[About the authors of this survey]

Institute of Social and Preventive Medicine - Faculty of Medicine - University of Geneva - Switzerland / Clinical Trials Research Unit - University of Auckland - Auckland - New Zealand

Questionnaire on the electronic cigarette
Please answer even if you have never used this product

  • Your answers will help us better understand who users of electronic cigarettes are, how this product is used, and what are the opinions of users of this product.
  • This study is independent of manufacturers and retailers of electronic cigarettes and of the pharmaceutical and tobacco industries.
  • To participate, you must be at least 18 years old.
  • Your responses are anonymous.
  • Your answers will be stored on a computer file to conduct statistical analysis. Your answers will not be transmitted to any third parties.
  • If you do not want your answers to be stored, please do not respond.
  • Results of this analysis will be published in a scientific journal [see our previous articles].
  • The study began in April 2010 and ends in December 2011, we expect 1,500 participants

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

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?
Have you ever visited a website or an online discussion forum dedicated to electronic cigarettes?
If you did, did these websites or these forums encourage you to use the electronic cigarette?
Have you ever posted a message on a discussion forum devoted to electronic cigarettes?
Do you currently smoke tobacco (cigarettes, cigare or pipe)?
During the past 31 days, on how many days did you smoke or use tobacco? days/31
Have you smoked any tobacco (even one puff of cigarette, cigar, pipe, etc.) in the past 7 days?
Are you currently trying to quit smoking or to stop using tobacco?
Are you currently trying to reduce your tobacco use?
One question for EX-smokers :

When did you quit smoking?		 I quit smoking on:
Day:
Month:
Year:
6 questions for smokers:

1 - On average, how many cigarettes (tobacco) do you smoke per day?

cig./day (tobacco)
2 - Usually, how soon after waking do you smoke your first cigarette of the day? minutes
3 - If you've already tried to quit smoking, how long did your most recent quit attempt last? It lasted:
4 - If you have gone back to smoking after trying to quit, when did you start smoking again? I started smoking again on:

Day:
Month:
Year:

5 - Do you intend to quit smoking?
6 - If you tried to quit smoking, are you sure that you could actually quit?
Questions for all:
Are you currently using a nicotine replacement medication? (patch, 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)?
Are you currently using the smoking cessation drug called nortriptyline?
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 drug that you mentioned above last? It lasted
When did you last use the drug that you mentioned above? I've used  it for the last time on:

Day:
Month:
Year:

On average, during the past week, how often did you feel:

Never

Hardly ever

A few times

Several times

Many times

A great many times

Almost all the time
   Short of breath at rest?

   Short of breath doing physical activities?

   Concerned about getting a cold or your breathing getting worse?

   Depressed (down) because of your breathing problems?

In general, during the past week, how much of the time:
   Did you cough?

   Did you produce phlegm?

On average, during the past week, how limited were you in these activities because of your breathing problems:

   Strenuous physical activities (such as climbing stairs, hurrying, doing sports)?

   Moderate physical activities (such as walking, housework, carrying things)?

   Daily activities at home (such as dressing, washing yourself)?

   Social activities (such as talking, being with children, visiting friends/ relatives)?

Never

Hardly ever

A few times

Several times

Many times

A great many times

Almost all the time

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
In which country do you live?
Have you obtained a diploma giving access to the University?
What is your profession or employment status?
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:
How many people are there in your household (including yourself)? people
How many children (under 18 years) are living with you? children (<18 years)
In your household, how many people smoke (including yourself)? There are smokers in my household (myself included)
At your place of work, is smoking prohibited? At my workplace, smoking is ...
Where did you learn about this survey ? (on which website, mailing list, etc.)
Comments:

Click below to send your answers and, for e-cig users, to continue the survey:

About the author s of this study:

Jean-Francois Etter, Dr. Polit Sci
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.

Dr Chris Bullen, MD
is director of the Clinical Research Unit of the University of Auckland, New Zealand. He directed numerous research projects and has authored numerous scientific publications.

[Created by JF Etter, 11.04.2010]