[About the authors of this survey]

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

Questionnaire for users of the electronic cigarette
Please answer only if you have already used an electronic cigarette

  1. Your answers will help us better understand who users of electronic cigarettes are and how they use this product.
  2. To participate, you must be at least 18 years old.
  3. If you wish to, you will be invited after one, 3, 6 and 12 months to answer follow-up surveys (total 5 surveys including this one), participation is voluntary and you can stop participating at any time without having to give any explanation.
  4. Your responses will be stored in a computer file for statistical analysis, and will not be transmitted to any third party. However, the people in charge of the ethics committee and the medical research authorities in Switzerland will have the right to access the data, subject to confidentiality.
  5. We will ensure a high security level for recorded data, particularly to minimize the risk of access by hackers.  
  6. If you do not want your answers to be kept on file, please do not respond.
  7. Results of this analysis will be published in a scientific journal [see our previous articles]. This is not a market research study, the aim of this study is purely scientific.
  8. This study is independent from manufacturers and retailers of electronic cigarettes and e-liquids, and of the pharmaceutical and tobacco industries. This study is conducted by researchers at the Univerity of Geneva, it is funded by the Swiss Tobacco Prevention Fund (an agency of the Swiss Government)
  9. There are 3 pages to this questionnaire, please answer all 3 pages.
  10. The study began in October 2012 and ends in December 2014, we expect 1200 participants
  11. You can contact the principal investigator (JF Etter) for more information.  

The electronic cigarette (e-cigarette) is a device that looks like a cigarette or cigar, with a battery and an electronic system that produces a vapor that often contains nicotine.
"Vaping" means using an electronic cigarette (drawing puffs of vapor), and a "vaper" is a user of electronic cigarettes

Do you know of the electronic cigarette?
Are you currently using the electronic cigarette?
In the future, do you intend to use the electronic cigarette?
Do you currently smoke tobacco (cigarettes, cigars or pipe)?
Do you currently use smokeless tobacco (snuff or snus or chewing tobacco)?
Before you first used the electronic cigarette, were you a smoker or a user of smokeless tobacco ?   Before I first used an e-cigarette...
The first time that you ever used nicotine, in which product was the nicotine? The nicotine was...
Have you smoked any tobacco (even one puff of cigarette, cigar, pipe, etc.), or used smokeless tobacco in the past 7 days?
During the past 31 days, on how many days did you smoke or use smokeless tobacco? days / 31
How old were you when you first started to smoke daily or to use smokeless tobacco daily ? I was years old
Four questions for EX-smokers and EX-users of smokeless tobacco :

1- When did you quit smoking or stop using smokeless tobacco?

 I quit smoking or stopped using smokeless tobacco on:
Day:
Month:
Year:
2- Before you quit smoking, how many cigarettes (tobacco) did you smoke per day, on average? I smoked cig./day before I quit smoking
3- Before you quit smoking, how soon after waking up did you smoke your first cigarette of the day, usually? minutes
4- Please rate your addiction to tobacco cigarettes when you were a smoker, on a scale of 0 to 100:

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

 Addiction to tobacco cigarettes when you were a smoker (0-100)
Questions for current smokers :
(Non-smokers, please click here to continue)

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

I currently smoke cig./day (tobacco)
Usually, how soon after waking up do you smoke your first cigarette of the day? minutes
Please rate your addiction to tobacco cigarettes on a scale of 0 to 100:

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

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

Day:
Month:
Year:

Are you currently trying to quit smoking?
Are you currently trying to reduce your smoking?
Do you intend to quit smoking?
If you tried to quit smoking, are you sure that you could actually quit?
Is it likely that, in one month from today, you will have quit smoking?
If you have decided to quit smoking, have you set a quit date?
If you have, what is your target quit date? I have decided to quit smoking on:

Day:
Month:
Year:

Do your relatives / friends / collegues ask you to quit smoking?
Questions for all:
In the past 3 months, did anyone close to you quit smoking?
In the past 3 months, did a health professional (doctor, nurse, psychologist,  pharmacist, etc.)...
   ... advise you to quit smoking?
   ... help you to quit smoking?
In the past 3 months, did you call a smoking cessation telephone line?
In the past 3 months, did you visit a smoking cessation website or an online discussion forum on smoking cessation, or did you use a smoking cessation "app" for mobile device?
Are you currently using a nicotine medication? (nicotine patch, nicotine gum, tablet, inhaler or nicotine nasal spray)
Are you currently using the smoking cessation drug called bupropion (Zyban, Wellbutrin or Zyntabac)?
Are you currently using the smoking cessation drug called varenicline (Champix or Chantix)?
If you ever used any other smoking cessation medication, please indicate which one:
What smoking cessation medication did you use most?
How long did your current episode or your most recent episode of use of the medication that you just mentioned above last? It lasted
When did you last use the medication that you mentioned above? I've used  it for the last time on:

Day:
Month:
Year:

Did you ever use an electronic cigarette in place of one of the smoking cessation medications listed above ?

Questions about alcohol use (please answer even if you do not drink alcohol):
How often do you have a drink containing alcohol? (Beer, cider, wine, alcopops, other alcoholic drinks)
How many drinks containing alcohol do you have on a typical day when you are drinking?
How often do you have six or more drinks on one occasion?

Questions about cannabis use (please answer even if you do not take cannabis):

During the last 12 months, how often did you take cannabis?

Cannabis users:
During the last 30 days, on how many days did you take cannabis?

On days / 30

Cannabis users:
How many hours were you "stoned" on a typical day when you had been using cannabis?

hours "stoned"

Cannabis users:
Over the past 12 months, how often were you "stoned" for 6 or more hours?

Here are some questions about yourself:
Are you?
How old are you?
You can participate if you are AT LEAST 18 years old		 I am years old
What is your body weight ? kg + g
or
pounds
What is your height ? cm
or
feet + inches
In which country do you live?
Have you obtained a diploma which allows you to be accepted into a university?
How would you describe your household income, compared to the average income of other households in your country?

Very below average = a
A little below average = b
About the average income of other households in my country = c
A little above average = d
Very above average = e
I do not know / I do not wish to answer = x

 The income of my household:
In your household, how many people smoke (including yourself)? There are smokers in my household (myself included)
Does you spouse / partner smoke?
In your home, is smoking prohibited? In my home, smoking is ...
At your place of work, is smoking prohibited? At my workplace, smoking is ...
At work, do your colleagues smoke in your presence?
How many of your 3 closest friends smoke?
How many hours per week are you exposed to other people's tobacco smoke? hours per week
Do you currently have a smoking-related disease ?
Did a relative, friend or colleague recently have a smoking-related disease?
Do you often feel sad or depressed?
During the past month, have you often been bothered by feeling down, depressed or hopeless?
During the past month, have you often been bothered by little interest or pleasure in doing things?
Women:
- are you currently pregnant?
- are you currently trying to get pregnant?
All:
Do you know what is the legal / regulatory status of electronic cigarettes in your country?
If you do, please describe and cite relevant laws, regulations, court decisions, etc :

Also, please send us by e-mail (click here) relevant laws and regulatory texts, court decisions, etc. from your country (either as attached files or links to websites)
In your country, do you know of any associations or clubs of e-cigarette users ("vapers")? Please cite the names of the associations which you know of, including the name of their website:  1.
2.
3.
Where did you learn about this survey ? (on which website, forum, mailing list, etc.)
We would like to contact you in 1, 3, 6 and 12 months from now, to ask you a  few questions about your use of e-cigarettes and tobacco.
If you wish to participate, please indicate your first name and e-mail address.
Your participation is very important for the quality of this study.
Your e-mail address is kept strictly confidential and will not be transmitted to anyone.
E-mail:
First Name:
We would like to ask you for your postal address, for 2 reasons:
1) To collect saliva samples from participants in this survey,. Saliva samples will be used to measure cotinine (a nicotine metabolite). The samples will be used solely for the analysis of cotinine and will be destroyed after this analysis. You will receive by mail a plastic vial to collect saliva.
2) To send the follow-up questionaires on paper to those who do not answer the online questionnaire at follow-up.

If you are interested in taking part in these analyses, please indicate your name and address. Names and addresses are kept strictly confidential and will not be transmitted to anyone.
First Name:
Last Name:
Address:
Postal code:
City:
U.S. State:
Country:

Internet telephone:

Comments:

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

About the authors of this study:

Principal investigator: Jean-Francois Etter, PhD (jean-francois.etter(at)unige.ch)
is senior lecturer at the Faculty of Medicine of the University of Geneva, Switzerland. He is in charge of the Stop-tabac.ch website and is the author of numerous scientific publications, most of them on tobacco dependence and smoking cessation.
Consultant: Thomas Eissenberg, PhD
is Professor of psychology, director of the Clinical Behavioral Pharmacology Laboratory at the Virginia Commonwealth University, Richmond, VA, USA. He is the author of numerous scientific publications.

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