content of nicotine per bottle, 360 mg (20 ml x 18 mg/ml), is of concern because the fatal dose of nicotine is estimated to be 30-60 mg for adults and 10 mg for children (2). Thus, these refill bottles are extremely dangerous and should be replaced by sealed, tamper-proof, leak resistant cartridges." They fail to mention that in the concentrations that are used, it's no more poisonous than any number of household chemicals.

 

[Papa Lazarou]

Doh! Must type quicker

Yes I think the cotinine levels are comparable to smokers Tom.

 

[Vocalek]

I think that it is too bad that in this survey they did not ask about health effects. They could have at least had an agree/disagree with "My health has improved" and "I have experienced minor problems such as sore throat due to using an e-cigarette" and "Due to using an e-cigarette I have experienced serious health problems for which I sought medical treatement."

 

[Tom09]

I gues we can add that the full text can be accessed here (at Vapersnetwork/Kate).

I think that it is too bad that in this survey they did not ask about health effects. They could have at least had an agree/disagree with "My health has improved" and "I have experienced minor problems such as sore throat due to using an e-cigarette" and "Due to using an e-cigarette I have experienced serious health problems for which I sought medical treatement."

Could have been made more explicit, but the questions about smoking status and respiratory symptoms (adopted from a clinical COPD questionare) can be considered health related. The authors made good use of the data from this formalized health status measurement and have destilled valuable factoids like:

Of interest, current smokers who used the e-cigarette had fewer respiratory symptoms than smokers who did not use it (a difference of 0.54 points on the Clinical COPD Questionnaire), which we speculate might be a consequence of reduced smoking. This difference is substantial, as it is larger than the minimally clinically important difference for this questionnaire (0.4 points) (32), and very close to the difference of 0.6 points previously reported between patients with moderate and severe COPD (31).

So, as far as such can be obtained in a survey, this adds a quatitative number for health improvement.

 

[Vocalek]

Thanks, Tom. That helps.

 

[stillalive]

"Age: 41 years (median) 
Men: 61% 
Former smokers: 70%"

Does that mean that 30% of the e-cig users they polled never smoked analogs, or that 30% of them were current smokers?

 

[Vocalek]

The 29.8% is split into 3 categories. From Table 1:

Smoking status
Daily smokers - 19.0
Occasional (non-daily) - 10.5
Former smokers - 70.2
Never smokers - 0.3

But then there is this:

There were more men (65% vs 46%, p<0.001) and more former smokers (77% vs 42%, p<0.001) among daily e-cigarette users than among never users. Daily users were more likely to have ever used bupropion (30 vs 19%, p<0.001) and nicotine therapy (70 vs 64%, p<0.001), but not varenicline. Among current smokers, daily e-cigarette users smoked fewer cigarettes than never users (13 vs 16 cig./day, p<0.001). However, before they first started using the e-cigarette, daily e-cigarette users smoked more tobacco than never users (25 vs 16 cig./day, p=<0.001).

Apparently those who used e-cigarettes on a more occasional basis were less likely to have become former smokers by the time they took this poll.

 

[stillalive]

very cool! I was hoping I was part of 30%, but I'll take .3% if I need to.

 

[Papa Lazarou]

From the paper "Only one never smoker used nicotine-containing e-cigarettes, a finding that could reflect the fact that under-age consumers were ineligible for the survey, or that contrary to the hypothesis expressed by some authors (4, 23, 24), e-cigarettes do not facilitate initiation to nicotine use in young never smokers."

There were 3587 respondents. This is a good thing. This is one of the top "concerns" expressed by the anti's.

 

[Vocalek]

Anybody know the demographics of underage smokers concerning socio-economic status? I get the feeling, but have no data to support it, that cigarette smoking is a lot more prominent in poor neighborhoods than in more affluent ones. In the poorer neighborhoods, the e-cigarette would be viewed as a "sissy" kind of thing. It would also be farther out of reach economically.

 

[Tom09]

From the paper "Only one never smoker used nicotine-containing e-cigarettes, a finding that could reflect the fact that under-age consumers were ineligible for the survey, or that contrary to the hypothesis expressed by some authors (4, 23, 24), e-cigarettes do not facilitate initiation to nicotine use in young never smokers."

There were 3587 respondents. This is a good thing. This is one of the top "concerns" expressed by the anti's.

Quite an important point from this survey. Paper states that age of study participants (and thus mostly current users) is 41 (31, 50) [Median (25th and 75th centiles)]. While possible underage users had been cut-off (ineligible), the quoted distribution shows, nonetheless, that e-cigs are near-to-exclusively used by veteran smokers. Not as if this could be a surprising result in the light of all the previously published surveys. Nonetheless, it is good to have an additional confirmation. Unfortunately, however, I feel as if this won’t stop allegations put forward by the antis. IMO, they don’t operate on the basis of evidence obtained on existing populations and prefer the imaginaginary.

 

[kristin]

Quite an important point from this survey. Paper states that age of study participants (and thus mostly current users) is 41 (31, 50) [Median (25th and 75th centiles)]. While possible underage users had been cut-off (ineligible), the quoted distribution shows, nonetheless, that e-cigs are near-to-exclusively used by veteran smokers. Not as if this could be a surprising result in the light of all the previously published surveys. Nonetheless, it is good to have an additional confirmation. Unfortunately, however, I feel as if this won’t stop allegations put forward by the antis. IMO, they don’t operate on the basis of evidence obtained on existing populations and prefer the imaginaginary.

It also indicates that younger ADULTS are not really using them a lot and everyone knows teens emulate those in their late teens/early 20's. So, without young adults using them to any extent, they won't have that great of an appeal to teens, either.

I was disappointed to see their view on e-liquid though. They state "the average content of nicotine per bottle, 360 mg (20 ml x 18 mg/ml), is of concern because the fatal dose of nicotine is estimated to be 30-60 mg for adults and 10 mg for children (2). Thus, these refill bottles are extremely dangerous and should be replaced by sealed, tamper-proof, leak resistant cartridges." They fail to mention that in the concentrations that are used, it's no more poisonous than any number of household chemicals.

Yeah - also completely failed to mention that the liquid could be made available with CHILDPROOF CAPS for households with kids. Doh!

 

[Ande]

I've heard that e-liquid may be available, in some weird hypothetical place, without a childproof cap.

Never seen it, though. Every bottle I've ever bought is safety labled (POISON- KEEP OUT OF REACH AND SIGHT OF CHILDREN) and has a childproof cap.

Several of them have caps that are quite a challenge, even for me. Do not drink and try to operate dekang bottles. Not gonna work.

I think they're overlooking a few facts:

Though potentially lethal (what isn't), it would be VERY hard to poison yourself or a child with e-liquid. If you get a single drop of strong liquid on your tongue, you're gonna spit, whether you want to or not. It tastes FOUL and the reflexes kick in. Get a quarter ml into your esophagous, and you're gonna hurl. MUCH harder to OD on this than say...nicorette gum.

In any case, it's still less toxic than a number of things that I use to clean the tub, the toilet, the floor, and the drains. As a responsible adult, I have to keep all those things AND my e-liquid out of mischief by keeping them where children won't get into them. And by teaching my children, of course, not to put unknown substances in their mouths. And by keeping my locked drawer locked, and making sure MY kids (hypothetical, but coming) know that daddy's desk drawer is not to be messed with.

That said, this survey looks like good info, overall.

With only a taste of the usual anti-nicotine hysteria. ;-)

Best,
Ande

PS- Children get poisoned far too often, all over the world. When you read about any particular case, it's rarely an especially hazardous substance that was involved. Much more often, it's hazardously STUPID adult behaviour that is the proximal cause.