Recommended core items to assess e-cigarette use in population-based surveys

Background: A consistent approach using standardized items to assess e-cigarette use in both youth and adult populations will aid cross-survey and cross-national comparisons of the effect of e-cigarette (and tobacco) policies and improve our understanding of the population health impact of e-cigarette use. Focusing on adult behavior, we propose a set of e-cigarette use items, discuss their utility and potential adaptation, and highlight e-cigarette constructs that researchers should avoid without further item development. Reliable and valid items will strengthen the emerging science and inform knowledge synthesis for policymaking.

Methods: Building on informal discussions at a series of international meetings of 65 experts from 15 countries, the authors provide recommendations for assessing e-cigarette use behavior, relative perceived harm, device type, presence of nicotine, flavors, and reasons for use.

Results: We recommend items assessing eight core constructs: e-cigarette ever use, frequency of use, and former daily use; relative perceived harm; device type; primary flavor preference; presence of nicotine; and primary reason for use. These items should be standardized or minimally adapted for the policy context and target population. Researchers should be prepared to update items as e-cigarette device characteristics change.

Conclusions: A minimum set of e-cigarette items is proposed to encourage consensus around items to allow for cross-survey and cross-jurisdictional comparisons of e-cigarette use behavior. These proposed items are a starting point. We recognize room for continued improvement, and welcome input from e- cigarette users and scientific colleagues.