Explaining the effects of electronic cigarettes on craving for tobacco in recent quitters.

OBJECTIVE: To explore how e-cigarettes attenuate craving for tobacco, in e-cigarette users who recently quit smoking.
DESIGN: Cross-sectional survey of recent quitters, Internet (French and English), 2012-2014. Participants were 374 daily users of e-cigarettes who had quit smoking in the previous two months, enrolled on websites dedicated to e-cigarettes and to smoking cessation. We measured perception that e-cigarettes attenuate craving for tobacco cigarettes, characteristics of e-cigarettes, modifications of the devices, patterns of e-cigarette use, reasons for use, satisfaction with e-cigarettes, dependence on e-cigarettes, and personal characteristics.
RESULTS: The strongest attenuation of craving for tobacco was obtained by using higher nicotine concentrations in refill liquids, modular systems (rather than unmodified devices), and high voltage batteries. The strength of the effect of e-cigarettes on craving was also associated with more intensive use (more puffs per day, more refill liquid). Stronger effects on craving were associated with satisfaction with e-cigarettes, and with reporting that e-cigarettes helped to quit smoking. Participants who reported the strongest effects on craving for tobacco were the most dependent on the e-cigarette and had the strongest urges to vape.
CONCLUSIONS: From a public health perspective, there is a trade-off between e-cigarettes that provide high levels of nicotine, high satisfaction and more effects on craving for tobacco, but may also be addictive, and e-cigarettes that contain less nicotine and are less addictive, but are also less satisfactory and less efficient at relieving craving and at helping dependent smokers quit smoking. This trade-off must be kept in mind when regulating e-cigarettes.