Institute of Social and Preventive Medicine - Faculty of Medicine
- University of Geneva - Switzerland
Questionnaire for users of the electronic
Please answer only if you have already used an electronic
Your answers will help us better understand who users
of electronic cigarettes are and how they use this product.
To participate, you must be at least 18 years old.
If you wish to, you will be invited after one, 3, 6 and 12
months to answer follow-up surveys (total 5 surveys
including this one), participation is voluntary and you can stop participating
at any time without having to give any explanation.
Your responses will be stored in a computer file
for statistical analysis, and will not be transmitted to any third party.
However, the people in charge of the ethics committee and the medical research
authorities in Switzerland will have the right to access the data, subject
We will ensure a high security level for recorded
data, particularly to minimize the risk of access by hackers.
If you do not want your answers to be kept on file,
please do not respond.
Results of this analysis will be published in a scientific
our previous articles]. This is not a market research study, the aim of this study is purely scientific.
This study is independent from manufacturers and retailers
of electronic cigarettes and e-liquids, and of the pharmaceutical and tobacco
industries. This study is conducted by researchers at the Univerity of Geneva, it is funded by the Swiss Tobacco Prevention Fund (an agency of the Swiss Government)
There are 3 pages to this questionnaire, please answer all 3 pages.
The study began in October 2012 and ends in December 2015,
we expect 1200 participants
You can contact the principal investigator
(JF Etter) for more information.
The electronic cigarette (e-cigarette) is
a device that looks like a cigarette or cigar, with a battery and an electronic
system that produces a vapor that often contains nicotine.
"Vaping" means using an electronic cigarette (drawing puffs of vapor),
and a "vaper" is a user of electronic cigarettes
Do you know of the electronic cigarette?
Are you currently using the electronic cigarette?
In the future, do you intend to use the electronic cigarette?
Do you currently smoke tobacco (cigarettes, cigars or pipe)?
Do you currently use smokeless tobacco (snuff or snus or chewing tobacco)?
Before you first used the electronic cigarette, were you a smoker
or a user of smokeless tobacco ?
Before I first used an e-cigarette...
The first time that you ever used nicotine, in which product was
The nicotine was...
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
How old were you when you first started to smoke daily or to use
smokeless tobacco daily ?
Four questions for EX-smokers and
EX-users of smokeless tobacco :
1- When did you quit smoking or stop
using smokeless tobacco?
I quit smoking or stopped using smokeless tobacco on:
2- Before you quit smoking, how many cigarettes (tobacco) did
you smoke per day, on average?
cig./day before I quit smoking
3- Before you quit smoking, how soon after waking up did you smoke
your first cigarette of the day, usually?
4- Please rate your addiction to tobacco cigarettes when you were
a smoker, on a scale of 0 to 100:
- I was NOT addicted to tobacco cigarettes at all =
- I was extremely addicted to tobacco cigarettes =
Addiction to tobacco cigarettes when you were a smoker
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
Usually, how soon after waking up do you smoke your first cigarette
of the day?
Please rate your addiction to tobacco cigarettes on a scale of 0 to 100:
- I am NOT addicted to tobacco cigarettes at all =
- I am extremely addicted to tobacco cigarettes =
Addiction to tobacco cigarettes (0-100)
If you've already tried to quit smoking... ...how long did your most recent quit attempt
My most recent quit attempt lasted:
...how long did your longest quit attempt
My longest quit attempt lasted:
If you have gone back to smoking after trying to quit, when
did you start smoking again the last time?
I started smoking again the last time on:
Are you currently trying to quit smoking?
Are you currently trying to reduce your smoking?
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
If you have decided to quit smoking, have you set a quit date?
If you have, what is your target quit date?
I have decided to quit smoking on:
Do your relatives / friends / collegues ask you to quit smoking?
In the past 3 months, did anyone close to you quit smoking?
In the past 3 months, did a health professional (doctor, nurse,
psychologist, pharmacist, etc.)... ...advise you to quit smoking?
...help you to quit smoking?
In the past 3 months, did you call a smoking cessation telephone
In the past 3 months, did you visit a smoking cessation website
or an online discussion forum on smoking cessation, or did you use a smoking cessation "app" for mobile
Are you currently using a nicotine medication? (nicotine patch,
nicotine gum, tablet, inhaler or nicotine nasal spray)
Are you currently using the smoking cessation drug called
bupropion (Zyban, Wellbutrin or Zyntabac)?
Are you currently using the smoking cessation drug called
varenicline (Champix or Chantix)?
If you ever used any other smoking cessation medication,
please indicate which one:
What smoking cessation medication did you use most?
How long did your current episode or your most recent episode
of use of the medication that you just mentioned above last?
When did you last use the medication that you mentioned above?
I've used it for the last time on:
Did you ever use an electronic cigarette in place of one of the
smoking cessation medications listed above ?
use (please answer even if you do not drink alcohol):
How often do you have a drink containing alcohol? (Beer, cider, wine,
alcopops, other alcoholic drinks)
How many drinks containing alcohol do you have on a typical day when
you are drinking?
How often do you have six or more drinks on one occasion?
Questions about cannabis use (please answer even
if you do not take cannabis):
During the last 12 months, how often did you take cannabis?
During the last 30 days, on how many days did you take cannabis?
days / 30
How many hours were you "stoned" on a typical day when you had been using
Over the past 12 months, how often were you "stoned" for 6 or more
Here are some questions about yourself:
How old are you? You can participate if you are AT LEAST 18 years old
What is your body weight ?
What is your height ?
In which country do you live?
Have you obtained a diploma which allows you to be accepted into a university?
How would you describe your household income, compared to the average
income of other households in your country?
Very below average = a
A little below average = b
About the average income of other households in my country = c
A little above average = d
Very above average = e
I do not know / I do not wish to answer = x
The income of my household:
In your household, how many people smoke (including yourself)?
smokers in my household (myself included)
Does you spouse / partner smoke?
In your home, is smoking prohibited?
In my home, smoking is ...
At your place of work, is smoking prohibited?
At my workplace, smoking is ...
At work, do your colleagues smoke in your presence?
How many of your 3 closest friends smoke?
How many hours per week are you exposed to other people's tobacco
hours per week
Do you currently have a smoking-related disease ?
Did a relative, friend or colleague recently have a smoking-related disease?
Do you often feel sad or depressed?
During the past month, have you often been bothered by feeling down,
depressed or hopeless?
During the past month, have you often been bothered by little interest
or pleasure in doing things?
- are you currently pregnant?
- are you currently trying to get pregnant?
Do you know what is the legal / regulatory status of electronic cigarettes
in your country?
If you do, please describe and cite relevant laws, regulations, court decisions,
Also, please send us by e-mail
(click here) relevant laws
and regulatory texts, court decisions, etc. from your country (either as
attached files or links to websites)
In your country, do you know of any associations or clubs of e-cigarette
users ("vapers")? Please cite the names of the associations which you know of, including
the name of their website:
Where did you learn about this survey ? (on which website, forum, mailing
We would like to contact you in 1, 3, 6 and 12 months from
now, to ask you a few questions about your use of e-cigarettes and
If you wish to participate, please indicate your first name and e-mail address.
Your participation is very important for the quality of this study. Your e-mail address is kept strictly confidential and will not be transmitted to anyone.
We would like to ask you for your postal address, for 2
reasons: 1) To collect saliva samples from participants in this survey,.
Saliva samples will be used to measure cotinine (a nicotine metabolite).
The samples will be used solely for the analysis of cotinine and will be destroyed
after this analysis. You will receive by mail a plastic vial to collect saliva. 2) To send the follow-up questionaires on paper to those who do not
answer the online questionnaire at follow-up.
If you are interested in taking part in these analyses, please indicate your
name and address. Names and addresses are kept strictly confidential and will not be
transmitted to anyone.
Please click below to send your answers and to continue
Principal investigator: Jean-Francois Etter,
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
publications, most of them on tobacco dependence and smoking cessation. 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
[Created by JF Etter, version 1, 10 September 2012]