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; nicotine; nicotine reduction; non-cigarette tobacco product; public policy.

Figure 1.

Concept map displaying 8 clusters ECIG user-identified clusters and statements describing a specific action/reaction if the ECIG liquid used by participants was only available in half the nicotine concentration. Numbered points on the map that are closer to one another represent statements of more similar content whereas points on the map that are further apart represent statements of less similar content. Greater number of layers in clusters indicate higher mean ratings of statements within each cluster based on the rating task. Mean ratings for clusters with 1 layer range from 2.56 to 2.99, 2 layers from 2.99 to 3.42, 3 layers from 3.42 to 3.85, 4 layers from 3.85 to 4.28, and 5 layers from 4.28 to 4.71.