Comparing cigarette and e-cigarette dependence and predicting frequency of smoking and e-cigarette use in dual-users of cigarettes and e-cigarettes

Introduction: The 4-item Patient-Reported Outcomes Measurement Information System Nicotine Dependence Item Bank is a psychometrically sound measure for assessing cigarette (PROMIS) and e-cigarette dependence (PROMIS-E). We evaluated whether dual-users of cigarettes and e-cigarettes self-report experiencing different levels of dependence on each product. We subsequently examined whether cigarette and e-cigarette dependence are associated with the frequency of using each product in dual-users.

Methods: Dual-users completed an online survey in Summer 2017 (n = 326; 49.7% male, 85.3% White, mean age 38.17 [13.08] years). Measurement invariance of the PROMIS and PROMIS-E was evaluated. Mean differences in cigarette and e-cigarette dependence then were examined. The correlation between cigarette and e-cigarette dependence also was examined. Finally, one-way MANOVA was used to evaluate how cigarette and e-cigarette dependence relate to past-month frequency of e-cigarette use and cigarette smoking.

Results: The PROMIS and the PROMIS-E were scalar measurement invariant, and, on average, dual-users reported stronger dependence on cigarettes than on e-cigarettes. Cigarette and e-cigarette dependence were related, yet distinct constructs (r = 0.35), suggesting that dual-users can discriminate between dependence on each product. Stronger cigarette dependence predicted more frequent past-month smoking and less frequent past-month vaping. Stronger e-cigarette dependence predicted more frequent past-month vaping and less frequent smoking.

Conclusions: Overall, dual-users reported stronger dependence on cigarettes than on e-cigarettes. However, dependence on each product was associated with increased use of each respective product and with less frequent use of the other product. Future research using the PROMIS can evaluate how potential FDA regulations could reduce nicotine dependence across products.