Device features and user behaviors as predictors of dependence among never-smoking electronic cigarette users: PATH Wave 4.

Introduction:
This text provides an analysis of the relationship between electronic cigarette (ECIG) device features, user behavior, and dependence, craving, and withdrawal in a sample of never-smoking ECIG users. The study aims to identify the factors that influence ECIG dependence-related domains and eliminate the potential confound of previous or current cigarette use.

Key Points:

* The study used data from the Population Assessment of Tobacco and Health (PATH) Study Wave 4 and included 711 adults who were current ECIG users and never cigarette smokers.
* The analysis examined individual and combined device characteristics, such as the presence of nicotine, type of liquid container, and device power level, as well as user behavior, such as frequency and duration of ECIG use.
* The results showed that higher dependence was associated with older age, using an ECIG with nicotine, using an ECIG with a non-refillable cartridge or refillable tank system, and more ECIG use in the past 30 days.
* Higher craving was associated with older age, white race, using an ECIG with nicotine, using an ECIG with a non-refillable cartridge or a refillable tank system, and more ECIG use in the past 30 days.
* Higher withdrawal was predicted by higher education level, using an ECIG with a tank or a cartridge, using a refillable ECIG, and using other only flavor relative to tobacco.
* There was no association between outcomes and two of the ECIG use behaviors, likely due to challenges with measuring these more detailed patterns of use.
* The study also identified limitations in the measures used to assess device/liquid features and recommended including pictures of devices and assessing other features of ECIG use that are relevant to dependence in future surveys.

Main Message:
The study highlights the complexity of ECIG device features and user behavior and their relationship with ECIG dependence, craving, and withdrawal. The findings suggest that different ECIG products necessitate different patterns of use to achieve comparable levels of nicotine and that the terminology used to describe individual and combination features can be inconsistent among users. The study also emphasizes the need for improved surveillance systems to assess ECIG device features and user behavior to ensure the development of reliable and valid measures of ECIG dependence. Overall, the text underscores the challenge with regulating ECIG products in the current marketplace, which is inundated with a myriad of device types.

Douglas AE, Childers MG, Romm KF, Felicione NJ, Ozga JE, Blank MD. Device features and user behaviors as predictors of dependence among never-smoking electronic cigarette users: PATH Wave 4. Addictive behaviors. 2022;125:107161. doi:10.1016/j.addbeh.2021.107161