[About the authors of this survey]

Institute of Social and Preventive Medicine - Faculty of Medicine - University of Geneva - Switzerland


E-cigarette survey: follow-up questionnaire

Please answer even if you do not use e-cigarettes anymore

  • Please take a few minutes to answer this questionnaire. Your participation in this follow-up survey is very important for the quality of this study.
  • Your answers will be stored on a computer file to conduct statistical analysis, they will not be transmitted to any third parties.
  • If you do not want your answers to be stored, please do not respond.

Are you currently using the electronic cigarette?
Do you currently smoke tobacco (cigarettes, cigars or pipe)?
Do you currently use smokeless tobacco (snuff or snus or chewing tobacco)?
Have you smoked any tobacco (even one puff of cigarette, cigar, pipe, etc.), or used smokeless tobacco in the past 7 days?
During the past 31 days, on how many days did you smoke or use smokeless tobacco? days / 31
One question for EX-smokers and EX-users of smokeless tobacco :

When did you quit smoking or stop using smokeless tobacco?

I quit smoking or stopped using smokeless tobacco on:
Day:
Month:
Year:
Questions for current smokers:
(Non-smokers, please click here to continue)

Currently, how many cigarettes (tobacco) do you smoke per day, on average?

I currently smoke cig./day (tobacco)

Usually, how soon after waking do you smoke your first cigarette of the day? minutes
Please rate your addiction to tobacco cigarettes on a scale of 0 to 100:

- I am NOT addicted to tobacco cigarettes at all = 0
- I am extremely addicted to tobacco cigarettes = 100

Addiction to tobacco cigarettes (0-100)
If you've already tried to quit smoking, how long did your most recent quit attempt last? My most recent quit attempt lasted:
If you have gone back to smoking after trying to quit, when did you start smoking again? I started smoking again on:

Day:
Month:
Year:

Do you intend to quit smoking?
If you tried to quit smoking, are you sure that you could actually quit?
Is it likely that, in one month from today, you will have quit smoking?

Please rate yourself for TODAY:
Desire or craving to smoke
Anxious, nervous
Angry, irritable, frustrated
Depressed mood, sad
Difficulty concentrating
Insomnia, sleep problems, awakening at night
Increased appetite, hungry, weight gain
Restless, impatient
Mood swings
Coughing
Sore throat
Nosebleed
Want to hold a cigarette between your fingers

Questions on past and current e-cigarette use:
When did you last use an electronic cigarette ? I used an e-cig for the last time on :
Day:
Month:
Year:
How long did your current or most recent episode of electronic cigarette use last? It lasted:
In the morning, usually, how soon after waking up do you use the electronic cigarette? minutes
Currently, on how many days per week do you use the electronic cigarette ? I use the e-cig on days per week
Currently how many puffs per day do you draw on you relectronic cigarette, on average? puffs per day
Does the refill liquid or cartridges that you currently use contain nicotine?
What is the concentration of nicotine in the e-liquid or cartridge that you are currently using? Now: mg nicotine per mL
How much do you spend monthly for your electronic cigarettes (purchase, refills, liquids,
cartridges, batteries, components, etc..)
I spend: per month
For how much longer do you intend to use the electronic cigarette? For still another

Reasons for using the e-cigarette:
I use the electronic cigarette ...

Not at all true

Not very true

Somewhat true

Very true

... because I enjoy it

... to deal with my craving for tobacco

... to quit smoking or avoid relapsing to smoking

... to deal with tobacco withdrawal symptoms

... to deal with situations or places where I cannot smoke (e.g. at home, at work, during business meetings, when visiting non-smoking friends, in a plane, bus or train, etc.)

... because in spite of my efforts, I am unable to stop using the electronic cigarette

...because I am addicted to the electronic cigarette

Other purpose or reason:

Not at all true

Not very true

Somewhat true

Very true

Urge to use the e-cigarette:
For you, stopping using the electronic cigarette for good would be:
Please rate your addiction to the electronic cigarette on a scale of 0 to 100:

- I am NOT addicted to the electronic cigarette at all = 0
- I am extremely addicted to the electronic cigarette = 100

Addiction to the e-cigarette (0-100)
How much of the time have you felt the urge to vape (=to use an electronic cigarette) today?
How strong have the urges been today?

Questions for all:
Are you the same person who answered our similar questionnaire, a few weeks ago?
Are you?
How old are you? I am years old
What is your body weight ? kg + g
or
pounds
We will contact you by e-mail in a few months, to ask you a  few questions about your use of e-cigarettes and of tobacco. If you have a new e-mail address (in addition to the address that we already have from you), please indicate it here. Your e-mail address is kept confidential and will not be transmitted to anyone.
Your participation in the follow-up surveys is very important for the quality of this study.
New e-mail:
Comments:

Please click below to send your answers and to continue the survey:


About the authors of this study:

Principal investigator: Jean-Francois Etter, PhD
is senior lecturer at the Faculty of Medicine of the University of Geneva, Switzerland. He is in charge of the Stop tabac.ch website and is the author of numerous
scientific publications.
Consultant: Thomas Eissenberg, PhD
is Professor of psychology, director of the Clinical Behavioral Pharmacology Laboratory at the Virginia Commonwealth University, Richmond, VA, USA. He is the author of numerous scientific publications.

[Created by JF Etter, version 1, 10 September 2012]