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

Introduction: Electronic cigarettes (ECIGs) vary greatly in their ability to deliver nicotine, which suggests they may also vary in their ability to produce dependence. This study examined individual and combined ECIG device features, and also user behaviors, as predictors of dependence in never-smoking ECIG users. Methods Data were collected from 711 current ECIG users who had smoked <100 cigarettes in their lifetime at Wave 4 of the Population Assessment of Tobacco and Health (PATH) Study. Multivariable linear regressions examined individual (e.g., contains nicotine, uses a tank, flavor preference) and combined (e.g., refillable tanks, refillable mods) device features, and user behaviors (e.g., uses/day) as predictors of dependence, withdrawal, and craving after accounting for demographic variables. Results Results for ECIG dependence and craving showed a similar pattern; higher levels were observed for older age, more frequent past 30-day use, using an ECIG containing nicotine (vs no nicotine), and using a non-refillable cartridge or refillable tank style (vs disposables). Higher withdrawal levels were observed for higher education levels and individual device features of tank (vs no tank), cartridge (vs no cartridge), refillable (vs non-refillable), and “other” flavor preference (vs tobacco flavor). Lower withdrawal levels were associated with a preference for sweet/fruit flavor(s) (vs tobacco flavor). Conclusions Few use behaviors and device features, whether examined alone or in combination, predicted dependence-related outcomes. Findings underscore the challenge with regulating ECIG products in the current marketplace, which is inundated with a myriad of device types.