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September
2017
Understanding
Use of Electronic Nicotine Delivery Systems (ENDS) Among Youth and
Adults: Final Cognitive Interview Report
Prepared for
Katrina
Trivers
Stacy
Thorne
National
Center for Chronic Disease Prevention and Health Promotion
Office
on Smoking and Health
Centers
for Disease Control and Prevention
4700
Buford Highway NE MS F79
Atlanta,
GA 30341
Prepared by
Sarah Parvanta
Sara Kennedy
Valerie Etta
JJ Hayes
Julia Kish Doto
RTI
International
3040
Cornwallis Road
Research
Triangle Park, NC 27709
RTI
Project Number 0213618.018.000.005.001
BACKGROUND &
OBJECTIVES
Given the rise of electronic nicotine
delivery systems (ENDS) awareness and use among adults and youth, it
is important to measure what the public understands about these
products. ENDS terminology has been particularly challenging to sort
out in the development of survey instruments evaluating perceptions
and behaviors related to ENDS. To yield valid indicators of these
outcomes, it is critical that survey questions use familiar, clear,
and accessible language pertaining to ENDS (e.g., product and device
types, ingredients or additives, and frequency of use). We conducted
a set of cognitive interviews with youth and adults to assess their
understanding of existing survey questions about ENDS and to inform
revision of instruments used in ENDS surveillance (e.g., National
Youth Tobacco Survey [NYTS], Behavioral Risk Factor Surveillance
System [BRFSS]). Specifically, we were interested in participants’
thoughts on the clarity, terminology, and relevance of each survey
question and response option.
METHODS
Participant Eligibility
Eligibility for the interviews
depended on several criteria for youth and adults:
Youth
had to be in grades 6 through 12 (12 to 17 years old), and adults
had to be 18 years old or older and not in high school.
All
participants had to read, understand, and speak English.
The
sample had to include participants with varying levels of experience
using electronic vaping products, including several non-users.
We
aimed for a diverse sample based race, ethnicity, and gender.
Participant Recruitment and Screening
We conducted two rounds of cognitive
interviews (Round 1: Tampa, FL; Round 2: Seattle, WA). Two market
research firms recruited participants and hosted the interviews
(Round 1: L&E Research; Round 2: Consumer Opinion Services). The
firms used their contact databases to identify potential participants
and screen them for eligibility via telephone using a CDC-approved
screener (Appendix A).
Recruiters invited and scheduled eligible participants for the study.
Before the interviews began the firms provided us with participants’
screening responses to confirm eligibility. Screening responses were
de-identified.
In
Round 1, we conducted interviews with 8 adults and 8 youth. Round 2
included 8 adults and 7 youth, for a total of 31 participants across
the two rounds. Exhibit 1
shows the participant characteristics.
Exhibit
1. Participant Characteristics
|
Round
1
|
Round
2
|
|
|
Youtha
(n
= 8)
n
(%)
|
Adults
(n
= 8)
n
(%)
|
Youth
(n
= 7)
n
(%)
|
Adults
(n
= 8)
n
(%)
|
Overall
(N
= 31)
n
(%)
|
Sex
|
|
|
|
|
|
Male
|
3
(37.5)
|
4
(50.0)
|
3
(42.9)
|
4
(50.0)
|
14
(45.2)
|
Female
|
5
(62.5)
|
4
(50.0)
|
4
(57.1)
|
4
(50.0)
|
17
(54.8)
|
Educationb
|
|
|
|
|
|
Middle
school (6th – 8th grade)
|
2
(25.0)
|
NA
|
1
(14.3)
|
NA
|
3
(9.7)
|
High
school (9th – 12th grade)
|
6
(75.0)
|
NA
|
6
(85.7)
|
NA
|
12
(38.7)
|
Ever
used e-cigarettes
|
|
|
|
|
|
Yes
|
6
(75.0)
|
6
(75.0)
|
3
(42.9)
|
8
(100.0)
|
23
(74.2)
|
No
|
2
(25.0)
|
2
(25.0)
|
4
(57.1)
|
0
(0.0)
|
8
(25.8)
|
Ever
tried other tobacco
|
|
|
|
|
|
Yes
|
4
(50.0)
|
8
(100.0)
|
2
(28.6)
|
8
(100.0)
|
22
(71.0)
|
No
|
4
(50.0)
|
0
(0.0)
|
5
(71.4)
|
0
(0.0)
|
9
(29.0)
|
Race/Ethnicity
|
|
|
|
|
|
Non-Hispanic
White
|
6
(75.0)
|
4
(50.0)
|
4
(57.1)
|
3
(37.5)
|
17
(54.8)
|
Non-Hispanic
Black or African American
|
1
(12.5)
|
1
(12.5)
|
0
(0.0)
|
3
(37.5)
|
5
(16.1)
|
Non-Hispanic
Other
|
0
(0.0)
|
1
(12.5)
|
2
(28.6)
|
1
(12.5)
|
4
(12.9)
|
Hispanic
|
1
(12.5)
|
2
(25.0)
|
1
(14.3)
|
1
(12.5)
|
5
(16.1)
|
a
The screener asked youth for their education level but not adults. b
One participant in Tampa who was 18 years old was categorized as
youth since they were still in High School.
Survey Item Feedback
Hardcopy interview materials included
separate cognitive interview guides for youth (Appendices
B and C) and adults
(Appendices D and E),
surveys for youth and adults, and a photograph showing examples of
electronic
vaping products, including disposables, cartridge systems, and tank
systems. The cognitive interview guides listed probes for each survey
item, which differed for youth and adults. Cognitive interviews
followed a think-aloud methodology to elicit participant reactions
and evaluate their understanding the survey items and instructions
(Willis, 2005). Using this approach, the interviewer asked
participants to read instructions and questions aloud and think
through their responses aloud. The interviewer then probed on
participants’ feedback to understand how they interpreted the
survey items.
Data Analysis
In
preparation for analysis, we developed a matrix that organized
participant feedback on each survey item. We employed a thematic
analysis that identified trends and patterns across participant
feedback to the questions and probes (Miles & Huberman, 1994).
Themes include:
clarity
of instructions
comprehension
and interpretation of questions and response options
relevance,
suitability, and comprehensiveness of response options
Below we report on findings from the
cognitive interviews and provide recommendations on how to revise the
candidate items and instructions. We present a list of the original
and subsequent revised questions in Exhibit 2 at the end of this
report.
question-by-Question findings: Youth
BRFSS
E-Cig Question:
[ALTERNATE
WORDING FOR INSTRUCTIONS]
The
next 2 questions are about vaping. Please don’t think of vaping
to use marijuana when you answer these questions.
Findings
Most
youth said they understood the meaning of “vaping”
and included e-cigarettes (or electronic cigarettes) as part of
their definition. In other words, they considered e-cigarettes
and vaping to be part of the same category.
Participants
seemed more familiar with “vape” and “vapes”
than “vaping” or “vaping products,” but
they still understood the term “vaping.”
In
Seattle, most youth had not heard of vaping marijuana.
Participants did not understand the alternate instruction “Please
don’t think of vaping to use marijuana when you answer
these questions.”
Youth
preferred the original version of the instructions (shown below)
to the alternate version (shown above). Participants said the
original instruction is more specific, provides a definition, and
described more.
One youth said both versions
made sense. One participant nodded in agreement when the
interviewer asked if it helped that the original version
mentioned “e-cigarettes and other electronic vaping
products” rather than “vaping” alone. A second
participant said listing vaping alone is too vague while
distinguishing “the two” (i.e., e-cigarettes and
vaping) makes the instructions easier to understand.
|
Suggested
Revisions to the Question
The
next two questions are about e-cigarettes and electronic vaping
products containing nicotine. Do not include marijuana when
answering these questions.
E-cigarettes
and electronic vaping products include vapes, vape pens, e-cigars,
mods, and others. These products are battery powered and usually
contain nicotine and flavors.
|
BRFSS
E-Cig Question:
[ORIGINAL
WORDING FOR INSTRUCTIONS]
The
next 2 questions are about electronic cigarettes and other electronic
“vaping” products containing nicotine. Do not include
Marijuana.
Electronic
cigarettes (e-cigarettes) and other electronic “vaping”
products include electronic hookahs (e-hookahs), vape pens, e-cigars,
and others. These products are battery-powered and usually contain
nicotine and flavors such as fruit, mint, or candy.
Findings
Overall,
youth were somewhat split in terms of knowing that e-cigarettes
and vaping products fall under the same ENDS umbrella. Several
participants said e-cigarettes look like a cigarette, cost less
than a vape, or are the “skinny” kind.
“In my opinion,
e-cigarettes are to quit smoking…and vape pens just play
with smoke...without any nicotine base so you don’t get
addicted” (Youth, Tampa, User).
This
participant also said e-cigarettes contain nicotine while vape
pens may or may not contain nicotine. However, later in the
interview, this participant said a personal vaping product means
“Like e-cigarettes, vapes...anything that has juice in it”
(Youth, Tampa, User).
It
is possible that probing on whether e-cigarettes and vaping
products were different increased the salience of their
differences over their similarities. As mentioned above, several
participants recognized that e-cigarettes and vaping products are
similar products, even if some visualize cigalikes when they
think of e-cigarettes.
Most
youth had heard of vape pens, while only a few had heard of
e-hookahs (although two of these participants did not know what
e-hookahs looked like). “Vapes” appeared to be the
most popular term, and more popular than “e-cigarettes.”
Vape pens appeared to be most familiar compared to the other
products listed in the original instruction. A few youth had
heard of e-cigars. One non-user participant had heard of “vaping”
but not “vapes.” Most youth had not heard of tanks,
while some were familiar with mods.
In
Tampa, youth were split in terms of knowing about marijuana use
in vaping products; some knew about this behavior and others did
not. Still, most youth understood the instruction “Do not
include marijuana.” Several youth thought it would be more
clear to say “Do not think about (using) marijuana when you
are answering these questions.”
In
Seattle, most youth were generally familiar with nicotine, even
if they could not define it specifically. Some mentioned the
association between nicotine and cigarettes. Most youth
understood that vaping products contain nicotine (i.e., nicotine
is “loaded” into the devices; the “flavors”
or “juice” contain nicotine). A few youth mentioned
that e-liquid without nicotine is available. One youth guessed
that vaping products contain less nicotine than cigarettes.
In Tampa, we did not ask youth
a general question about nicotine, but instead asked if they
thought people usually use nicotine or marijuana in personal
vaporizers. Most youth were unsure, but two participants knew
that vaporizers contain nicotine.
|
Suggested
Revisions to the Question
The
next two questions are about e-cigarettes and electronic vaping
products containing nicotine. Do not include marijuana when
answering these questions.
E-cigarettes
and electronic vaping products include vapes, vape pens, e-cigars,
mods, and others. These products are battery-powered and usually
contain nicotine and flavors.
|
BRFSS
E-Cig Question:
[ALTERNATE
WORDING FOR [1] 10.1]
Have
you ever tried a vaping product, even just one time?
1 Yes
2 No
[Go to next section]
7 Don’t
know / Not Sure
9 Refused
[Go to next section]
Findings
Youth
generally understood the alternate question but there were a few
points of confusion among some participants.
Most
thought that this question referred to any vaping product.
“It’s
like have you ever tried a vaping product? So, that could be
like anything basically like to do with vaping.” (Youth,
Seattle, User)
When
asked, one participant thought that asking “have you ever
vaped” sounded more involved.
“I
think it sounds more into the subject and it might cause people
who have only tried it once to say no, or don’t know.”
(Youth, Seattle, User).
Participants
understood the phrase, “even just one time.”
Youth understood that the
question asked about trying vaping products at any point in their
lives, without that being specifically stated.
|
Suggested
Revisions to the Question
We
do not recommend adopting this alternate version of the question.
The
question stem should include reference to e-cigarettes and other
vaping products more broadly.
Removing the phrase “in
your entire life” may be appropriate.
|
BRFSS
E-Cig Question:
[1]
10.1
Have
you ever used an e-cigarette or other electronic “vaping”
product, even just one time, in your entire life?
1 Yes
2 No
[Go to next section]
7 Don’t
know / Not Sure
9 Refused
[Go to next section]
Findings
For
this question, we explored participants’ understanding of
the terms “e-cigarette” compared to “other
electronic vaping product” and their comprehension of the
phrases “just one time” and “in your entire
life.”
Participants
generally understood the question to refer to any e-cigarette or
other vaping product.
At
least one participant did not understand this question to be
asking about products including vape pens.
“Have
you ever used an e-cigarette or other electronic vaping
products, even just one time in your entire life? No. I’ve
only tried a vape pen.” (Youth, Seattle, User)
Most
participants preferred the original wording. They reported the
original version was clearer because it included examples. Some
thought that it might not be clear to everyone that this question
included e-cigarettes.
“Yeah,
I think, well it’s more specific so I feel like that’s
a more clear question.” (Youth, Seattle, Non-User)
Participants
generally understood the phrase even just one time.
“One time as in, like,
if you picked it up once, inhaled once, and exhaled once all in
one go. That’s just one time.” (Youth, Tampa,
Non-User)
Some
participants did not think that the phrase in your entire life
was necessary but they thought it might be helpful to others.
“I
think, for me, I guess, it would seem like it would either be a
very definitive yes or no, or guess for some if you don’t
remember, but I think that would be something that you would
remember so I don’t think you’d have to say ‘in
your entire life’.” (Youth, Seattle, Non-User)
|
Suggested
Revisions to the Question
|
BRFSS
E-Cig Question:
[2]
10.2
Do
you now use e-cigarettes or other electronic “vaping”
products every day, some days, or not at all?
1 Every
day
2 Some
days
3 Not
at all
7 Don’t
know / Not sure
9 Refused
Findings
Most
user participants selected the response option “Some days,”
while most non-users selected the response option “Not at
all.” The interpretation of “some days” widely
differed among youth participants, with a range of four times a
week to once a month.
“Comes
to mind as not once a day per week, but more as like maybe you
pick up a cigarette at least three times a week.”
“Rarely—that would be probably to me twice every 2
to 3 months.” (Youth, Tampa, User)
“To
me, more than 5 days out of the month.” (Youth, Tampa,
Non-User)
“I’m
not sure because people have different definitions for “some
days.” It could be twice a day, it could be once every
month.” (Youth, Seattle, Non-User)
“Some
days would be more in a social way or with your friends. Rarely
would be every couple of weeks or months or as a get together.”
(Youth, Seattle, User)
One
participant noted that some days and rarely are kind of the same
thing. Some days would mean 3 to 4 days a week.
Participants
did not demonstrate or express difficulty in interrupting the
term “now.” Several participants who had once tried
e-cigarettes or electronic vaping products, but have since ceased
to use them, selected the response option “Not at all.”
One
participant selected his response option with the understanding
that “now” referred to current activity. Thus,
because he does not use e-cigarettes or other electronic
“vaping” products now but has done so in the past,
he selected the response option “Not at all.”
Another
participant explained if he selected the response option, “not
at all” because he had only picked up an e-cigarette and
tried it one time. (Youth, Tampa, Non-User)
Two
youth participants in round two shared that many youths vape for
the purposes of being cool or for the tricks, rather than the
flavor.
“Yeah,
I know people would like them, but I don’t think they
would do it for the flavor…
I know some people do it to get over smoking
nicotine and regular cigarettes, and then I just feel like some
people in school do it just for fun and to be cool. (Youth,
Seattle, Non-User)
“I
think people just do it to, cause a lot of people do it just to
do it, just not for like health use or something, they just do
it to like, cause I seen like on Twitter and stuff like videos
of people doing it.
Like people just do like tricks and stuff with it,
like people just do it for fun.” (Youth, Seattle, User)
When
asked “rarely” or “occasionally” response
options, most non-users participants noted “rarely.”
Interpretations of rarely ranged from once a month to every 6
months.
“Like
every 6 months.” (Youth, Seattle, Non-User)
“I
guess like once every month maybe.” (Youth, Seattle,
Non-User)
One participant noted that the
response option “don’t know” is not needed. The
participant stated, “They shouldn’t say “don’t
know” because kids know what they’re doing. I don’t
think you need to have that answer because they know what they’re
doing with their body.” (Youth, Tampa, User)
|
Suggested
Revisions to the Question
Do
you now use e-cigarettes or other electronic “vaping”
products every day, some days, or not at all?
1 Every
day
2 Some
days
3 Not
at all
9 Refused
|
NYTS
2017 Marijuana questions
[ORIGINAL
WORDING FOR [3] 34.]
Have
you ever used marijuana, marijuana concentrates, marijuana waxes,
THC, or hash oils in an e-cigarette?
A.
I have never used an electronic product
B.
Yes
C.
No
Findings
Participants
understood the term “electronic product.” They said
it referred to vapes, vape pens, “e-cigarettes, and all
these other electronic devices that you could put nicotine in.”
(Youth, Tampa, User)
Most
youth had not heard of marijuana concentrates. Some had heard of
waxes, hash oils, and THC.
Most
youth said they would feel comfortable answering this question on
a survey.
Four
youth answered “Yes” to this NYTS question. One
participant selected “Yes” incorrectly because he or
she had used marijuana before, but not in an e-cigarette.
One
participant incorrectly answered “No” to this
question even though he or she had never used an electronic
vaping product before. He or she thought “No” and “I
have never used an electronic product” were equivalent
responses.
One participant said referring
to “e-cigarettes” in questions about marijuana and
vaping is not appropriate because e-cigarettes are for “a
different type of liquid…” than marijuana oil,
“…like that juice of
some sort” (Youth, Tampa, User). Conversely, another
participant suggested asking if you have put “weed”
in your e-cigarette, rather than listing multiple
marijuana products in this question.
|
Suggested
Revisions to the Question
We
recommend replacing the original version with the alternate
version tested in Seattle for several reasons: the original
version may yield unreliable responses (i.e., responses that are
prone to error); the alternate version tested in Tampa did not
resonate with marijuana users; and the alternate version tested
in Seattle yielded reliable responses and resonated with most, if
not all, youth participants. The recommended version follows:
Have you ever used an e-cigarette or
electronic vaping device to use marijuana?
A.
Yes
B. No
|
NYTS
2017 Marijuana questions
[ALTERNATE
WORDING FOR [3] 34.]
Have
you ever used an electronic cigarette or electronic vaping device to
use marijuana?
A. I
have never vaped
B. Yes
C.
No
Findings
Non-marijuana
users tended to prefer the alternate wording because it says
“Have you ever vaped marijuana.” In addition, one
marijuana user preferred the alternate wording and subsequently
chose an accurate answer to this version of the question (after
choosing an inaccurate answer to the original version).
Conversely, both of the
remaining youth who had used marijuana before did not think the
alternate wording made sense. One participant said people don’t
say “Have you vaped marijuana?” Another participant
pointed out that it is not possible to use all marijuana products
in vaping devices, and mentioned marijuana oil as the appropriate
product.
|
Suggested
Revisions to the Question
|
NYTS
2017 Marijuana questions
[ALTERNATE
WORDING FOR [3] 34.]
Have
you ever used an electronic cigarette or electronic vaping device to
use marijuana?
A.
Yes
B.
No
Findings
All
participants who saw this alternate version provided an accurate
response that matched their actual reported behavior.
Participants understood that this version referred to using
marijuana specifically through vaping devices (rather than
ingesting marijuana in other ways or in general).
Most
youth thought this alternate version was easier to answer for
several reasons: the response options were limited to “Yes”/”No”;
it does not imply that answering “Yes” means you have
used all types of marijuana listed in the original version (e.g.,
concentrates, hash oils); and the wording is less distracting.
Some youth thought this alternate version was more broad than the
original version. One ENDS and marijuana user suggested revising
this version to “Have you ever used marijuana in an
electronic…”
Participants
tended to prefer vaping “device” over vaping
“product.”
One participant thought that
electronic cigarette and electronic vaping device were different
because “they are separated in the question” (Youth,
Seattle, User), but did not know how they differed. Another
participant thought this question should list both “electronic
cigarette” and “electronic vaping device.”
|
Suggested
Revisions to the Question
|
NYTS
2017
[ALTERNATE
WORDING FOR [4] 32]
[IF
PARTICIPANT HAS NOT USED VAPING PRODUCTS, ASK THIS QUESTION ABOUT
PEOPLE IN GENERAL]
Where
have you gotten or bought vaping products? (Select one or more)
1. A
gas station or convenience store
2. A
grocery store
3. A
drugstore
4. A
mall or shopping center kiosk/stand
5. On
the Internet
6. A
vape shop or other store that only sells e-cigarettes
7. Some
other place not listed here
8. From
a family member
9. From
a friend
10. From
some other person that is not a family member or a friend
11. I
have never tried a vaping product
Findings
For
this question, we explored participants’ reactions to the
existing response options.
Overall,
participants said the response options were thorough and there
were no other options that should be added. A few participants
commented that grocery stores and drug stores do not sell the
products and suggested they could be eliminated as options.
“The
only two I don’t really see [as options] is a grocery
store or a drug store. I suppose you could get medicinal
marijuana at a drug store but I don’t know. I don’t
automatically think vaping products come from a drug store.”
(Youth, Seattle, Non-user)
Participants
identified gas stations, vape shops, and friends as the top
responses where users have purchased them and non-users have seen
them.
One
participant said smoke shops should be added as a response
option.
|
Suggested
Revisions to the Question
|
NYTS
2017
[4]
32.
During
the past 30 days, where did you get or buy the e-cigarettes that you
have used? (Select one or more)
1. I
have never tried an e-cigarette in the past 30 days
2. A
gas station or convenience store
3. A
grocery store
4. A
drugstore
5. A
mall or shopping center kiosk/stand
6. On
the Internet
7. A
vape shop or other store that only sells e-cigarettes
8. Some
other place not listed here
9. From
a family member
10. From
a friend
11. From
some other person that is not a family member or a friend
Findings
This
question examines a different wording of question NYTS 2017 4
[32]. Our cognitive interview guide assessed participant reaction
to the question stem (i.e., additional of phrase “During
the past 30 days,” the use of the phrase e-cigarettes
instead of vaping products and the order of the response option,
“I have never tried…”) (listing first versus
listing last).
Participants’
reactions to the placement of the response option, “I have
never tried…” (first verses last) were mixed.
Participants who said it should go first explained that it would
save time by not having to read all the responses. Those who
wanted it at the bottom said it would be less confusing by having
it at the end.
Only
one participant said having “During the past 30 days”
may change someone’s answers so it should remain and two
others said it was not necessary or they were indifferent about
it.
When
asked about using the term “e-cigarettes” instead of
“vaping products,” participants did differentiate
e-cigarettes from vaping products with vaping products being a
more inclusive term.
“People
might have tried vaping but not e-cigs, so their answers may
change.” (Youth, Seattle, Non-User)
“Should
say vaping products because e-cigarettes are different. Some
[products] are recreational than addict[ive].” (Youth,
Seattle, User)
“Probably
include vaping products in this question too, not just
e-cigarettes. I don’t really see kids using
e-cigarettes…[they] are for older people.” (Youth,
Seattle, User,)
“I don’t think
different things about the products but I count them as
different things…e-cigarettes are vaping products but
vaping products can be lots of other things that are not
e-cigarettes.” (Youth, Seattle, User)
|
Suggested
Revisions to the Question
Where
did you get or buy the vaping products you have used, including
e-cigarettes? (Select one or
more)
1. A
gas station or convenience store
2. A
grocery store
3. A
drugstore
4. A
mall or shopping center kiosk/stand
5. On
the Internet
6. A
vape shop or other store that only sells e-cigarettes
7. From
a family member
8. From
a friend
9. Some
other place / some other person (not a family member or a friend)
10.
I have never tried a vaping product
|
NYTS
2017
[5]
33
What
are the reasons you have used e-cigarettes? (Select one or more)
1. I
have never tried an e-cigarette
2. Friend
or family member used them
3. To
try to quit using other tobacco products, such as cigarettes
4. They
cost less than other tobacco products, such as cigarettes
5. They
are easier to get than other tobacco products, such as cigarettes
6. Famous
people on TV or in movies use them
7. They
are less harmful than other forms of tobacco, such as cigarettes
8. They
are available in flavors, such as mint, candy, fruit, or chocolate
9. They
can be used in areas where other tobacco products, such as
cigarettes, are not allowed
10. I
used them for some other reason
Findings
This
NYTS question on reasons for using an e-cigarette was tested in
Round 2 only. We explored if there were any answer choices that
should be added or that did not belong.
Friend
or family member was the most common response among users. Other
selected response options included because e-cigarettes cost less
than cigarettes, are available in flavors, and can be used in
areas where other tobacco products are not.
Multiple
participants reported that “peer pressure” was a main
reason other youth might use e-cigarettes.
“Well
I know from people telling me, they’re peer pressured into
it or they do it just because another friend does it. I think
that could be included.” (Youth, Seattle, Non-User)
Other
possible reasons for using e-cigarettes included “craving
nicotine,” to do tricks with clouds of vapor, and to make
YouTube or social media videos.
Several
participants thought that it was unlikely that any youth would
select “famous people on TV or in movies use them.”
“Why, why would there
be an answer that was, famous people on TV or movies use them?
That seems like not very associated to this. Even though like, I
know people do, but I don’t see why people would do it
just because like, a celebrity’s doing it.” (Youth,
Seattle, Non-user)
|
Suggested
Revisions to the Question
|
NYTS
2016 E-Cig Product Types Question
[6]
34.
Thinking
about all types of e-cigarettes, have you used the disposable kind or
rechargeable/refillable/tank kind?
A.
I have never tried an e-cigarette
B.
Only the disposable kind
C.
Only the rechargeable/refillable/tank kind
D.
Both the disposable kind and rechargeable/refillable/tank kind
Findings
Participant
responses were mixed and varied based on whether the participant
was a user. Most non-users answered “I have never tried an
e-cigarette,” while most users answered
“rechargeable/refillable/tank kind.” However, one
participant suggested adding another response option.
“I
think that definitely a “Not sure” or “Don’t
know” answer would be good here... because I know that I
don’t know the answer to this question in my case.
Otherwise, I think that the answers are pretty solid, there are
only ones that ... it’s a pretty narrow question, which in
this case is good, it needn’t have that many answers.”
(Youth, Seattle, User)
Of
two participants who were asked if the first response option was
confusing and if it should be put at the bottom, one noted that
the first response option did not confuse them. However, the
second participant suggested that this response option should be
moved to bottom.
When
probed, it was discovered that several of the participants were
familiar with one or two of the three kinds of e-cigarettes
within option C, the majority being the refillable or
rechargeable kind. Only four participants mentioned the tank kind
in their response. Four participants noted that the rechargeable
and refillable e-cigarettes are all the same thing, while one
participant noted that the refillable, rechargeable and tank
e-cigarettes are all the same kind.
“Because
I guess in my mind, rechargeable, refillable, tank pens are all
kinda the same. So, and I mean refillable means you can just use
the tank over and over if you own cartridges I guess. “(Youth,
Seattle, Non-User)
One
participant had only heard of the rechargeable kind; however,
after reading the question the participant understood that
rechargeable and refillable e-cigarettes are the same thing
because of the slashes between both terms in response choice C.
Thus, the inclusion of slashes was helpful in the comprehension
of the question.
Regarding
the clarity of the responses, one participant noted that response
option C was a little unclear. When probed how they would ask
about those different things, the participant noted “I
guess I would add another question with the tank kind.”
(Youth, Tampa, Non-User)
Another
suggested eliminating the word “kind” from the
branch of the question. “For the most part, but it could
be better because you don’t often answer with ‘kind.’
It could be more... like it is very broad. If you’re
trying to be more specific, you could drop kind and leave it at
rechargeable/refillable/tanks. (Youth, Tampa, User)
One
participant in Tampa noted that vaping was not in the response
option choices and asked if a vape fit in one group.
Although
only one of the youth participants selected response B, 9 of 15
youth participants could correctly defined disposable
e-cigarettes.
“It
makes me think of the e-cigarettes that you but, that they are
disposable but they only have such a certain lifespan. When they
die, you dispose of them, and you’ve got to throw them
away.” (Youth, Tampa, User)
When
prompted, one participant noted that disposables are
self-explanatory and can be disposed of after use. (Youth, Tampa,
User)
“I imagine that the
disposable kind would be more like, like you can’t change
out the cartridge like it’d just be like you buy one and
then you use that and it’s done.” (Youth, Seattle,
Non- User)
|
Suggested
Revisions to the Question
Thinking
about all types of e-cigarettes, have you used the disposable or
rechargeable/refillable/tank?
Add another question
specifically for the tank e-cigarette.
|
NYTS
2016 E-Cig Product Types Question
[ALTERNATE
WORDING FOR [6] 34.]
Thinking
about all types of vaping products, have you ever used…
1. Vaping
products that you can’t refill using bottles of e-liquid
2. Vaping
products with refillable tanks and special features
3 Vaping
products with refillable tanks and no special features
4. I
have never tried a vaping product
Findings
Of
11 participants, only 4 stated that the alternate version was
easier to answer, while other participants found the alternate
version to be confusing.
One
participant noted that the alternate version was asking an
entirely different question because the original question was
about e-cigarettes while the alternate version was about vaping
products and special features.
Another
participant noted that the original question was easier to
answer because it explained more types. “The first one,
because it explains more of the types. If I didn’t I would
just be thinking about one time.” (Youth, Tampa, User)
One
participant believed that the original question and alternate
question were the same but had different response formats. “I
think they’re both the same kind of question, just like a
different like answer type. 6B, this is more of like a complete
the sentence I guess. 6A is like actual multiple choice. But
they’re just the same question I guess, just I think they
are the same.” (Youth, Seattle, Non-User)
“I
think the first one was easier to understand because ‘have
never tried a vaping product’ was at the top.”
(Youth, Tampa, Non-User)
Several
participants lacked knowledge about special features or
temperature control, which made it difficult to select the
appropriate response option.
In Round 2, one participant
suggested changing the order position of the response option “I
have never tried a vapor product” to the first response
option (Youth, Seattle, User). Another participant liked the same
response option at the bottom of the list explaining that it
didn’t make sense with the sentence in the question
ellipse. (Youth, Seattle, Non-User)
|
Suggested
Revisions to the Question
Thinking
about all types of vaping products, have you ever used…
I
have never tried a vaping product
Vaping
products that you can’t refill using bottles of e-liquid
Vaping
products with refillable tanks and special features
Vaping
products with refillable tanks and no special features
|
Styles
2017 Dripping Questions:
[8]
DRIP1.
“Dripping”
is a method of heating electronic vapor product liquid by dripping
drops directly onto a heating element and then immediately inhaling.
Have you ever used the dripping method
to add e-liquid to your electronic vapor product?
1 Yes
2 No
3 Don’t
know/not sure
Findings
Only
one youth had heard of dripping. A second youth did not know what
it was, but also said his or her extended family member used the
dripping method.
Most
participants understood “e-liquid.” Some mentioned
“juice” or “syrup.” Several participants
knew that e-liquid contained nicotine.
One
participant explained that “your vaping product”
referred “e-cigarettes, vapes, anything with the juice in
it,” even though earlier in the interview, he or she
reported that e-cigarettes are different from vaping.
One participant incorrectly
guessed that dripping referred to refilling/changing out
e-liquid.
|
Suggested
Revisions to the Question
“Dripping”
is a method of dripping
drops of electronic vaping
product liquid directly onto the heating element inside an
electronic vaping device and then immediately
inhaling the heated vapor.
Have
you ever used the “dripping” method with your
electronic vaping device?
1
Yes
2
No
3
Don’t know / Not sure
|
Styles
2017 Dripping Questions:
[ALTERNATE
WORDING FOR [8]
DRIP1]
“Dripping”
is a method of heating e-liquid by dripping it directly onto a
heating element inside an electronic vaping product and then
immediately inhaling. Have you ever used the dripping method to add
e-liquid to your electronic vaping product?
1 Yes
2 No
3 Don’t
know / Not sure
Findings
Most
youth preferred this alternate version more than the original
version. One participant preferred the reference to “e-liquid”
in the alternate version rather than “electronic vapor
product liquid” in the original version.
A few participants did not
understand one or both versions. One of these participants
incorrectly guessed that the alternate version referred to
“adding e-liquid” and “just, globing it in
there” (Tampa, Youth, User).
|
Suggested
Revisions to the Question
Although
our primary recommendation is to use the revision above, some of
the findings pertaining to e-liquid and refilling devices may
suggest that the question should explicitly address these
factors. Therefore, we offer a second possibility for revision
that lists e-liquid instead of electronic vapor liquid and adds
an instruction to distinguish dripping from refilling. However,
we recognize that some participants may not have heard of
e-liquid, and adding more information is not necessarily
effective because participants may skip over it.
“Dripping”
is a method of dripping
drops of e-liquid
or “juice”
directly onto the heating element inside an electronic vaping
device and then immediately
inhaling the heated vapor.
“Dripping” is
different from refilling an electronic vaping device.
Have
you ever used the “dripping” method with your
electronic vaping device?
1
Yes
2
No
3
Don’t know / Not sure
|
Styles
2017 Dripping Questions:
[ALTERNATE
WORDING FOR [8]
DRIP1]
“Dripping”
is a method of heating e-liquid by dripping it directly onto a heated
coil inside a vaping product and then immediately inhaling. Have
you ever used dripping to add e-liquid to a vaping product?
1 Yes
2 No
3 Don’t
know / Not sure
Findings
Most
youth had not heard of dripping. One participant reported hearing
of people describing this method but said it was not called
“dripping.” Two youth thought they had used the
dripping method but seemed to confuse this method with merely
refilling their device. Notably, one non-user claimed to have not
heard of dripping but described the method perfectly: “I
think there’s like a coil inside the e-cigarette, when you
use it, it like, releases the liquid onto the coil…And
then the liquid evaporates and then that’s where you get
all like, the vapor.” (Youth, Seattle, Non-User)
Most
participants were at least somewhat familiar with e-liquid
although some were more familiar with the terms “juice,”
“vape juice,” or “syrup.”
Very
few participants were familiar with coils.
A
few participants preferred “electronic vapor product
liquid” rather than “e-liquid” because the
longer term is easier to visualize. This subset of participants
had not heard of e-liquid before. One participant knew the term
“e-liquid” and preferred this term over “electronic
vapor product liquid” because “e-liquid” is
less wordy.
There was little consensus as
to whether this alternate version was easier to understand than
the original version. One participant preferred the original
version but seemed to think a heating element could refer to
multiple types of heated surfaces. Another participant preferred
the original version because it better described how to fill up
the device, which is an incorrect interpretation of
dripping.
|
Suggested
Revisions to the Question
“Dripping”
is a method of dripping
drops of electronic vaping
product liquid directly onto the heating element inside an
electronic vaping device and then immediately
inhaling the heated vapor.
Have
you ever used the “dripping” method with your
electronic vaping device?
1 Yes
2 No
3
Don’t know / Not sure
|
Styles
2017 Dripping Questions:
[8]
16. New. [**ASK ONLY IF PARTICIPANT HAS USED DRIPPING]
Why
did you use the dripping method?
-
DRIP2a.
|
It
makes the flavor taste better
|
DRIP2b.
|
It
makes a stronger “hit”
|
DRIP2c.
|
It
makes a thicker cloud of vapor
|
DRIP2d.
|
I
was curious
|
DRIP2e.
|
Other
reason
|
Findings
Although
most participants had not heard of dripping, they generally
understood the response options.
Youth
thought “I was curious” would be the most likely
reason for dripping.
Participants
understood the flavor option because they generally associated
e-cigarettes and e-cigarette liquid with flavors.
“The
juice comes in, like, different flavors like strawberry. Really
wild flavors.” (Youth, Tampa, Non-user)
Some
youth associated thicker or larger clouds of vapor as being cool
or being perceived as cool.
“Most
of the reason why people use it is because, like, the smoke
coming out ... It looks cool. And, like, the bigger the better.”
(Youth, Tampa, User)
Participants
understood the answer choice “stronger hit.”
One
youth who had used the dripping method explained why he had used
it:
“Uh,
I, I was just kinda curious. My friend came over with his vape,
and he was showing me how to do it, and I’m like, ‘Whoa,
that’s cool’.” (Youth, User, Tampa)
Another
participant referenced a reason for dripping would be for the
flavor, a stronger hit, and to do tricks.
“Uh,
well, it makes,
it does make the flavor taste better. It’s just stronger,
more potent. It makes a stronger hit, so it’s harsher…
And it makes
it thicker uh vapor to where it’s clouds and you can do
tricks with them.” (Youth, Seattle, User)
|
Suggested
Revisions to the Question
|
Image
Activity
Have
you ever seen any of these products? Are there any that you’ve
never seen?
What’s
the difference between these products [point to disposables,
cartridges, and tanks as you ask this]?
Are
we missing any products in this picture?
Findings
All
participants could answer this question about products without
difficulty. When probed during Round 1 on which products
participants have seen that were not on the list, one participant
noted the big hookah and another noted sticks mods.
Five
participants clearly recalled seeing all the electronic vaping
products in the picture. Most participants noted seeing the tank
and disposable products.
Participants
identified gas stations as the top response for locations where
they have seen or purchased electronic vaping products. Other
responses included around school, smoke shops, vape shops, and
online.
Many
of the participants found the picture of electronic vaping
products helpful.
“Yeah.
Because it explains and it shows the different types of vapes
and the difference between vapors, e-cigs, and hookahs.”
(Youth, Tampa, User)
While
looking at the picture several of the participants were able to
recognize and differentiate some of the electronic products by
size (e.g., tanks).
Three
participants noted seeing kids at or around school with
electronic vaping products.
“Yeah,
for e-cigarettes and vaping, they use the tanks, not really
cartridge systems. ..It’s bad that they look like
cigarettes, they light up on the end. They call cigarettes
cancer sticks.” (Youth, Tampa, Non-User)
Of
four participants, two did not know the difference between an
e-hookah and a regular hookah. The two participants that knew the
difference correctly stated that e-hookah was smaller than the
regular hookah.
“Well
obviously, like it’s in a smaller thing, so, and the other
hookah is like big and stuff, I’ve seen like videos and
stuff.” (Youth, Seattle, User)
|
Suggested
Recommendations
|
question-by-Question findings: adults
BRFSS
E-Cig Question:
The
next 2 questions are about electronic cigarettes and other electronic
“vaping” products containing nicotine. Do not include
Marijuana.
Electronic
cigarettes (e-cigarettes) and other electronic “vaping”
products include electronic hookahs (e-hookahs), vape pens, e-cigars,
and others. These products are battery-powered and usually contain
nicotine and flavors such as fruit, mint, or candy.
Findings
Most
adults had heard of electronic cigarettes, e-cigarettes, and
electronic vaping products. One participant said the term
“e-cigarettes” is more commonly used than “electronic
cigarettes.” A few participants were not familiar with the
term “vaping.” However, two other participants said
“vaping” is a common term.
Several
participants were familiar with the term “vapes.”
Referring to vaping products, one participant said, “Most
all people I know that use it refer to them as, you know, vape
pens or devices” (Adult, Tampa, User). Most were not
familiar with mods except for one participant in Seattle who
frequently vaped using marijuana (and rarely vaped using
nicotine). “Personal vaporizers” was also an
unfamiliar term.
Some
adults had heard of mods while others had not. Few mentioned
tanks. Most adults were not familiar with e-cigars. Some had
heard of e-hookahs but a few were less familiar with this
product. In Seattle, participants were not asked specifically
about e-cigars or e-hookahs when discussing the instructions but
almost no one pointed out these products specifically in their
feedback.
Participants
were split in terms of understanding that e-cigarettes and vaping
fall under the same ENDS umbrella. Some thought e-cigarettes were
distinct from vapes, while others thought these products were
part of the same category. One participant had heard of
electronic cigarettes but not electronic vaping products; he or
she guessed that vaping products were associated with
e-cigarettes.
Several
adults put e-cigarettes and electronic vaping products in the
same category. One participant associated e-cigarettes with a
fake cigarette that is not rechargeable and said vape pens are
larger with a chamber for flavors. Another participant associated
tank systems with marijuana use and e-cigarettes with nicotine,
but understood that tank systems can also contain nicotine. Our
interpretation is that most adults understand that e-cigarettes
and vaping products all represent one electronic product category
but think e-cigarettes look like cigalikes and vaping products
look like devices other than cigalikes.
We
asked Seattle participants specifically if they noticed the
reference to nicotine in the instructions. All responded yes.
Most
adults had heard of smoking marijuana with vaping devices or
performed this behavior.
Most
adults understood the instruction “Do not include
marijuana.” For example, one participant interpreted these
instructions as meaning, “Maybe not to talk about marijuana
in my usage” (Adult, Tampa, User).
One
adult suggested changing this instruction to “Do
not include marijuana in the thought process maybe, for the rest
of the questions” (Tampa, Adult, Non-User).
Most adults did not think the
instructions should list specific product brands.
|
Suggested
Revisions to the Question
The
next two questions are about e-cigarettes and electronic vaping
products containing nicotine. Do not include marijuana when
answering these questions.
E-cigarettes
and electronic vaping products include vapes, vape pens, e-cigars,
mods, and others. These products are battery-powered and usually
contain nicotine and flavors.
|
BRFSS
E-Cig Question:
[1]
10.1
Have
you ever used an e-cigarette or other electronic “vaping”
product, even just one time, in your entire life?
1 Yes
2 No
[Go to next section]
7 Don’t
know / Not Sure
9 Refused
[Go to next section]
Findings
For
this question, we explored how easy or difficult it was for
participants to answer, how they understood the word “used”
and what substances they thought of when answering.
Adult
participants found this question to be clear and easy to answer.
Participants
understood “used” to mean putting the product to your
mouth and that it might include only one puff.
Participants
understood this question was not asking about marijuana use and
generally thought of e-cigarettes as containing nicotine,
although they were aware that not all e-cigarettes contained
nicotine.
“No
(not thinking of marijuana), the e-cigarette was specific there…
it’s very clear that it e-cigarettes, nicotine products,
not marijuana.”
Some participants thought that
if the question had just referenced electronic vaping products,
it could have been confusing about whether the question was
referring to nicotine or marijuana.
|
Suggested
Revisions to the Question
|
BRFSS
E-Cig Question:
[ALTERNATE
WORDING FOR [1] 10.1]
Have
you ever tried a vaping product with nicotine, even just one time?
1 Yes
2 No
[Go to next section]
7 Don’t
know / Not Sure
9 Refused
[Go to next section]
Findings
An
alternate version of this question was tested during Round 2.
Many participants did not clearly understand this question to
include e-cigarettes.
A
participant who reported ever e-cigarette use but responded no to
this question explained he answered no to this question because
he imagined devices that produced large clouds were separate from
e-cigarettes.
“I
see these people when I was back at school puffing on these
things. They blow big clouds of smoke out and they keep doing
it. I’m just like, wow, that’s a little harsh. It
just looks like they’re getting too much smoke or
something. It’s crazy.” (Adult, Seattle, User)
Another
participant specifically pictured “mods” when asked
this question.
“I
automatically, on this one, for some reason go more towards a
mod though. I think just because it’s more common to have
a non-nicotine cartridge for your mod than it is for, like,
e-cigs, or a cigarette, it’s supposed to be nicotine
based, so, I go right to a mod for this.” (Adult, Seattle,
User)
Although some participants
preferred this because it was shorter, it introduced confusion
around which products were included.
|
Suggested
Revisions to the Question
|
BRFSS
E-Cig Question:
[2]
10.2
Do
you
now
use e-cigarettes or other
electronic “vaping” products
every
day,
some
days,
or
not
at
all?
1 Every
day
2 Some
days
3 Not
at all
7 Don’t
know / Not sure
9 Refused
Findings
For
question 2, most participants did not find the term “now”
confusing in any way. Participants clearly answered the questions
in regard to present day and not by past actions.
Most
participants correctly differentiated between every day, some
days, and not at all. Participants that currently use
e-cigarettes or other electronic vaping products but not on an
everyday basis, proceeded to select “some days.”
A
few participants noted some areas of confusion:
“Once
again, I don’t understand the relevance of the don’t
know not sure response but with me, it would be some days.”
(Adult, Tampa, User)
“Actually
the “every day, some days,” I don’t know if it
makes a difference but to me it’d probably be more
straightforward to say ‘every day, occasionally or not at
all.’ Occasionally would seem to fit more for me because
it’s not some days. Its more of an occasion. It’s
not on a particular day that I’m just smoking that
product. Seems a little more specific than just every now or
then.” (Adult, Tampa, User)
Responses
around the interpretation of “some days” varied on an
individual basis. Although the number of days differed, most
participants understood that some days referred to a few days in
the week or in a month.
“Maybe
5 days a week, and smoke about 3 times, about 20 minutes each.
(Could some days mean something less than 5 out of 7?) Some days
means you don’t use something every day, like coffee.
There are some days I can go without smoking, I don’t get
the urge to want to smoke anything.” (Adult, Tampa, User)
“Some
days. Well I’m not like an everyday user. I just know I
like social settings or if I’m really stressed I might. So
definitely not every day for me. Cause I do it sometimes so yeah
just some days. Just doing like on the weekends, maybe 5 to 10
days out of the month. So definitely not every day use.”
(Adult, Seattle, User)
Additional
probes for the words “occasionally” and “rarely”
were included to this question during Round 2. Some participants
were about to differentiate between occasionally, some days, and
rarely while others were not. The inability to differentiate the
terms was most likely a result of using indefinite terms that
vary per personal vaping usage.
“Rarely
is the same as occasionally. Rarely means 1-2 days a week, some
days would be 3+ days a week.” (Adult, Seattle, User)
“Some
days and occasionally would be interchangeable.” (Adult
Seattle, User)
One
participant noted that to receive a correct answer, a distinction
on the definition of each term must be made.
“If
you want the correct answer from somebody, you’re going to
have to make a distinction on what it is. Is it every day just
like this one is, some days, and just occasionally and some
day’s kind of differ a little bit. Occasionally just kind
if means every weekend, or you know every other day. (Adult,
Seattle, User)
When
asked how participants would write this question any differently
participants provided the following responses.
“If
I had to write this question, I would exclude electronic and
just say somedays vape. I would also add ‘rarely’
and ‘not sure’.” (Adult, Tampa, User)
Only one participant noted
using another term, “dabbing,” besides e-cigarettes
or electronic vaping products. All other participants that noted
the original terms were clear.
|
Suggested
Revisions to the Question
|
Summer
Styles 2017:
[3]
1. New.
Have
you ever tried any of the following products, even just one time?
TOBTR1.
|
Cigarettes
|
TOBTR2.
|
Cigars
(e.g., big cigars, cigarillos, or little cigars that look like
cigarettes)
|
TOBTR3.
|
Electronic
vapor products (e.g., e-cigarettes, e-hookahs, e-cigars, e-pipes,
hookah pens, vape pens, or some other electronic vapor product)
|
TOBTR4.
|
Smokeless
tobacco (e.g., chewing tobacco, snuff, dip, snus, or dissolvable
tobacco)
|
TOBTR5.
|
Pipes
filled with tobacco
|
TOBTR6.
|
Water
pipes, also known as hookahs filled with tobacco
|
TOBTR7.
|
Some
other tobacco product
|
TOBTR8.
|
None
[SP]
|
Findings
Cigarettes,
cigars, and electronic vapor products were identified as the most
tried products, even just one time.
Most
participants noted that it was clear they could pick more than
one response. However, one participated noted that he or she did
not know participants could select more than one answer and that
the question should include “select all that apply.”
(Adult, Tampa, User)
When
asked about using the term “vapor” instead “vaping,”
most participants preferred the term “vaping.”
“Probably
vaping, because you’re actively vaping something. It just
makes more sense than ‘vapor’.” (Adult, Tampa,
User)
Five
of eight participants had never heard of vapes, mods, and
personal vaporizers. Of the three products, mods were the most
unheard of product.
“Mods
I haven’t heard of, but vapes and personalize, yes, I
have. I visualize everybody carries them around constantly.”
(Adult, Tampa, User)
Several
participants had heard of the term “smokeless tobacco”
but noted that people never use the term. Participants shared
that smokeless tobacco is commonly called “chew,”
“snus,” “snuff,” and on some on occasions
“dip.”
“People
never use the term smokeless tobacco, just use snus. I haven’t
heard a lot of people use the term smokeless tobacco, people
just call it snus. But dip is different, it is the loose cut
tobacco like Copenhagen that you put in your lip, that is
different than snus. Chewing tobacco is the same thing.”
(Adult, Seattle, User)
“Heard
it referred to as smokeless tobacco, but more commonly called
chew or chewing tobacco. Either smokeless tobacco or ‘chew/dip’
and then there is snus or snuff – generally all tobacco
you put in your mouth, but they are all different and each is a
distinct product.” (Adult, Seattle, User)
Products
that participants had not heard of included water pipes, e-pipes,
hookahs, dissolvable tobacco, other tobacco products.
Most
participants knew that water pipes and hookahs were the same
thing. One participant stated “People get caught up in the
wording. I’ve never heard anybody say water pipes”
(Adult, Tampa, User). This statement was deemed correct when one
participant in Round 2 noted he did not know the difference
between water pipes and hookahs. The wording most likely confused
the participant.
“I
don’t know the difference between water pipes and other
hookahs – I believe that as opposed to using nicotine or
any other flavored product, you can use water as another option,
like a vapor product that is using water.” (Adult,
Seattle, User)
None
of the participants had difficulty understanding the meaning of
“tried.” Participants understood “tried”
to mean using of the listed products at least one time.
“To
use it at least use it once.” (Adult, Tampa, User)
“Experimented,
not necessarily more than once. Tried it once so you’d
have an opinion about it. Either the word tried or experimented
would be fitting. Try and experiment no difference. Only
difference is you see something and you want to try it and see
what it is like. Try is like someone just offers it to you and
you didn’t want to do in advance. It just presented itself
to me.” (Adult, Tampa, User)
“Done it at least
once.” (Adult, Tampa, User)
|
Suggested
Revisions to the Question
|
Summer
Styles 2017:
[4]
8.
EVPBUY.
Where
have you ever purchased electronic vapor products (a device or
e-liquid), such as e-cigarettes, e-hookahs, e-cigars, e-pipes, hookah
pens, vape pens?
TOBGT1.
|
A
gas station or convenience store
|
TOBGT2.
|
A
drug store
|
TOBGT3.
|
A
supermarket, a grocery store, or a warehouse club
|
TOBGT4.
|
Over
the Internet
|
TOBGT5.
|
A
mall or shopping center kiosk/stand
|
TOBGT6.
|
A
vape shop or
specialty store that sells electronic cigarettes (e-cigarettes)
|
TOBGT7.
|
A
smoke shop, tobacco specialty store or tobacco outlet store
|
TOBGT8.
|
I
got them from some other person
|
TOBGT8.
|
Somewhere
else
|
Findings
The
most popular responses included smoke shops followed by gas
stations with malls and drug stores being the least popular
responses.
Of
note, several participants (users and non-users) responded with
locations where they have seen the products, not necessarily
where they have purchased them. This may be a result of asking
this question of the non-users as one participant commented, “My
choice is not there. I’ve never purchased.” (Adult,
Tampa, Non-user)
When
asked if vape shops were different than smoke shops, responses
were mixed. Those participants who said they differed shared the
reasons for the difference was in breadth of products sold and
generational differences in customers.
“I
think a smoke shop would sell e-cigarettes but a vape shop would
not sell cigarettes.” (Adult, Tampa, Non-user)
“Smoke
shop is nicotine based and a vape shop is not.” (Adult,
Tampa, User)
“Vape
shops…are strictly vape. They don’t sell
cigarettes. They advocate for not smoking. I’ve never even
seen someone smoke a cigarette outside a vape shop. They are two
different things.” (Adult, Tampa, User)
“I
would just say smoke shop or vape shop. One is electronic and
one is not…9 times out of 10 tobacco stores have both,
just a smaller selection.” (Adult, Tampa, User)
“I
don’t think the older generation [would] go to a vape
shop, whereas, the new generation won’t go to a smoke
shop.” (Adult, Tampa, User)
Several
participants shared that the two types of shops were the same.
“I
wouldn’t have thought they were two different places.”
(Adult, Seattle, User)
“I
put smoke shop and vape shop in the same category.”
(Adult, Seattle, User)
One
participant recommended the term grocery store be used in
place of supermarket and another suggested collapsing the
first two response options into one option called, “A
retail location.”
Although most participants
said the response options were complete, two suggested including
additional response options; vending machines (i.e., such as
those at casinos) and flea markets.
|
Suggested
Revisions to the Question
Where
have you ever purchased electronic vapor products (a device or
e-liquid), such as e-cigarettes, e-hookahs, e-cigars, e-pipes,
hookah pens, vape pens?
TOBGT1.
|
A
gas station or convenience store
|
TOBGT2.
|
A
drug store
|
TOBGT3.
|
A
grocery store, or a warehouse club
|
TOBGT4.
|
Over
the Internet
|
TOBGT5.
|
A
mall or shopping center kiosk/stand
|
TOBGT6.
|
A
vape shop or
specialty store that sells electronic cigarettes (e-cigarettes)
|
TOBGT7.
|
A
smoke shop, tobacco specialty store or tobacco outlet store
|
TOBGT8.
|
I
got them from some other person
|
TOBGT8.
|
Somewhere
else
|
|
Summer
Styles 2017:
[5]
12.
New.
EVPRUL.
Which
statement best describes the rules about using electronic vapor
products (e.g., e-cigarettes, e-hookahs, e-cigars, e-pipes, hookah
pens, vape pens, or some other electronic vapor product) inside your
home?
1
|
It
is not allowed anywhere or at any time inside my home
|
2
|
It
is allowed in some places or at sometimes inside my home
|
3
|
It
is allowed anywhere and at any time inside my home
|
4
|
Don’t
know/Not sure
|
Findings
Responses
were mixed and varied based on whether the participant was a
user. Users were more likely to allow use in their homes.
Several
participants said their answer would depend on whether children
were also physically present (i.e., not allowing use while
children were present).
“If
there’s children, you don’t want them to be around
vapor or anything that could be harmful.” (Adult, Seattle,
User)
“Although
I said I smoke anywhere, but [if] my daughter is home, I don’t
do it because I don’t want her to see me…that
response option is not here.” (Adult, Tampa, User)
“I
think of my friends that have kids. I think they would probably
not want you to use it if their kids were awake, but maybe if
their kids were asleep.” (Adult, Seattle, User)
Other
reasons for not allowing use in the home included if individuals
are eating or if the vape clouds get too large for individuals in
the home to see well.
A
few participants who allowed the products to be used
anywhere/anytime inside the home, explained their answer by
commenting that they did not view electronic vapor products as
harmful. These participants said they although they did allow EVP
to be used in their homes, they did not allow cigarette smoking
inside their home.
“It’s
vapes…I don’t care. I wouldn’t do a hookah
thing [inside my home.] That would put more steam in the room.”
(Adult, Tampa, User)
“It’s
allowed anywhere because it’s the same as the smoke you’ve
seen in foggers. It’s more like the nebulizers. It’s
the same thing but instead of water, its vegetable oil.”
(Adult, Tampa, User)
“If
it was like real cigarettes, there would be rules but because
it’s vape, there’s not.” (Adult, Seattle,
User)
A
few participants were confused by the wording of the response
options. For example, some were confused by the verbiage
“electronic vaping products.” Others were unclear
about the overall reference to time versus place.
“Anywhere
but not any time? So you are saying it’s allowed in my
room but not at any time?” (Adult, Seattle, User)
“[The
term] ‘Vaping’ throws me.” (Adult, Tampa,
User)
“I
don’t like smoke in my house. I don’t care what it
is. Obviously, that was confusing.” (Adult, Tampa, User)
“I don’t know.
I’m not sure if it’s asking and they’ve
already said use it.” (Adult, Tampa, User)
|
Suggested
Revisions to the Question
|
Summer
Styles 2017:
[ALTERNATE
WORDING FOR [6] 10.
New]
Have
you heard that vaping products can help people quit smoking tobacco
from any of the following sources?
HLPHR2.
|
Print
advertisement (magazine or newspaper)
|
HLPHR3.
|
Internet
(social media, a website, or blog)
|
HLPHR4.
|
Television
(show or ad)
|
HLPHR5.
|
A
healthcare provider (doctor, nurse, dentist, etc.)
|
HLPHR6.
|
Vape
shop (employee/owner, store sign, etc.)
|
HLPHR7.
|
Friend
or family member
|
HLPHR8.
|
Other
|
HLPHR9.
|
Don’t
know/Don’t remember
|
HLPHR1.
|
I
have never heard that vaping products can help people quit smoking
tobacco
|
Findings
During
Round 2, we tested an alternate version of this question.
Participants generally understood both questions to be asking the
same thing.
Many
participants preferred the alternate
question because it was shorter and more direct.
Most
participants easily understood the term vaping
products. However,
only referring to “vaping products” introduced some
confusion for at least one participant.
“I
think e-cigarettes were invented to replace the cigarette. I’m
not quite sure what the vaping thing is supposed to be doing
there…. Vaping products. Electronic vaping products…This
one (version of the question) doesn’t say anything, it
just says vaping products. That made me think, what are we
talking about.” (Adult, Seattle, User)
Most participants thought the
question would be easier to answer if it was asked as two
questions.
|
Suggested
Revisions to the Question
Consider
separating this item into two questions. A yes or no question
assessing if a survey respondent has heard that e-cigarettes can
help people quit smoking tobacco and a second question on
sources.
Considering asking about
“e-cigarettes or other electronic vaping products.”
|
Summer
Styles 2017:
[6]
10.
New.
Have
you heard that electronic vapor products (e.g., e-cigarettes,
e-hookahs, e-cigars, e-pipes, hookah pens, vape pens, or some other
electronic vapor products) can help people quit smoking tobacco from
any of the following sources?
HLPHR1.
|
I
have never heard that electronic vapor products can help people
quit smoking tobacco [SP]
|
HLPHR2.
|
Print
advertisement (such as in a magazine or newspaper)
|
HLPHR3.
|
Internet
(such as on social media, a website, or blog)
|
HLPHR4.
|
Television
(show or ad)
|
HLPHR5.
|
A
healthcare provider (doctor, nurse, dentist, etc.)
|
HLPHR6.
|
Vape
shop (employee/owner, store sign, etc.)
|
HLPHR7.
|
Friend
or family member
|
HLPHR8.
|
Other
|
HLPHR9.
|
Don’t
know/Don’t remember
|
Findings
For
this question, we tested comprehension of the question and
explored if any response options should be removed or added. We
also investigated how participants understood the term “quit
smoking.”
This
question required participants to first recall if they had heard
that e-cigarettes could help people quit smoking and then where
they had heard this. Although participants tended to reach the
correct answer, responding frequently required participants to
re-read the question and think for longer periods of time about
what the question was asking.
A
few participants selected response options for where they assumed
people would hear that e-cigarettes would help people quit
smoking, without having heard it from that source directly.
For
example, one participant selected vape shops because she assumed
vape shops would tell customers e-cigarettes help people quit
smoking to increase sells though she, herself, had never been to
a vape shop.
Some
participants thought the option “I have never heard…”
should be the last response option. It was confusing to read the
“I have never heard” first after the question asked
about sources of information.
Participants
understood “quit smoking tobacco” to include all
tobacco products.
“All
of it. No snuff, no chewing tobacco, no tobacco period.”
(Adult, Tampa, Non-user)
Some
participants based their belief that e-cigarettes could help
people quit smoking or cut back on smoking from their own
personal experiences.
“It
actually helped me, so I would go with um, I don’t see
myself (as a response option). So maybe other or myself. Just
because I don’t go out as, as much because of the heat
index, and like I haven’t totally quit cigarettes, but
I’ve noticed that since I’ve been doing the vape, my
packs definitely last a lot longer.” (Adult, User, Tampa)
“Yeah, I would say so
the other (response option) would be me, because I’m, I’m
actually experimenting. When I moved down here, I was smoking a
lot. At work. And then I went from just work to my house and then
when I was going out, so I was like, okay, this is getting out of
hand. Because I have a kid, I don’t like smoking around
her. So then, um, I vape every now and then which is, I feel,
better for me.” (Adult, Tampa, User).
|
Suggested
Revisions to the Question
Consider
separating this item into two questions. A yes or no question
assessing if a survey respondent has heard that e-cigarettes can
help people quit smoking tobacco and a second question on
sources.
Consider
moving the response option “I have never heard…”
to the bottom.
Consider adding “from
personal experience” as a response option.
|
styles
2017 Heat-Not-Burn Tobacco Questions:
[7]
17.
New.
“Heat-not-burn”
tobacco products heat tobacco sticks or capsules to produce an
aerosol or “vapor.” They are different from electronic
vapor products such as e-cigarettes, which heat a liquid to produce
an aerosol or “vapor.” Some brands of “heat-not-burn”
tobacco products include iQOS, glo, Ploom TECH, and Revo. Before
today, have you heard of “heat-not-burn” tobacco
products?
1 Yes
2 No
3 Don’t
know/Not sure
Findings
The
majority of participants had not heard of heat-not-burn tobacco
nor capsules or sticks. The two participants who said they did
hear of it, did not recognize the brands. Two other were unsure
if they had heard of it.
“Yeah, I know what they
are talking about. I recognize this brand glo but I wouldn’t
know that it was heat-not-burn.” (Adult, Seattle, User)
Participants
found the question confusing and they disliked the term,
“heat-not-burn” saying it was “a mouthful,”
and something “a doctor would say.” They commented
there should be a different name for it. One participant said it
was the same as dabbing marijuana.
“The word itself is
weird. There should be a different word for it.” (Adult,
Tampa, User)
“It’s a mouthful
to say, ‘heat-not-burn.’ Then naming the products is
a mouthful.” (Adult, Tampa, User)
“[The] only word I know
on that is vapor. Everything else is confusing.” (Adult,
Tampa, User)
Use
of the term aerosol was a bit disconcerting for some and few said
it reminded them of hair spray.
“The aerosol part is
kinda scary.” (Adult, Tampa, User)
“I’m picturing a
hair spray can or a bug spray can. It doesn’t sound too
appealing to me.” (Adult, Tampa, User).
“May be close but two
totally different words. Aerosol makes me think of spray and
vapor is liquid turning into smoke or steam.” (Adult,
Seattle, User)
Acceptability
regarding the use of the term “cloud” varied.
“No, you don’t
call it a cloud. I’ve never heard of anyone call[ing] it
anything other than a vapor.” (Adult, Seattle, User)
“Some people think it’s
cool to refer to it as a ‘vape cloud.’”
(Adult, Seattle User)
“I would call it vapor
in a social setting. I am sure there is a scientific difference
between aerosol and vapor if I am talking about these products
but I don’t care about science.” (Adult, Seattle,
User)
“Never heard of anyone
refer to the cloud as an aerosol or vapor. They just call it
smoke.” (Adult, Seattle, User)
|
Suggested
Revisions to the Question
|
Styles
2017 Dripping Questions:
[8]
DRIP1. ORIGINAL WORDING
“Dripping”
is a method of heating electronic vapor product liquid by dripping
drops directly onto a heating element and then immediately inhaling.
Have you ever used the dripping method
to add e-liquid to your electronic vapor product?
1 Yes
2 No
3 Don’t
know / Not sure
Findings
Most
adults had not heard of dripping, including some ENDS users.
Two
ENDS users had used the dripping method and provided the correct
description of this method. One of these adults reported that
“packing” is another term for “dripping.”
Some adults seemed to confuse
dripping with refilling in both the alternate version and the
original version.
|
Suggested
Revisions to the Question
|
Styles
2017 Dripping Questions:
[ALTERNATE
WORDING FOR [8]
DRIP1]
“Dripping”
is a method of heating e-liquid by dripping it directly onto a
heating element inside an electronic vaping product and then
immediately inhaling. Have you ever used the dripping method to add
e-liquid to your electronic vaping product?
1 Yes
2 No
3 Don’t
know / Not sure
Findings
Most adults preferred this
alternate wording to the original wording because, as they
reported, it was more streamlined, sounded better, more specific,
and more concise and straightforward.
|
Suggested
Revisions to the Question
We recommend revising the
dripping item to be more concise. Our suggested revision, which
combines the findings from the original version, this Round 1
alternate version, and the Round 2 alternate version, is shown
below.
|
Styles
2017 Dripping Questions:
[ALTERNATE
WORDING FOR [8]
DRIP1]
“Dripping”
is a method of heating e-liquid by dripping it directly onto a heated
coil inside a vaping product and then immediately inhaling. Have
you ever used dripping to add e-liquid to a vaping product?
1 Yes
2 No
3 Don’t
know / Not sure
Findings
Most
participants preferred the original version to this alternate
version because they said the description was easier to
understand. However, one frequent user of marijuana in vaping
devices thought the original wording—without the reference
to coils—sounded like the dabbing method with THC (i.e.,
dripping drops onto a heating element).
One
participant preferred the reference to “electronic vapor
product liquid” rather than “e-liquid” because,
as he or she reported, e-liquid is for e-cigarettes
rather than vaping.
Despite
participants’ affinity toward this version, responses were
usually incorrect. Although most adults were not familiar with
dripping, they selected “No” rather than “I
don’t know.” Two adults selected “Yes”
but one of these participants did not seem to know what dripping
was. He or she said, “That’s
where you get the various flavors.” (Adult, Seattle,
Non-User)
A
few adults thought they knew of the dripping method but described
it incorrectly. Another thought the method was like making drip
coffee. Most adults, however, did not seem to understand dripping
even after reading the description in the question.
One
adult thought “dripping” and “dabbing”
were synonymous. (Note, this participant is in addition to the
participant above who said that the original wording sounds like
it refers to dabbing.)
Most
adults were not familiar with coils.
Most
adults recognized the term “e-liquid” but “juice”
was more widely used. A few adults mentioned “e-juice,”
“syrup,” or “drops.” One participant who
frequently smoked marijuana through vaping devices reported that
juice refers to nicotine, while oils refers to marijuana.
Adults were split in terms of
thinking that all e-liquid contains nicotine. A few thought some
e-liquid contains nicotine and some does not. A few did not know
what e-liquid was made of but associated it with “flavors.”
Two adults confirmed that e-liquid contains nicotine.
|
Suggested
Revisions to the Question
We
recommend applying similar revisions to the adult dripping item
as we did for the youth dripping item. However, given that
e-liquid and juice were highly recognized among adults, the adult
version of the question could potentially list these terms, as
show below:
“Dripping”
is a method of dripping
drops of electronic vaping
product liquid (e-liquid or e-juice) directly onto the heating
element inside an electronic vaping device and then immediately
inhaling the heated vapor.
Have
you ever used the “dripping” method with your
electronic vaping device?
1
Yes
2
No
3
Don’t know / Not sure
|
Styles
2017 Dripping Questions:
[9]
16. New. [**ASK ONLY IF PARTICIPANT HAS USED DRIPPING]
Why
did you use the dripping method?
DRIP2a.
|
It
makes the flavor taste better
|
DRIP2b.
|
It
makes a stronger “hit”
|
DRIP2c.
|
It
makes a thicker cloud of vapor
|
DRIP2d.
|
I
was curious
|
DRIP2e.
|
Other
reason
|
Findings
For
this question, we explored if participants understood the
response options and asked participants familiar with the
dripping method if any reasons for dripping were missing.
During
the first round, the second response option was tested in its
original wording “It makes a stronger throat hit.”
Some adult participants found this wording to be odd and
suggested removing the word throat.
“It
makes a stronger throat hit is kind of, um, weird. We do use the
word hit, though, when we just say hits better, like if it’s
stronger.” (Adult, Tampa, User)
One
participant who was very familiar with the dripping method
thought that the current response options covered the reasons he
and his friends had used the dripping method.
“Me,
myself, personally, it would be first three. The dripping is
almost, you get this almost the same hit as you do as you taking
a drag off of a cigarette. And you can make it stronger by
turning it, turning up the amperage, or turning it down if you
want a weaker hit.” His top choice was thicker cloud of
vapor because “You can actually do tricks with the vapor.
Blow rings out ... I can, I can blow rings. But my friends can
blow rings, they can blow a ring inside that ring, it actually
looks like a jellyfish.” (Adult, Tampa, User)
Participants were asked if the
question should ask: “What is the main reason you drip?”
All participants understood the meaning to be the same but some
participants preferred this phrasing because they felt it sounded
more open and “less accusatory.”
|
Suggested
Revisions to the Question
Remove
the word throat from the second response options so that it
reads: It makes a stronger “hit.”
Consider
adding a response option “To do tricks with clouds of
vapor.”
Consider revising the question
to “What are the reasons you use the dripping method?”
|
Image Activity
Have
you ever seen any of these products? Are there any that you’ve
never seen?
What’s
the difference between these products [point to disposables,
cartridges, and tanks as you ask this]?
Are
we missing any products in this picture?
Findings
Several
participants had seen all the products in the image activity
picture, while many others identified with seeing the disposable,
cartridge, and tank systems.
A
few participants noted “hookah pipes” and “hookahs”
as a missing product in the picture. Another participant
described a product that appeared to be missing but did not know
the specific name.
“There
is a Buse one that as a thicker barrel to it and the top is a
little different, but that is the only one that may be missing.”
(Adult, Seattle, User)
One
participant said “the pictures need to be more clear.
Because it’s hard to tell with them separated, they all
kind of look like the normal stuff you see so I can’t
really picture anything that’s missing.” (Adult,
Seattle, User)
“Maybe
the hookah product is missing, no pictures of hookah, so a few
missing.” (Adult, Tampa, User)
Only
a few participants could differentiate between the mechanical mod
and regulated mod. The participants who did respond noted
differences in tank size.
“The
black square one looks like it holds more juice than the others
because the tank is bigger.” (Adult, Tampa, User)
“Maybe
this one has a bigger tank.” (Adult, Tampa, User)
Several
participants noted that picture should be included along with the
survey questions.
“Yes, it would be
helpful, pictures are always worth a thousand words.”
(Adult, Tampa, User)
|
Suggested
Recommendations
|
global findinGs and CONCLUSIONS
Based on the research findings, we
present the following key conclusions:
In general, participants
understand most questions and if a question is unclear, they are
able to determine their answer based on the available wording.
However, there could be misperceptions as to what the question is
referencing. For example, with respect to e-hookahs versus hookahs.
Images and graphics may help to clarify which devices the questions
are referring to.
Participants appreciate the
definitions the questions provide but find the definitions more
useful when they are presented towards the end of the question or as
an additional separate question (i.e., one that follows a question
assessing knowledge such as have you heard of x or do you use y).
Vaping, although a commonly
accepted term, has a wide breath of definitions and misperceptions
exist as to which products contain nicotine. Youth generally
perceive e-cigarettes as a product used by adults and vaping is
often done socially for tricks and sport.
Few participants have heard of
dripping and heat-not-burn. Dripping was occasionally confused with
marijuana dabbing. We recommend questions clarify if and when they
are asking about marijuana usage versus tobacco usage.
One notable difference by city
was that youth in Tampa were more
familiar with vaping marijuana than in Seattle. This may be because
marijuana use remains illegal in Florida.
Below in Exhibit 2, we present a list
of the original and subsequent revised questions.
Exhibit
2. Summary of Recommended Changes
Recommendations for Youth Survey Questions
BRFSS
E-Cigarette Question Instructions
Original
instructions:
The
next 2 questions are about electronic cigarettes and other electronic
“vaping” products containing nicotine. Do not include
Marijuana.
Electronic
cigarettes (e-cigarettes) and other electronic “vaping”
products include electronic hookahs (e-hookahs), vape pens, e-cigars,
and others. These products are battery-powered and usually contain
nicotine and flavors such as fruit, mint, or candy.
Recommended
revised instructions:
The next
two questions are about e-cigarettes and electronic vaping products
containing nicotine. Do not include marijuana when answering these
questions.
E-cigarettes
and electronic vaping products include vapes, vape pens, e-cigars,
mods, and others. These products are battery-powered and usually
contain nicotine and flavors.
BRFSS
E-Cigarette Ever Use Question
Original
survey question:
Have
you ever used an e-cigarette or other electronic “vaping”
product, even just one time, in your entire life?
1. Yes
2. No [Go to next
section]
7. Don’t know
/ Not Sure
9. Refused [Go to
next section]
Recommended
revised survey question:
Have
you ever used an e-cigarette or other electronic “vaping”
product, even just one time?
1. Yes
2. No [Go to next
section]
7. Don’t know
/ Not Sure
9. Refused [Go to
next section]
BRFSS
E-Cigarette Current Use Question
Original
survey question:
Do
you now use e-cigarettes or other electronic “vaping”
products every day, some days, or not at all?
1.
Every day
2.
Some days
3.
Not at all
7.
Don’t know / Not sure
9.
Refused
Recommended
revised survey question:*
Do
you now use e-cigarettes or other electronic “vaping”
products every day, some days, or not at all?
1.
Every day
2.
Some days
3.
Not at all
9.
Refused
*
Rarely was included in the adult recommendation for this question.
While youth participants preferred rarely but there was variation in
how they defined it so it was not included in the recommendation.
NYTS
2017 Marijuana Question [Question 34]
Original
survey question:
Have
you ever used marijuana, marijuana concentrates, marijuana waxes,
THC, or hash oils in an e-cigarette?
A. I have never
used an electronic product
B. Yes
C. No
Recommended
revised survey question:
Have you ever used
an electronic cigarette or electronic vaping device to use marijuana?
A. Yes
B. No
NYTS
2017 E-Cigarette Source Question [Question 32]
Original
survey question:
During
the past 30 days, where did you get or buy the e-cigarettes that you
have used? (Select one or more)
1. I have never
tried an e-cigarette in the past 30 days
2. A gas station or
convenience store
3. A grocery store
4. A drugstore
5. A mall or
shopping center kiosk/stand
6. On the Internet
7. A vape shop or
other store that only sells e-cigarettes
8. Some other place
not listed here
9. From a family
member
10. From a friend
11. From some other
person that is not a family member or a friend
Recommended
revised survey question:
Where
did you get or buy the vaping products you have used, including
e-cigarettes? (Select one or more)
1. A
gas station or convenience store
2. A
grocery store
3. A
drugstore
4. A
mall or shopping center kiosk/stand
5. On
the Internet
6. A
vape shop or other store that only sells e-cigarettes
7. From
a family member
8. From
a friend
9. Some
other place / some other person (not a family member or a friend)
10.
I have never tried a vaping product
NYTS
2017 Reasons for E-Cigarette Use [Question 33]
Original
survey question:
What
are the reasons you have used e-cigarettes? (Select one or more)
1. I have never
tried an e-cigarette
2. Friend or family
member used them
3. To try to quit
using other tobacco products, such as cigarettes
4. They cost less
than other tobacco products, such as cigarettes
5. They are easier
to get than other tobacco products, such as cigarettes
6. Famous people on
TV or in movies use them
7. They are less
harmful than other forms of tobacco, such as cigarettes
8. They are
available in flavors, such as mint, candy, fruit, or chocolate
9. They can be used
in areas where other tobacco products, such as cigarettes, are not
allowed
10. I used them
for some other reason
Recommended
revised survey question:
What
are the reasons you have used e-cigarettes? (Select one or more)
1. I have never
tried an e-cigarette
2. Friend or family
member used them
3. To try to quit
using other tobacco products, such as cigarettes
4. They cost less
than other tobacco products, such as cigarettes
5. They are easier
to get than other tobacco products, such as cigarettes
6. I was peer
pressured into using them
7. They are less
harmful than other forms of tobacco, such as cigarettes
8. They are
available in flavors, such as mint, candy, fruit, or chocolate
9. They can be used
in areas where other tobacco products, such as cigarettes, are not
allowed
10. I used them for
some other reason
NYTS
2016 E-Cig Product Types Question [Question 34]
Original
survey question:
Thinking
about all types of e-cigarettes, have you used the disposable kind or
rechargeable/refillable/tank kind?
1. I have never
tried an e-cigarette
2. Only the
disposable kind
3. Only the
rechargeable/refillable/tank kind
4. Both the
disposable kind and rechargeable/refillable/tank kind
Recommended
revised survey question:
Thinking
about all types of vaping products, have you ever used…
1. I
have never tried a vaping product
2. Vaping
products that you can’t refill using bottles of e-liquid
3. Vaping
products with refillable tanks and special features
4. Vaping
products with refillable tanks and no special features
Styles
2017 Dripping Question
Original
survey question:
“Dripping”
is a method of heating electronic vapor product liquid by dripping
drops directly onto a heating element and then immediately inhaling.
Have you ever used the dripping method to add e-liquid to your
electronic vapor product?
1. Yes
2. No
3. Don’t
know/not sure
Recommended
revised survey question:
“Dripping”
is a method of dripping drops
of electronic vaping product liquid directly onto the heating element
inside an electronic vaping device and then immediately
inhaling the heated vapor.
Have you ever used the “dripping” method with your
electronic vaping device?
1.
Yes
2.
No
3.
Don’t know / Not sure
Styles
2017 Reasons for Dripping Question
Original
survey question:
Why
did you use the dripping method?
1.
It makes the flavor taste better
2.
It makes a stronger throat “hit”
3.
It makes a thicker cloud of vapor
4.
I was curious
5.
Other reason
Recommended
revised survey question:
Why
did you use the dripping method?
1.
It makes the flavor taste better
2.
It makes a stronger “hit”
3.
It makes a thicker cloud of vapor
4.
I was curious
5.
To do tricks with clouds of vapor
6.
Other reason
E-Cigarette
Image Activity
Recommendation:
Cost
permitting, include the picture of the products in advance of asking
the survey questions.
Recommendations for Adult Survey Questions
BRFSS
E-Cigarette Question Instructions
Original
survey instructions:
The
next 2 questions are about electronic cigarettes and other electronic
“vaping” products containing nicotine. Do not include
Marijuana.
Electronic
cigarettes (e-cigarettes) and other electronic “vaping”
products include electronic hookahs (e-hookahs), vape pens, e-cigars,
and others. These products are battery-powered and usually contain
nicotine and flavors such as fruit, mint, or candy.
Recommended
revised survey instruction:
The next two
questions are about e-cigarettes and electronic vaping products
containing nicotine. Do not include marijuana when answering these
questions.
E-cigarettes
and electronic vaping products include vapes, vape pens, e-cigars,
mods, and others. These products are battery-powered and usually
contain nicotine and flavors.
BRFSS
E-Cigarette Ever Use Question
Original
survey question:
Have
you ever used an e-cigarette or other electronic “vaping”
product, even just one time, in your entire life?
1 Yes
2 No [Go to next
section]
7 Don’t know
/ Not Sure
9 Refused [Go to
next section]
Recommended
revised survey question:
No
Recommendations.
BRFSS
E-Cigarette Current Use Question
Original
survey question:
Do
you
now
use e-cigarettes or
other electronic “vaping” products
every
day,
some
days,
or
not
at
all?
1 Every day
2 Some days
3 Not at all
7 Don’t know
/ Not sure
9 Refused
Recommended
revised survey question:*
Do
you
now
use e-cigarettes or
other electronic “vaping” products
every
day,
some
days,
or
not
at
all?
1 Every day
2 Some days
3 Rarely
4 Not at all
7 Don’t know
/ Not sure
9 Refused
*Rarely
was not included in the youth version of this question. Rarely or
occasionally may be used for the adult version of this question. Both
tested equally well.
Summer
Styles 2017 E-Cigarette Point of Sale Question
Original
survey question:
Where have you ever
purchased electronic vapor products (a device or e-liquid), such as
e-cigarettes, e-hookahs, e-cigars, e-pipes, hookah pens, vape pens?
TOBGT1. A gas
station or convenience store
TOBGT2. A drug
store
TOBGT3. A
supermarket, a grocery store, or a warehouse club
TOBGT4. Over the
Internet
TOBGT5. A mall or
shopping center kiosk/stand
TOBGT6. A vape shop
or specialty store that sells electronic cigarettes (e-cigarettes)
TOBGT7. A smoke
shop, tobacco specialty store or tobacco outlet store
TOBGT8. I got them
from some other person
TOBGT8. Somewhere
else
Recommended
revised survey question:
Where have you ever
purchased electronic vapor products (a device or e-liquid), such as
e-cigarettes, e-hookahs, e-cigars, e-pipes, hookah pens, vape pens?
1. A gas station
or convenience store
2. A drug store
3. A grocery store,
or a warehouse club
4. Over the
Internet
5. A mall or
shopping center kiosk/stand
6. A vape shop or
specialty store that sells electronic cigarettes (e-cigarettes)
7. A smoke shop,
tobacco specialty store or tobacco outlet store
8. I got them from
some other person
9. Somewhere else
Summer
Styles 2017 ENDS Home Rules
Original
survey question:
Which
statement best describes the rules about using electronic vapor
products (e.g., e-cigarettes, e-hookahs, e-cigars, e-pipes, hookah
pens, vape pens, or some other electronic vapor product) inside your
home?
1 It is not allowed
anywhere or at any time inside my home
2 It is allowed in
some places or at sometimes inside my home
3 It is allowed
anywhere and at any time inside my home
4 Don’t
know/Not sure
Recommended
revised survey question:
Which
statement best describes the rules about using electronic vapor
products (e.g., e-cigarettes, e-hookahs, e-cigars, e-pipes, hookah
pens, vape pens, or some other electronic vapor product) inside your
home?
-
1
|
It is not
allowed anywhere or at any time inside my home (i.e., must
go outside to use)
|
2
|
It is
allowed in some places or sometimes inside my home (i.e.,
can use in a certain room like a basement or bedroom or can use
certain times like when no children around)
|
3
|
It is
allowed anywhere inside my home
|
4
|
It is
sometimes allowed inside my home
|
Summer
Styles 2017 Sources of Information about E-Cigarettes and Quitting
Original
survey question:
Have
you heard that electronic vapor products (e.g., e-cigarettes,
e-hookahs, e-cigars, e-pipes, hookah pens, vape pens, or some other
electronic vapor products) can help people quit smoking tobacco from
any of the following sources?
1. I
have never heard that electronic vapor products can help people quit
smoking tobacco
2. Print
advertisement (such as in a magazine or newspaper)
3. Internet
(such as on social media, a website, or blog)
4. Television
(show or ad)
5. A
healthcare provider (doctor, nurse, dentist, etc.)
6. Vape
shop (employee/owner, store sign, etc.)
7. Friend
or family member
8. Other
9. Don’t
know/Don’t remember
Recommended
revised survey question:
Have
you ever heard that electronic vapor products (e.g., e-cigarettes,
e-hookahs, e-cigars, e-pipes, hookah pens, vape pens, or some other
electronic vapor products) can help people quit smoking tobacco?
1.
Yes
2.
No
3.
Don’t know / Not sure
[Ask
if yes]
Where
have you heard that electronic vapor products (e.g., e-cigarettes,
e-hookahs, e-cigars, e-pipes, hookah pens, vape pens, or some other
electronic vapor products) can help people quit smoking tobacco?
1. Print
advertisement (such as in a magazine or newspaper)
2. Internet
(such as on social media, a website, or blog)
3. Television
(show or ad)
4. A
healthcare provider (doctor, nurse, dentist, etc.)
5. Vape
shop (employee/owner, store sign, etc.)
6. Friend
or family member
7. From
personal experience
8. Other
9. Don’t
know/Don’t remember
styles
2017 Heat-Not-Burn Tobacco Question
Original
survey question:
“Heat-not-burn”
tobacco products heat tobacco sticks or capsules to produce an
aerosol or “vapor.” They are different from electronic
vapor products such as e-cigarettes, which heat a liquid to produce
an aerosol or “vapor.” Some brands of “heat-not-burn”
tobacco products include iQOS, glo, Ploom TECH, and Revo. Before
today, have you heard of “heat-not-burn” tobacco
products?
1 Yes
2 No
3 Don’t
know/Not sure
Recommended
revised survey question:
Have
you heard of heat-not-burn tobacco products? “Heat-not-burn”
tobacco products heat tobacco sticks or capsules to produce an
aerosol or “vapor.” They are different from electronic
vapor products such as e-cigarettes, which heat a liquid to produce
an aerosol or “vapor.” Some brands of “heat-not-burn”
tobacco products include iQOS, glo, Ploom TECH, and Revo.
1 Yes
2 No
3 Don’t
know/Not sure
Styles
2017 Dripping Question
Original
survey question:
“Dripping”
is a method of heating electronic vapor product liquid by dripping
drops directly onto a heating element and then immediately inhaling.
Have you ever used the dripping method to add e-liquid to your
electronic vapor product?
1 Yes
2 No
3 Don’t know
/ Not sure
Recommended
revised survey question:
“Dripping”
is a method of dripping drops of electronic vaping product
liquid (e-liquid or e-juice) directly onto the heating element inside
an electronic vaping device and then immediately inhaling the
heated vapor.
Have
you ever used the “dripping” method with your electronic
vaping device?
1 Yes
2 No
3 Don’t
know / Not sure
Styles
2017 Reasons for Dripping Question
Original
survey question:
Why
did you use the dripping method?
1. It makes the
flavor taste better
2. It makes a
stronger throat “hit”
3. It makes a
thicker cloud of vapor
4. I was curious
5. Other reason
Recommended
revised survey question:
What
are the reasons you used the dripping method?
1. It makes the
flavor taste better
2. It makes a
stronger throat “hit”
3. It makes a
thicker cloud of vapor
4. To do tricks
with clouds of vapor
5. I was curious
6. Other reason
Image
Activity
Recommendation:
Include images throughout the surveys if budget/ survey
administration mode allows.
REFERENCES
Miles,
M. B., & Huberman, A. M. (1994). Qualitative
data analysis. Thousand
Oaks, CA: Sage Publications.
Willis,
G. B. (2005). Cognitive
interviewing: A tool for improving questionnaire design. Thousand
Oaks, CA: Sage Publications.
APPENDICES
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | DiVito, Norma |
| File Modified | 0000-00-00 |
| File Created | 2021-01-14 |
