Measuring perceptions related to e-cigarettes: Important principles and next steps to enhance study validity

Abstract

Measuring perceptions associated with e-cigarette use can provide valuable information to help explain why youth and adults initiate and continue to use e-cigarettes. However, given the complexity of e-cigarette devices and their continuing evolution, measures of perceptions of this product have varied greatly. Our goal, as members of the working group on e-cigarette measurement within the Tobacco Centers of Regulatory Science (TCORS) network, is to provide guidance to researchers developing surveys concerning e-cigarette perceptions. We surveyed the 14 TCORS sites and received and reviewed 371 e-cigarette perception items from seven sites. We categorized the items based on types of perceptions asked, and identified measurement approaches that could enhance data validity and approaches that researchers may consider avoiding. The committee provides suggestions in four areas: (1) perceptions of benefits, (2) harm perceptions, (3) addiction perceptions, and (4) perceptions of social norms. Across these 4 areas, the most appropriate way to assess e-cigarette perceptions depends largely on study aims. The type and number of items used to examine e-cigarette perceptions will also vary depending on respondents' e-cigarette experience (i.e., user vs. non-user), level of experience (e.g., experimental vs. established), type of e-cigarette device (e.g., cig-a-like, mod), and age. Continuous formative work is critical to adequately capture perceptions in response to the rapidly changing e-cigarette landscape. Most important, it is imperative to consider the unique perceptual aspects of e-cigarettes, building on the conventional cigarette literature as appropriate, but not relying on existing conventional cigarette perception items without adjustment.

Perceptions and Reasons Regarding E-Cigarette Use among Users and Non-Users: A Narrative Literature Review

“…E-cigarette use is a complex behavior, and response options in questionnaires assessing perceptions and reasons in general may not be representative for all users, cigarette smokers, dual users, and non-users. Our overview, in addition to the work of Gibson et al [ 26 ] and Pearson et al [ 24 ], validated measures such as the Fagerström test for nicotine dependence [ 104 ] and the International Tobacco Control measures [ 105 ], and adds insight into developing and validating items for measuring e-cigarette use, risk perceptions of e-cigarettes, perceived benefits of e-cigarettes, and reasons for e-cigarette use. Summarizing, validated measures provide insight into e-cigarette use to develop tailored information based on the needs of e-cigarette users, cigarette smokers, dual users, and non-users.…”

“…However, as the appeal of e-cigarettes is increasing among non-users, it is interesting to study the reasons non-users report that could lead them to initiate e-cigarette use, and whether these reasons differ from cigarette smokers switching to e-cigarettes. In order to better understand the process of switching from cigarettes to e-cigarettes or experimenting with e-cigarettes, it is important to have an insight into perceptions of e-cigarettes and reasons for use among different types of users [ 6 , 11 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. This paper therefore provides an overview of such perceptions and reasons among adult and youth e-cigarette users, cigarette smokers, dual users, and non-users.…”

Changing Perceptions of Harm of e-Cigarette vs Cigarette Use Among Adults in 2 US National Surveys From 2012 to 2017

“… 18 Little is known about how the overall risk perception of e-cigarettes has evolved or changed over time. In addition, previous studies 20 used different approaches to measure risk perception of e-cigarettes, making findings difficult to compare across studies and over time. In the present study, we examine whether and to what extent the perceived relative harm of e-cigarettes compared with cigarettes has changed during a 6-year period (2012-2017) in the United States.…”

The Association between Potential Exposure to Magazine Ads with Voluntary Health Warnings and the Perceived Harmfulness of Electronic Nicotine Delivery Systems (ENDS)

“…ENDS and tobacco control policies at the local level may also shape risk perceptions, which were not controlled for in the present study. As one study suggested, harm perceptions can be evaluated using different measures (e.g., harm perception versus socio-norm perceptions); a future study with more comprehensive measures is needed [ 40 ]. In addition, we did not evaluate addiction perceptions in this study, which will be evaluated in a follow-up study.…”