Electronic cigarette use: comparing smokers, vapers, and dual users on characteristics and motivational factors
Claire Schoren 1  
Karin Hummel 1
More details
Hide details
Maastricht University, Netherlands
Claire Schoren   

Maastricht University, P. Debyeplein 1, 6200 MD Maastricht, Netherlands
Publication date: 2017-04-01
Submission date: 2016-04-25
Final revision date: 2017-02-13
Acceptance date: 2017-03-08
Tob. Prev. Cessation 2017;3(April):8
This study examined vaping behaviour, precursors of vaping, and motivational differences between smokers, dual users and vapers. The objectives were to assess a) vaping characteristics and reasons for use, b) differences in motivational factors and behavioural precursors associated with e-cigarette use, and c) socio-demographic and motivational factors associated with electronic cigarette use.

A cross-sectional survey among 259 vapers, 135 smokers, and 83 dual users was conducted in the Netherlands. The questionnaire, based on the I-Change Model, assessed demographics, smoking and vaping behaviour, quit attempt, attitudes towards e-cigarettes, social influences, self-efficacy about not to vape and intention to quit.

Vaping e-cigarettes was mostly started for health reasons. Less than 2% of the vapers had never used conventional cigarettes. Vapers reported most advantages of e-cigarettes whereas smokers were least convinced of them, encountered more modelling of vaping in their social environment and reported higher self-efficacy to control vaping. Older respondents and respondents with low levels of education and low income were more likely to use e-cigarettes instead of conventional cigarettes.

Although vaping was mostly started for health reasons, the use of the product was not strictly limited to (former) smokers. Health communication for non-smokers is needed to stress potential dangers. Both vapers and non-vapers encounter barriers for using e-cigarettes in difficult situations. If e-cigarettes are used as a smoking cessation tool, more information is needed to help users cope with these situations. For future interventions we recommend to take potential motivational differences among low and high income and educated groups into account.

Society AC: Electronic Cigarettes (E-Cigarettes). CA: A Cancer Journal for Clinicals [2014], [64]:[3]:169-70. doi: 10.1097/JTO.0000000000000129.
Buisman R, Croes, E: Factsheet Elektronische Sigaretten (E-sigaretten). Trimbos-instituut, Utrecht [2014]. Available at: (accessed 30 April 2015).
Rijksinstituut voor Volksgezondheid en Milieum (RIVM): E-sigaretten Factsheet. Bilthoven: RIVM [2014]. Available at: (accessed 30 April 2015).
Hummel K, Hoving C, Nagelhout GE, Vries Hd, Putter Bvd, Candel MJJM, et al.: Prevalence and reasons for use of electronic cigarettes among smokers: Findings from the International Tobacco Control (ICT) Netherlands Survey. International Journal of Drugs Policy [2015]. doi: 10.1016/j.drugpo.2014.12.009.
Verdurmen J, Monshouwer, K., Laar, van, M: Factsheet Continu Onderzoek Rookgewoonten 2014 [Factsheet]. Trimbos Instituut, Utrecht: Trimbos instituut [2014].Available at: (accessed 3 August 2016).
Nagelhout GE, Heijndijk SM, Cummings KM, Willemsen MC, van den Putte B, Heckman BW, et al.: E-cigarette advertisements, and associations with the use of e-cigarettes and disapproval or quitting of smoking: Findings from the International Tobacco Control (ITC) Netherlands Survey. International Journal of Drug Policy [2016], [29]:73-79. doi: 10.1016/j.drugpo.2015.12.015.
Etter JF: Electronic cigarettes: a survey of users. BMC public health [ 2010], [10]:[231]. doi: 10.1186/1471-2458-10-231.
Farsalinos KE, Romagna G, Tsiapras D, Kyrzopoulos S, Voudris V: Characteristics, perceived side effects and benefits of electronic cigarette use: a worldwide survey of more than 19,000 consumers. International journal of environmental research and public health [2014], [11]:[4]:4356-73. doi: 10.3390/ijerph110404356.
McQueen A, Tower S, Sumner W: Interviews with “vapers”: Implications for future research with electronic cigarettes. Nicotine & Tobacco Research [2011], [13]:[9]:860-7. doi: 10.1093/ntr/ntr088.
Pepper JK, Brewer NT: Electronic nicotine delivery system (electronic cigarette) awareness, use, reactions and beliefs: a systematic review.Tobacco control [2013], [tobaccocontrol-2013 051122]. doi: 10.1136/tobaccocontrol-2013-051122.
Ramo DE, Young-Wolff KC, Prochaska JJ: Prevalence and correlates of electronic-cigarette use in young adults: Findings from three studies over five years. Addictive behaviors [2014], [41C]:[142-7]. doi: 10.1016/j.addbeh.2014.10.019.
Regan AK, Promoff G, Dube SR, Arrazola R: Electronic nicotine delivery systems: adult use and awareness of the 'e-cigarette' in the USA. Tobacco control [2013], [22]:[1]:19-23. doi: 10.1136/tobaccocontrol-2011-050044.
Adkison SE, O'Connor RJ, Bansal-Travers M, Hyland A, Borland R, Yong HH, et al.: Electronic nicotine delivery systems: international tobacco control four-country survey. American journal of preventive medicine [2013], [44]:[3]:207-15. doi: 10.1136/tobaccocontrol-2011-050044.
Adriaens K, Van Gucht D, Declerck P, Baeyens F: Effectiveness of the Electronic Cigarette: An Eight-Week Flemish Study with Six-Month Follow-up on Smoking Reduction, Craving and Experienced Benefits and Complaints. International journal of environmental research and public health [2014], [11]:[11]:11220-48. doi: 10.3390/ijerph111111220.
Dawkins L, Turner J, Roberts A, Soar K: 'Vaping' profiles and preferences: an online survey of electronic cigarette users. Addiction (Abingdon, England) [2013], [108]:[6}:1115-25. doi: 10.1111/add.12150.
Etter JF, Bullen C: Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy. Addiction (Abingdon, England) [2011], [106]:[11]:2017-28. doi: 10.1111/j.1360-0443.2011.03505.x.
Goniewicz ML, Lingas EO, Hajek P: Patterns of electronic cigarette use and user beliefs about their safety and benefits: an Internet survey. Drug and alcohol review [2013], [32]:[2}:133-40. doi: 10.1111/j.1465-3362.2012.00512.x.
Pepper JK, Ribisl KM, Emery SL, Brewer NT: Reasons for starting and stopping electronic cigarette use. International journal of environmental research and public health [2014]. [11]:[10]:10345-61. doi: 10.3390/ijerph111010345.
Steinberg MB, Zimmermann MH, Delnevo CD, Lewis MJ, Shukla P, Coups EJ, et al.: E-Cigarette Versus Nicotine Inhaler: Comparing the Perceptions and Experiences of Inhaled Nicotine Devices. Journal of general internal medicine [2014], [29]:[11]:1444-50. doi: 10.1007/s11606-014-2889-7.
Brown J, West R, Beard E, Michie S, Shahab L, McNeill A: Prevalence and characteristics of e-cigarette users in Great Britain: Findings from a general population survey of smokers. Addictive behaviors [2014], [39]:[6]:1120-5. doi: 10.1016/j.addbeh.2014.03.009.
Biener L, Hargraves JL. A Longitudinal Study of Electronic Cigarette Use in a Population-based Sample of Adult Smokers: Association with Smoking Cessation and Motivation to Quit. Nicotine & Tobacco research [2014], [ntu200]. doi: 10.1093/ntr/ntu200.
Brown J, Beard E, Kotz D, Michie S, West R: Real‐world effectiveness of e‐cigarettes when used to aid smoking cessation: a cross‐sectional population study. Addiction (Abingdon, England) [2014], [109]:[9]:1531-40. doi: 10.1111/add.12623.
Bullen C, Howe C, Laugesen M, McRobbie H, Parag V, Williman J, et al.: Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet [2013], [382]:[9905]:1629-37. doi: 10.1371/journal.pone.0122544.
Cahn Z, Siegel M: Electronic cigarettes as a harm reduction strategy for tobacco control: A step forward or a repeat of past mistakes&quest. Journal of public health policy [2011], [32]:[1]:16-31. doi:10.1057/jphp.2010.41.
Caponnetto P, Campagna D, Cibella F, Morjaria JB, Caruso M, Russo C, et al.: EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as tobacco cigarettes substitute: a prospective 12-month randomized control design study. PloS one [2013], [8]:[6]:e66317. doi: 10.1371/journal.pone.0066317.
Etter JF, Bullen C: A longitudinal study of electronic cigarette users. Addictive behaviors [2013], [39]:[2]:491-4. doi: 10.1016/j.drugalcdep.2016.01.003.
Hajek P: Electronic cigarettes have a potential for huge public health benefit. BMC medicine [2014], [12]:[1]:225. doi: 10.1186/s12916-014-0225-z.
Nutt DJ, Phillips LD, Balfour D, Curran HV, Dockrell M, Foulds J, et al.: Estimating the harms of nicotine-containing products using the MCDA approach. European addiction research [2014], [20]:[5]:218-25. doi: 10.1159/000360220.
Polosa R, Caponnetto P, Morjaria JB, Papale G, Campagna D, Russo C: Effect of an electronic nicotine delivery device (e-Cigarette) on smoking reduction and cessation: a prospective 6-month pilot study. BMC public health [2011], [11]:[786]. doi: 10.1186/1471-2458-11-786.
Polosa R, Morjaria JB, Caponnetto P, Campagna D, Russo C, Alamo A, et al.: Effectiveness and tolerability of electronic cigarette in real-life: a 24-month prospective observational study. Internal and emergency medicine [2013], [9]:[5]:537-46. doi: 10.1007/s11739-013-0977-z.
Fairchild AL, Bayer R, Colgrove J: The renormalization of smoking? E-cigarettes and the tobacco “endgame”. New England Journal of Medicine [2014], [370]:[4]:293-5. doi: 10.1056/NEJMp1313940.
Camenga DR, Delmerico J, Kong G, Cavallo D, Hyland A, Cummings KM, et al.: Trends in use of electronic nicotine delivery systems by adolescents. Addictive behaviors [2014], [39]:[1]:338-40. doi: 10.1016/j.addbeh.2013.09.014.
Center for Disease Control and Prevention(CDC): Notes from the field: electronic cigarette use among middle and high school students - United States, 2011-2012. MMWR Morbidity and mortality weekly report [2013], [62]:[35]:729-30.
Pentz MA, Shin H, Riggs N, Unger JB, Collison KL, Chou CP: Parent, peer, and executive function relationships to early adolescent e-cigarette use: A substance use pathway? Addictive behaviors [2014], [42C]:[73-8]. doi: 10.1016/j.addbeh.2014.10.040.
Primack BA, Soneji S, Stoolmiller M, Fine MJ, Sargent JD: Progression to Traditional Cigarette Smoking After Electronic Cigarette Use Among US Adolescents and Young Adults. JAMA pediatrics [2015], [1-7]. doi: 10.1001/jamapediatrics.2015.1742.
Dicey J: Shocking new e-cigarette study! The e-cigarette time bomb…. [2014].
Berg J: Preferred flavors and reasons for e-cigarette use and discontinued use among never, current, and former smokers. International Journal of Public Health [2016], [61]:[2]:225-236. doi: 10.1007/s00038-015-0764-x.
Kalkhoran S, Grana RA, Neilands TB, Ling PM: Dual use of smokeless tobacco or e-cigarettes with cigarettes and cessation. American Journal of Health Behavior [2015], [39]:[2]:277-284. doi: 10.5993/AJHB.39.2.14.
Chapman SLC, Wu LT: E-cigarette prevalence and correlates of use among adolescents versus adults: A review and comparison. Journal of Psychiatric Research [2014], [54]:43-54. doi: 10.1016/j.jpsychires.2014.03.005.
Rüther T, Wissen F, Linhardt A, Aichert DS, Pogarell O, de Vries H: Electronic Cigarettes—Attitudes and Use in Germany. Nicotine & Tobacco Research [2015], [ntv188]. doi: 10.1093/ntr/ntv188.
de Vries H, Mesters I, Van de Steeg H, Honing C: The general public’s information needs and perceptions regarding hereditary cancer: an application of the Integrated Change Model. Patient education and counseling [2005], [56]:[2]:154-65. doi: 10.1016/j.pec.2004.01.002.
De Vries H, Eggers SM, Bolman C: The role of action planning and plan enactment for smoking cessation. BMC Public Health [2013], [13]:[1]:393. doi: 10.1186/1471-2458-13-393.
Eggers SM, Aaro LE, Bos AE, Mathews C, de Vries H: Predicting condom use in South Africa: a test of two integrative models. AIDS and Behavior [2014], [18]:[1]:135-145. doi: 10.1007/s10461-013-0423-2.
Knops-Dullens T, de Vries N, de Vries H: Reasons for non-attendance in cervical cancer screening programmes: an application of the Intergrated Model for Behavioural Change. European Journal of Cancer Prevention [2007], [16]:[5]:436-445. doi: 10.1097/01.cej.0000236250.71113.7c.
McMillen Trends in Electronic Cigarette Use Among U.S. Adults: Use is Increasing in Both Smokers and Nonsmokers. Nicotine and Tobacco Research [2014]. doi: 10.1093/ntr/ntu213.
Bunnel RE, Agaku IT, Arrazola RA, Apelberg BJ, Caraballo RS, Corey CG, et al.: Intentions to smoke cigarettes among never-smoking US middle and high school electronic cigarette users: National Youth Tobacco Survey, 2011-2013. Nicotine and Tobacco Research [2015],[17]:228-35. doi: 10.1093/ntr/ntu166.
Leventhal AM, Strong DR, Kirkpatrick MG, Unger JB, Sussman S, Riggs NR, et al.: Association of electronic cigarette use with initiation of combustile tobacco product smoking in early adolescence. The Journal of American Medical Association [2015],[314]:700-707. doi: 10.1001/jama.2015.8950.
Zhu SH, Gamst A, Lee M, Cummins S, Yin L, Zoref L: The Use and Perception of Electronic Cigarettes and Snus among the U.S. Population. PloS one [2013], [8]:[10]:e79332. doi: 10.1371/journal.pone.0079332.
Gallus S, Lugo A, Pacifici R, Pichini S, Colombo P, Garattini S, et al.: E-Cigarette Awareness, Use, and Harm Perception in Italy: A National Representative Survey. Nicotine & Tobacco research [2014], [ntu124]. doi: 10.1093/ntr/ntu124.
Kinnunen JM, Ollila H, El-Amin SE, Pere LA, Lindfors PL, Rimpela AH: Awareness and determinants of electronic cigarette use among Finnish adolescents in 2013: a population-based study. Tobacco control [2014], [tobaccocontrol-2013]. doi: 10.1136/tobaccocontrol-2013-051512.
McRobbie H, Bullen C, Hajek P: Electronic cigarettes for smoking cessation and reduction. The Cochrane Library [2012], [11].
Kalkhoran S, Glantz SA: E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis. The Lancet Respiratory Medicine [2016], [4]:116-128. doi: 10.1016/S2213-2600(15)00521-4.
Pokhrel P, Herzog TA, Muranaka N, Regmi S, Fagan P: Contexts of cigarette and e-cigarette use among dual users: a qualitative study. BMC public health [2015], [15]:[859]. doi: 10.1186/s12889-015-2198-z.
A Combination of Factors Related to Smoking Behavior, Attractive Product Characteristics, and Socio-Cognitive Factors are Important to Distinguish a Dual User from an Exclusive E-Cigarette User
Kim Romijnders, Jeroen Pennings, Osch van, Vries de, Reinskje Talhout
International Journal of Environmental Research and Public Health
E-Liquid Flavor Preferences and Individual Factors Related to Vaping: A Survey among Dutch Never-Users, Smokers, Dual Users, and Exclusive Vapers
Romijnders, Krüsemann, Boesveldt, Graaf, Vries, Talhout
International Journal of Environmental Research and Public Health
Examining the relationship between impulsivity-related personality traits and e-cigarette use in adults
Dimitra Kale, Alan Pickering, Andrew Cooper
Addictive Behaviors