Institute of Social and Preventive Medicine - Faculty of Medicine
- University of Geneva - Switzerland
Questionnaire for users of electronic
cigarettes, page 2 of 3
When did you first use an electronic cigarette ?
I used an e-cig for the first time on :
When did you last use an electronic cigarette ?
I used an e-cig for the last time on: (if you are a current user, please indicate today's date)
How old were you when you first started to use the electronic cigarette daily ?
How long did your current or most recent episode of electronic
cigarette use last?
In total (all episodes summed), during your life, for how long did you use the electronic cigarette?
In the morning, usually, how soon after waking up do you use the electronic
Currently, on how many days per week do you use the electronic cigarette?
I use it on
days per week
Do you use the e-cigarette mainly during week days (Monday to Friday) or mainly during weekends (from Friday night to Sunday)?
Currently how many puffs per day do you draw on your electronic
cigarette, on average?
puffs per day
Before using the electronic cigarette, how many cigarettes did
you smoke per day, on average?
cig./day before using e-cigs
What equipment do you currently use most?
A- A disposable e-cigarette (non-rechargeable) B- A commercial e-cigarette kit (with rechargeable battery) C- A modular system (I use my own combination of separate devices: batteries, atomizers, etc.)
I use most:
What brand and model of electronic cigarette do you
currently use most?
- If you've stopped using the electronic cigarette, indicate the brand(s)
you used the most.
- Please also rate the quality of this model.
E-cig brand :
E-cig model :
Quality of this model :
How much did you pay for the electronic cigarette kit that you currently
use most? (that is, the e-cig model you cited above)
Please describe the "throat hit" of the e-cigarette you currently
use most (that is, the e-cig model you cited above):
How many different brands of electronic cigarettes have you ever used?
different brands of electronic cigarettes
One month ago, were you using the same brand of electronic cigarette
Do you use cartridges that are already filled (ready to use), or a tank
system, or do you add drops of liquid in your electronic cigarette ("drip")?
What brand, model and nicotine content of refill liquid do you
currently use most for your electronic cigarette?
- If you've stopped using the electronic cigarette, indicate the e-liquid brand
you used the most in the past..
- Please also rate this e-liquid.
E-liquid brand :
E-liquid model :
E-liquid nicotine content :
Satisfaction with this e-liquid model :
Please describe the "throat hit" of the e-liquid you currently
use most (that is, the e-liquid you cited above):
How many different brands of refill liquids have you ever used?
different brands or refill liquids
A month ago, were you using the same brand of refill liquid
What brand, model and nicotine content of disposable pre-filled cartridges or cartomizers do you currently use most for your electronic cigarette?
- If you've stopped using the electronic cigarette, indicate the brand
you used the most in the past.
Disposable pre-filled cartridge brand:
Disposable pre-filled cartridge model:
Disposable pre-filled cartridge nicotine content:
Satisfaction with this disposable pre-filled cartridge :
Please describe the "throat hit" of the disposable pre-filled cartridge or cartomizer
you currently use most (that is, the cartridge model you cited above):
How many different brands of disposable pre-filled ccartridges / cartomizers have you
different brands or disposable pre-filled cartrdiges / cartomizers
A month ago, were you using the same brand of disposable pre-filled cartridge or cartomizer as today?
For your refill liquid or cartridges, what flavor do you use most?
Please rate the flavor you just mentioned above?
If you don't like this flavor, explain why?
What is the effect of this particular flavor on your smoking?
Does the refill liquid or cartridges that you currently use contain nicotine?
What is the concentration of nicotine in the liquid or cartridge that
you are currently using, on average?
mg nicotine per milliliter
What was, on average, the concentration of nicotine in the liquid or cartridge
that you used one month ago?
One month ago:
mg nicotine per milliliter
What is the capacity (in milliliters, mL) of the bottles of liquid that
you use most to fill your electronic cigarettes?
mL per bottle
How many milliliters (ml) of e-liquids do you use per
month, on average?
milliliters (ml) per month
Does the refill liquid (or cartridge) that you use most contain propylene glycol (PG), or vegetal glycerin (VG or glycerol), or a mix of PG and VG ?
Currently, how many times per day do you refill your electronic
cigarette, on average? (That is, how many times a day do you add liquid or
do you insert a new cartridge or cartomizer?)
refills per day
Usually, how long does a refill or tank or cartridge of your electronic
cigarette last before you need to refill it? Please answer all 3 fields for this question
Usually, for how many puffs does a refill or tank or cartridge
last ? Please answer all 3 fields for this question
of e-liquid produces on average
Usually, how long (puffing) does the battery of your electronic cigarette
The battery lasts
Usually, for how many puffs does the battery of your electronic
puffs per battery
How much do you spend monthly for your electronic cigarettes
(purchase, refills, liquids, cartridges, batteries, components, etc..)
Where do you usually buy your electronic cigarettes ?
Where do you usually buy your refill liquids or cartridges?
On which website(s) do you buy your electronic cigarettes, devices and accessories (not e-liquids)?
Websites for e-cigs:
On which website(s) you buy your e-liquids?
Websites for e-liquids:
For how much longer do you intend to use the electronic
For still another
Have you ever used the electronic cigarette and tobacco on the
If you did, why did you use tobacco and e-cigarettes on the same day?
To decrease my tobacco use
In places where smoking is prohibited
Because I like using both tobacco and e-cigs
Did you ever modify your electronic cigarette?
If you did, please describe these "mods":
Did you ever replace the original battery of your electronic cigarette
with a battery of a different type or size or capacity (in mAh)?
If you did, please describe:
Do you currently stock e-cigarette materials, just in case e-cigarette were prohibited in the future ?
Did you ever mix your own refill liquid for your electronic cigarette ?
If you did, please describe:
Did you ever add any substance to a commercial e-liquid and used this modified e-liquid ?
If you did, which substance(s) did you add to your refill liquid, and
for how long did you use the e-cigarette to inhale this substance.?
Did you ever use the electronic cigarette to inhale an illicit substance? (the real substance, not just an artificial flavor)
Other illicit substance:
If you did, what is the effect of the e-cigarette on your use of this substance?
Did you ever use e-liquid with cannabis flavor? (artificial flavor, not real cannabis)
If you did, what is the effect of using an e-cig with artificial cannabis flavor on your use of real cannabis?
If you ever mixed you own refill liquid ("e-liquid" or
"juice"), please indicate why: (If you never did, please click here)
I mixed my own liquid to...
Not at all true
Not very true
...to obtain a better flavor
...to decrease the concentration of nicotine
...to increase the concentration of nicotine
...to obtain a better "throat hit"
...because the modified liquid is less expensive
...to produce more vapor
...to gradually reduce your nicotine intake
...and how do you mix your e-liquid?
...I add nicotine
...I add propylene glycol
...I add flavors
...I add vegetal glycerin
...I add another substance,
Please list the ingredients in the e-liquid that you mix: