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

Overview

Journal J Med Internet Res

Publisher JMIR Publications

Specialty Medical Informatics

Date 2024 Oct 1

PMID 39353183

Authors

Marike Andreas

Nadja Grundinger

Nadine Wolber

Daria Szafran

Tatiana Gorig

Ute Mons

Valerie Lohner

Sabine Vollstadt-Klein

Sven Schneider

Affiliations

Soon will be listed here.

Abstract

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.

References

Shiffman S, Sembower M . Dependence on e-cigarettes and cigarettes in a cross-sectional study of US adults. Addiction. 2020; 115(10):1924-1931. PMC: 7540348. DOI: 10.1111/add.15060. View

Rose J . Nicotine and nonnicotine factors in cigarette addiction. Psychopharmacology (Berl). 2005; 184(3-4):274-85. DOI: 10.1007/s00213-005-0250-x. View

Lee Y, Morgan-Lopez A, Nonnemaker J, Pepper J, Hensel E, Robinson R . Latent Class Analysis of E-cigarette Use Sessions in Their Natural Environments. Nicotine Tob Res. 2018; 21(10):1408-1413. DOI: 10.1093/ntr/nty164. View

Sargent J, Stoolmiller M, Dai H, Barrington-Trimis J, McConnell R, Audrain-McGovern J . First E-Cigarette Flavor and Device Type Used: Associations With Vaping Persistence, Frequency, and Dependence in Young Adults. Nicotine Tob Res. 2021; 24(3):380-387. PMC: 8842392. DOI: 10.1093/ntr/ntab172. View

Vollstadt-Klein S, Grundinger N, Gorig T, Szafran D, Althaus A, Mons U . Study protocol: evaluation of the addictive potential of e-cigarettes (EVAPE): neurobiological, sociological, and epidemiological perspectives. BMC Psychol. 2021; 9(1):181. PMC: 8600891. DOI: 10.1186/s40359-021-00682-8. View

Hartmann-Boyce J, Begh R, Aveyard P . Electronic cigarettes for smoking cessation. BMJ. 2018; 360:j5543. DOI: 10.1136/bmj.j5543. View

Maloney S, Soule E, Palafox S, McFadden K, Guy M, Eissenberg T . A longitudinal analysis of electronic cigarette forum participation. Addict Behav. 2018; 91:75-81. PMC: 9413692. DOI: 10.1016/j.addbeh.2018.08.006. View

Dawkins L, Kimber C, Doig M, Feyerabend C, Corcoran O . Self-titration by experienced e-cigarette users: blood nicotine delivery and subjective effects. Psychopharmacology (Berl). 2016; 233(15-16):2933-41. DOI: 10.1007/s00213-016-4338-2. View

Schlosser A . Self-disclosure versus self-presentation on social media. Curr Opin Psychol. 2019; 31:1-6. DOI: 10.1016/j.copsyc.2019.06.025. View

10.

Cadham C, Liber A, Sanchez-Romero L, Issabakhsh M, Warner K, Meza R . The actual and anticipated effects of restrictions on flavoured electronic nicotine delivery systems: a scoping review. BMC Public Health. 2022; 22(1):2128. PMC: 9675183. DOI: 10.1186/s12889-022-14440-x. View

11.

Simpson K, Kechter A, Schiff S, Braymiller J, Yamaguchi N, Ceasar R . Characterizing symptoms of e-cigarette dependence: a qualitative study of young adults. BMC Public Health. 2021; 21(1):959. PMC: 8138971. DOI: 10.1186/s12889-021-10945-z. View

12.

Bold K, Sussman S, OMalley S, Grana R, Foulds J, Fishbein H . Measuring E-cigarette dependence: Initial guidance. Addict Behav. 2017; 79:213-218. PMC: 5807200. DOI: 10.1016/j.addbeh.2017.11.015. View

13.

Struik L, Yang Y . e-Cigarette Cessation: Content Analysis of a Quit Vaping Community on Reddit. J Med Internet Res. 2021; 23(10):e28303. PMC: 8576600. DOI: 10.2196/28303. View

14.

Perry R, Girgulis J, Harrison S, Barrett S . Dual users' perceptions of the addictive properties of cigarettes versus E-cigarettes. Addict Behav. 2022; 136:107483. DOI: 10.1016/j.addbeh.2022.107483. View

15.

Naqvi N, Bechara A . The airway sensory impact of nicotine contributes to the conditioned reinforcing effects of individual puffs from cigarettes. Pharmacol Biochem Behav. 2005; 81(4):821-9. PMC: 1434786. DOI: 10.1016/j.pbb.2005.06.005. View

16.

Strombotne K, Buckell J, Sindelar J . Do JUUL and e-cigarette flavours change risk perceptions of adolescents? Evidence from a national survey. Tob Control. 2020; 30(2):199-205. PMC: 7572758. DOI: 10.1136/tobaccocontrol-2019-055394. View

17.

Hammond D, Reid J, Burkhalter R, Bansal Travers M, Gravely S, Hyland A . E-Cigarette Flavors, Devices, and Brands Used by Youths Before and After Partial Flavor Restrictions in the United States: Canada, England, and the United States, 2017‒2020. Am J Public Health. 2022; 112(7):1014-1024. PMC: 9222458. DOI: 10.2105/AJPH.2022.306780. View

18.

Dawkins L, Cox S, Goniewicz M, McRobbie H, Kimber C, Doig M . 'Real-world' compensatory behaviour with low nicotine concentration e-liquid: subjective effects and nicotine, acrolein and formaldehyde exposure. Addiction. 2018; 113(10):1874-1882. PMC: 6150437. DOI: 10.1111/add.14271. View

19.

Gades M, Alcheva A, Riegelman A, Hatsukami D . The Role of Nicotine and Flavor in the Abuse Potential and Appeal of Electronic Cigarettes for Adult Current and Former Cigarette and Electronic Cigarette Users: A Systematic Review. Nicotine Tob Res. 2022; 24(9):1332-1343. PMC: 9356694. DOI: 10.1093/ntr/ntac073. View

20.

Szafran D, Gorig T, Vollstadt-Klein S, Grundinger N, Mons U, Lohner V . Addictive Potential of e-Cigarettes as Reported in e-Cigarette Online Forums: Netnographic Analysis of Subjective Experiences. J Med Internet Res. 2023; 25:e41669. PMC: 9862333. DOI: 10.2196/41669. View