JMIR Publications

ABSTRACT

Background:

Numerous studies have shown that e-cigarettes have addictive potential. In a netnographic analysis we previously showed that users of e-cigarette online forums discuss experiences of addiction. However, it is unclear what makes e-cigarettes addictive apart from nicotine. In a focus group analysis, we recently identified three unique features of e-cigarettes that users linked to experiences of addiction: The pleasant taste, unobtrusiveness, and unlimited usability of e-cigarettes.

Objective:

In this study, we triangulated data from the netnographic analysis and focus group discussions to validate the previously identified features of e-cigarette addictive potential and further investigate the addictive properties of e-cigarettes.

Methods:

Drawing on a netnographic analysis of three popular German-language e-cigarette forums, we studied whether experiences of addiction were linked to specific e-cigarette features. We included 451 threads in the analysis that had been coded for addictive experiences in a previous study by our team. First, we employed a deductive analysis with pre-registered codes to find out whether the features of pleasant taste, unobtrusiveness, and unlimited usability were mentioned in relation to the addictive potential of e-cigarettes in the online forums. Second, an inductive approach was chosen to identify further possible addictive features of e-cigarettes.

Results:

The distinctive attributes of e-cigarettes highlighted in our previous work—pleasant taste, unlimited usability, and unobtrusiveness—were also found in the e-cigarette online forums. Forum participants discussed these features in connection to addictive symptoms. Furthermore, our inductive analysis uncovered nicotine dosage as an additional e-cigarette characteristic linked to experiences of addiction. The analysis revealed that nicotine doses are chosen by the users for different reasons, such as using low liquid concentrations to be able to vape continuously and thus avoid craving symptoms. Overall, we identified four different user types for dosing (high doses for intermittent or constant use, low doses for constant use and switching between high and low doses depending on the situation).

Conclusions:

Our comprehensive analysis of online forum threads revealed that users' experiences of addiction are linked to four specific features unique to e-cigarettes. Recognizing these addictive features of e-cigarettes is crucial for designing cessation programs, preventing initiation, and informing public health policies to reduce the addictiveness of e-cigarettes. Clinical Trial: Preregistration: https://osf.io/dxgya Protocol: https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-021-00682-8