THE PERCEPTION, PSYCHOLOGICAL EFFECTS, AND CESSATION

OF E-CIGARETTES AMONG COLLEGE STUDENTS

____________

A Thesis

Presented

To the Faculty of

California State University Dominguez Hills

____________

In Partial Fulfillment

of the Requirements for the Degree

Master of Arts

In

Clinical Psychology

____________

by

Michelle Kang

Spring 2019
 I dedicate this to my mother and father, who are my motivation to be successful in life.

Without them I would not be here. Thank you for all the love and support you have given

me since day one. My mother Sook Kang and father Sei Chong Kang.

ii
 ACKNOWLEDEGMENTS

I would like to thank my thesis chair and mentor, Dr. Carl Sneed and my committee, Dr.

Keisha Paxton and Dr. Philip Vieira. Their participation and input greatly improved my

thesis.

Thank you to my colleagues, Bryant Portillo, Christopher Odudu, Logan Baughman, and

Andrew Soto from Dr. Carl Sneed’s research lab who greatly assisted in this research.

Further, I would like to acknowledge CSUDH PEGS: Graduate Writing Institute for

Excellence in strengthening my research and writing skills.

Lastly, I would like to show my gratitude to the faculty from the Psychology Department

who helped me grow and fill in the knowledge of clinical psychology.

iii
 TABLE OF CONTENTS

PAGE

DEDICATION .................................................................................................................... ii

ACKNOWLEDEGMENTS ............................................................................................... iii

TABLE OF CONTENTS ................................................................................................... iv

LIST OF TABLES ............................................................................................................. vi

ABSTRACT ...................................................................................................................... vii

CHAPTER

1. INTRODUCTION ............................................................................................................ 1

Background ................................................................................................................ 2
Problem Statement ..................................................................................................... 8
Purpose of the Study................................................................................................... 8
Research Questions and Hypotheses .......................................................................... 9
Definition of Terms .................................................................................................. 10

2. REVIEW OF THE LITERATURE ................................................................................ 11

Introduction ............................................................................................................. 11
E-Cigarettes and the Perception of Safety .............................................................. 12
Conventional Cigarette Users’ Perceptions on E-Cigarettes .................................. 15
Non-Smokers Unfavorable Opinions of E-Cigarettes ............................................ 18
Opinions of Friends and Family ............................................................................. 21
Stress and the Use of E-Cigarettes and Conventional Cigarettes ........................... 24
Self-Esteem and the Use of E-Cigarettes and Conventional Cigarettes ................. 27
Cessation to Vape or Smoking ................................................................................ 29

iv
CHAPTER PAGE

3. METHODOLOGY ........................................................................................................33

Participants .............................................................................................................33
Measures ................................................................................................................34
Data Analysis Procedure ........................................................................................35

4. RESULTS ......................................................................................................................39

Preliminary Analyses Regarding Sample Characteristics......................................39

Perceptions of E-Cigarettes Between Various Groups ..........................................43
Psychological Conditions and the Likelihood to Smoke .......................................45
Cessation between E-Cigarettes and Conventional Cigarettes ..............................47

5. DISCUSSION ................................................................................................................48

Perceptions of E-Cigarettes....................................................................................49
Psychological Conditions Due to Conventional Cigarettes and E-Cigarettes .......53
The Difficulties of Quitting Conventional Cigarettes versus E-Cigarettes ...........57
Limitations .............................................................................................................60
Significance of the Study to the Field of Clinical Psychology ..............................61
Recommendations ..................................................................................................62
Recommendations for Future Research .................................................................63
Summary ................................................................................................................63

REFERENCES ..................................................................................................................65

APPENDIX: SURVEY......................................................................................................79

v
 LIST OF TABLES

PAGE

1. Sample Demographic Characteristics ........................................................................39

2. Ethnic Make-Up Sample ............................................................................................40

3. Current Class Standing ...............................................................................................41

vi
 ABSTRACT

E-cigarettes have evolved since 1965 with research indicating users believing that

e-cigarettes are less harmful than their conventional counterparts. For this study, I

investigated the relationship between the perceptions of e-cigarettes and conventional

cigarettes, in relation to stress and self-esteem associated with use, the likelihood to

smoke as a result, and the cessation of conventional cigarettes than e-cigarettes.

Findings from an independent t-test showed a significant difference between e-

cigarette users and non-users in their perception of e-cigarette use. Further, there was a

significant difference of perception from non-smokers and their opinions of e-cigarette or

conventional cigarette use. Following this further, an analysis of variance found no

relationship between stress or low self-esteem and usage groups in the findings. Last, it

was found from Pearson Correlation that e-cigarette users found it more difficult to quit

using e-cigarettes compared to conventional cigarette smokers who are able to quit

smoking cigarettes.
 1
CHAPTER 1

INTRODUCTION

The use of tobacco dates back to the early 1500 BC when the Mayans burnt

tobacco leaves in religious ceremonies. During these religious ceremonies, the plant was

blessed with powers of healing (Doll, 1998; Musgrave & Musgrave, 2000). Christopher

Columbus discovered tobacco and brought it to Europe in 1482 (Brandt, 2007; Musgrave

& Musgrave, 2000), while Jean Nicot, King of France’s Consult, shipped the tobacco

plant for further research from Portugal to Paris in 1560. After this discovery, the

popularity of cigarettes began to increase amongst Europeans, as they were smoking in

alehouses, using smoking as a social tool. Tobacco had an enormous demand on growth

and sale, as most Europeans smoked tobacco as it began shaping the character of their

personalities (Brandt, 2007). By the late 16th century, the use of the plant started to

evolve in different parts of the world (Musgrave & Musgrave, 2000). It wasn’t until the

18th century that cigarette consumption increased where both men and women smoked

and doctors offered cigarettes to patients as a tool for relaxation (Doll, 1998).

As tobacco continued to evolve and the act of smoking itself was utilized as a

social tool, the adverse health effects had not yet been clearly defined. Although lung

cancer was medically recognized during the 18th century, it was not yet linked to

smoking tobacco (Proctor, 2012). In 1898, Hermann Rottmann, a medical student from

Germany, researched German tobacco workers who had been diagnosed with lung tumors

(Proctor, 2012). In 1912, physician Robert Adler noted that the incidence of abuse
 2
towards tobacco and alcohol could be malignant neoplasms of the lung yet highlighted

that this statement was not his final judgment (Proctor, 2012). Although Rottman

proposed that lung tumors could be a result of tobacco dust, Adler corrected him stating

that it was smoking that caused pulmonary tumors.

Additional research on lung cancer in relation to tobacco use has increased since

Robert Adler and Hermann Rottman first linked tobacco use to lung cancer. Tobacco use

is the leading cause of preventable casualties; nearly one in five deaths occurs as a result

of cigarette smoking (Centers for Disease Control and Prevention [CDC], 2017), and life-

long cigarette smokers have a greater chance of developing health conditions such as

malignancy, cancerous tumors, cardiovascular disease, and chronic obstructive

pulmonary disease, all leading to death (World Health Organization [WHO], 2012).

The history of cigarettes and smoking extends several centuries, starting with the

consumption of tobacco leaves to that of cigarettes. As tobacco production evolved,

tobacco companies took advantage of extending tobacco use nationwide, which gave rise

to the need for advertising in order to gain more consumers.

Background

The Federal Trade Commission (FTC) is an agency that protects consumers and

promotes competition, while monitoring the tobacco industry for the consumers’ health

and safety concerns (FTC, 2018). The FTC reported that tobacco companies spending on

cigarette advertising and promotion increased from $8.3 billion in 2015 to that of $8.71

billion in 2016 (FTC, 2018). Tobacco companies advertise in order to maximize their

brand’s popularity, while also increasing awareness of their product. There are ways that
 3
the tobacco industry advertises smoking so that their company can succeed. For example,

an actor may smoke a cigarette in a movie or television show seen by consumers,

influencing a consumer’s perception to see smoking as something cool or normal to do.

Furthermore, adolescents may witness their peers smoking and begin to view this as

acceptable or normal behavior amongst their social milieus. High school athletes often

watch professional athletes chew tobacco and end up partaking in similar behaviors.

Parental units can also influence their children to smoke, as children observe their parents

smoking and may fall victim to second-hand smoke. There are many different strategies

that tobacco companies use in advertising in order to gain popularity of tobacco and

cigarettes, while increasing sales opportunities.

Advertising for tobacco is targeted toward youth because smoking in youth is

associated with smoking as an adult (Shang, Huang, Cheng, Li, & Chaloupka, 2016;

Watkins, Glantz, & Chaffee, 2018). Youth who use tobacco products are also placed at a

higher risk for addiction and are more likely to continue using tobacco products

throughout adulthood (CDC, 2017). The CDC has identified biological and genetic

factors as to why youth may begin smoking at young ages. For example, if a mother was

smoking during pregnancy, it is likely that her child will smoke in later life. The CDC has

also highlighted that youth may be more biologically sensitive to nicotine, causing them

to become more dependent on this drug at a younger age. Additionally, if a child’s

parents were smokers, the child may grow up to smoke and will experience a higher level

of difficulty in ceasing the habit.

 4
The experience of smoking cigarettes can start at a very young age; each day,

more than 3,200 individuals under the age of 18 smoke their first cigarette (U.S.

Department of Health and Human Services [USDHHS], 2014). As a result, the tobacco

industry has successfully fulfilled their goals to expose youth to their product and

increase their interest, leading to a lifetime of smoking.

Smoking Cessation

Fortunately, there are many people who want to quit smoking cigarettes and

tobacco control policies have assisted in decreasing the number of smokers by creating

smoking laws for smoke-free areas. Thus, smokers have fewer opportunities to smoke. In

addition to mass media highlighting harmful effects of tobacco use, the creation of quit

lines and other smoking cessation programs, have emerged, including the increase of

taxes on tobacco (Levy et al., 2010). These strategies appeared to be working, as 6 out of

10 adult cigarette smokers in the United States had reported that they wanted to

completely quit smoking in 2015 (CDC, 2017). There are many resources available that

can help people quit; treatments, medications, telephone hotlines, and online counseling.

People who desire to quit may attempt evidence-based methods of quitting, such as

behavioral support or medication. Such methods may also include the use of Nicotine

Replacement Therapy. These evidence-based methods are more likely to yield successful

results, as some smokers may either quit gradually or stop abruptly (Usher,

Raiamanoharan, & West, 2014). Furthermore, studies found the relationship between

family support and smoking cessation was found to be effective in stop smoking (Scholz
 5
et al., 2016). Indeed, society is finding ways to steer people away from smoking tobacco,

which challenges tobacco companies to create new ways to lure their customers back.

Although many people have quit or attempted to quit smoking cigarettes, tobacco

companies worked against many smoking cessation programs, encouraging smokers to

maintain their addiction. To illustrate, tobacco companies have created new products that

deliver nicotine into a device called an electronic cigarette, or e-cigarette (Marcham &

Springston, 2017) Tobacco companies knew that since e-cigarettes are offered in a

variety of flavors and contemporary designs, it was bound to interest their consumers

(Seidenberg, Jo, & Ribisl, 2015).

E-Cigarettes

In lieu of the many methods of quitting tobacco, traditional smokers have also

switched to e-cigarettes. Smokers who try this device feel that e-cigarettes are a cessation

aid, while acting as a social enhancement and improving one’s health (Pokhrel, Herzog,

Muranaka, & Fagan, 2015). Studies have found that smokers find e-cigarettes as a new

pleasure, especially due to the different flavors that are offered (Measham, O’Brien, &

Turnbull, 2016). Additionally, smokers view e-cigarettes as a fun or fashionable toy

(Measham et al., 2016), unfortunately missing the important point of smoking e-

cigarettes; the health hazards of using such a device.

E-cigarettes were designed by Herbert Gilbert and patented in 1965 as a

smokeless non-tobacco cigarette (Marcham & Springston, 2017). These devices consist

of a fluid-filled reservoir which contains a tobacco-like fluid that is vaporized by a

mechanism using a battery powered device. The strength of nicotine in e-cigarettes range
 6
from 0% to 2.0%, equaling 20mg/mL, whereas a traditional cigarette contains one

milligram per cigarette (Benowitz, 2001; Cox et al., 2016). Thus, finishing one cartridge

from an e-cigarette is similar to smoking a packet of traditional cigarettes. For example,

one e-cigarette cartridge can deliver over 200 inhales, equal to one packet of traditional

cigarettes.

E-cigarettes have evolved since the original schematic was first patented. The

devices are now offered in different sizes, designs, and potency of fluid tobacco. The

first-generation e-cigarette looked similar to traditional cigarettes. For example, they

depicted a white body with a tan mouthpiece (USDHHS, 2016). Second generation e-

cigarettes were larger than a traditional cigarette, and depicted the shape of a pen,

highlighting a refillable cartridge of flavored nicotine. The third generation offered a

tank-style e-cigarette, which appeared bulkier than its former counterparts. This e-

cigarette allowed for different levels of heat intensity and was also rechargeable.

A study completed in 2012 discovered that there were more than 460 brands and

7,700 flavors of e-cigarettes (Zhu et al., 2014). Today, tobacco-like fluids come in a

variety of flavors such as strawberry, cherry, and chocolate, making the products more

favorable and marketable to consumers. E-cigarettes are referred to by a variety of names

such as e-hookahs, mods, vape pens, vape, and tank systems (CDC, 2017). Vapor is

defined as the nicotine aerosol that is generated from the device, where people typically

shorten the term vapor into vape, the action of smoking an e-cigarette (Czogala et al.,

2014). E-cigarettes produce similar effects to their plant-based predecessors, but in a

 7
different manner such as the method of smoking. Both e-cigarettes and traditional

cigarettes contain addictive nicotine and other chemicals that are harmful to one’s health.

The tobacco industry spent $6.4 million in 2011, increasing to $115 million by

2014 to advertise their products (CDC, 2017). E-cigarette companies were aware that the

media influenced youth population and were likely to fall back on heavy marketing

campaigns as they did with traditional cigarettes in the late 1920s (Cook, 2014). In fact,

e-cigarettes have become increasingly popular among youth and young adults by

delivering different flavors, appealing contemporary designs, and a misconception that e-

cigarette products are a safer alternative than traditional cigarettes. Smokers are choosing

e-cigarettes as an alternative to tobacco smoking as many users see it as a means of

bypassing the negative effects of traditional smoking. However, this is not the case, as

smoking e-cigarettes is just as harmful as smoking conventional cigarettes.

Since e-cigarettes were introduced, the CDC found an increase in the use among

youth and young adults from 2011 to 2015 (CDC, 2013; CDC, 2014). For instance, the

prevalence of e-cigarette users amongst high school students was 5% in 2011, rising to

40% in 2015. It is evident that tobacco companies have successfully introduced e-

cigarettes to the younger generation. Although government agencies inform the public

about negative health effects of e-cigarettes including nicotine addiction, developmental

effects on the brain from nicotine exposure, and psychosocial health, many users don’t

seem to care and begin or continue vaping e-cigarettes (USDHHS, 2016).

 8
Problem Statement

College students arrive on campus with a host of pressures and stressors that they

are experiencing. Studies have highlighted how college students do smoke for reasons

outside of social realms, such as relaxation, stress relief, and emotional regulation

(Delene & Brogowicz, 1990; Rosa, Aloise-Young, & Henry, 2014). The need to fit into a

new academic environment combined with a variety of social exposures encourages some

students to utilize smoking as a coping skill such as the use of conventional cigarettes and

e-cigarettes. Conventional cigarettes are generally considered more harmful than their

electronic counterparts; however, it is considered better to avoid both forms of tobacco

use (Chen, Bullen, & Dirks, 2017). Modern usage of conventional cigarettes and e-

cigarettes is associated with coping skills and certain psychological stressors. One study

demonstrated that smokers score lower on a general scale measuring well-being (Barros,

Kozasa, Formagini, Pereira, & Ronzani, 2015). Positive expectancies about e-cigarettes

were associated with quitting smoking, while negative expectancies were linked with

smokers who utilized both conventional cigarettes and e-cigarettes (Harrell et al., 2015).

Purpose of the Study

The purpose of this research was to investigate the perceptions of e-cigarettes and

conventional cigarettes amongst college students. This research also investigated the use

of e-cigarettes and conventional cigarettes in relation to stress, self-esteem, and the

likelihood to use these products. A secondary purpose to this study was to determine the

cessation towards e-cigarettes and conventional cigarettes amongst college students.

 9
Research Questions and Hypotheses

This research study was guided by seven hypotheses:

Perceptions

H1A: E-cigarette users will perceive e-cigarette use as a safer alternative of

smoking than non-users.

H1B: Conventional cigarette smokers will perceive e-cigarette use as a safer

alternative of smoking than non-users.

H1C: Non-smokers will have a less favorable opinion of e-cigarette smoking in

public places than that of their e-cigarette using counterparts.

H1D: Individuals who have family and friends who smoke conventional cigarettes

or e-cigarettes will have a less favorable opinion with e-cigarette use around them than

non-smokers who do not have friends and family who use conventional or electronic

cigarettes.

Psychological Effects

H2A: Individuals who experience high stress are more likely to use e-cigarettes or

conventional cigarettes.

H2B: Students with low self-esteem are more likely to use e-cigarettes or

conventional cigarettes.

Cessation to E-Cigarettes or
Conventional Cigarettes

H3A: It is more difficult to exclusively quit conventional cigarettes than e-

cigarettes.
 10
Definition of Terms

This study used the following terms:

Electronic Cigarettes: Electronic cigarettes are devices that have a fluid-filled reservoir

which contains a tobacco-like fluid that is vaporized by a mechanism using a battery

power (Marcham & Springston, 2017).

Conventional Cigarettes: A thin cylinder of finely cut tobacco rolled in paper for smoking

(Marcham & Springston, 2017).

 11
CHAPTER 2

REVIEW OF THE LITERATURE

Introduction

Tobacco companies have always explored new ideas and sought products that

seemed safer than regular conventional cigarettes (Trumbo & Harper, 2013). As new

products are being introduced to the market, cigarette smokers are convinced that e-

cigarettes are a safer alternative since they do not contain tobacco. E-cigarettes work by

automatically heating the liquid nicotine and other chemical compounds such as nicotine,

carbonyl compounds, and volatile organic compounds (USDHHS, 2016) via an electronic

element, then steam from the liquid nicotine and other chemicals are released which are

then inhaled and absorbed orally (Trumbo & Harper, 2013; USDHHS, 2016).

Consequently, e-cigarettes have numerous health effects to individuals who use this

device, especially among youth, young adults, and pregnant women (USDHHS, 2016).

Questions arose when e-cigarettes were introduced to the general public because many

smokers wondered if e-cigarettes were a safer alternative than conventional cigarettes as

consumers were not getting the truth about e-cigarettes from tobacco companies. Cooper,

Louisa, Harrell, and Perry (2017) completed a study that focused on e-cigarettes, where

dual users of conventional cigarettes and e-cigarettes were asked about their perception of

cigarettes. Both groups reported that they believed e-cigarettes posed lower to no harm on

their health while also believing that it was safer than smoking conventional cigarettes.

Cigarette smokers who experience undesirable consequences from smoking are more
 12
likely to use e-cigarettes for smoking cessation (Pokhrel & Herzong, 2015). The Food

and Drug Administration (FDA) has not approved e-cigarettes as a method of smoking

cessation and the U.S. Preventive Services Task Force has stated that there has not been

enough evidence where e-cigarettes are recommended for smoking cessation in adults

(CDC, 2018). If the U.S. Preventive Services Task Force, who is a group of health

experts that makes recommendations about preventive health care, has not found enough

evidence that e-cigarettes are a safer alternative, consumers must learn to understand the

safety of e-cigarette use. Recent studies have also investigated the perception of e-

cigarettes from e-cigarette users to determine if they are aware of the health risks

involved in smoking e-cigarettes.

E-Cigarettes and the

Perception of Safety

A formative study on the perceptions of e-cigarettes was completed on

undergraduate students who were specifically e-cigarette users and non-users (Case,

Crook, Lazard, & Mackert, 2016). Thirty undergraduate students were recruited for the

study and completed semi-structured interviews. The participants of this qualitative study

were non-users and were more dubious about e-cigarettes than e-cigarette smokers. E-

cigarette smokers appeared to have positive attitudes towards e-cigarette use compared to

that of their non-using counterparts. E-cigarette users also appeared to believe that the e-

cigarettes were healthier and less harmful than conventional cigarettes. When e-cigarette

users were asked why they believed it was healthier and less harmful, several themes

emerged, including that e-cigarettes contained fewer chemicals, less nicotine, and less
 13
smoke than conventional cigarettes. For example, e-cigarette users believed that there

was less smoke entering the lungs, while also perceiving that other individuals around

them were not at risk of secondhand smoke since the devices release a vapor instead of

smoke. Vapor is defined as the nicotine aerosol that is generated from the device and

inhaled by the e-cigarette smoker (Czogala et al, 2014). E-cigarette vapor contains

nicotine and other chemicals including solvents, flavorants, and toxicants that both the

smoker and people within the vicinity are exposed to (Marcham & Springston, 2017;

(USDHHS, 2016). Depending on the brand, the potency of nicotine contained in the e-

cigarette depends on whether the device is smoke indoors or outdoors. Nonusers within

the vicinity of e-cigarettes are involuntarily exposed to nicotine, albeit not toxic tobacco-

specific combustion products (Czogala et al, 2014). Therefore, it is partially true when

people believe e-cigarettes are safer than their conventional counterparts, due to e-

cigarettes not releasing toxic tobacco smoke similarly to conventional cigarettes. Lastly,

in the same study, another e-cigarette user claimed that electronic cigarettes have flavors

and lower amounts of nicotine, which appeared to increase perceptions of higher levels of

safety. In truth, the flavoring in e-cigarette is just as addictive as nicotine. A study

completed by Farasalinos, Romagna, Tsiapras, Kyrzopoulos, Spyrou, & Voudris (2013),

concentrated on the impact that flavors from e-cigarettes have on this misconception.

Flavors in e-cigarettes can be a way to distract the smoker from tasting tobacco.

Olfactory and gustatory senses in smokers can highlight pleasurable perceptions from the

flavors, including an aversion to tobacco flavor (Farasalinos et al., 2013). While e-

 14
cigarettes do not contain tobacco, there are other dangerous chemical compounds that can

mislead smokers to believe that e-cigarettes are safe.

A meta-analysis survey of e-cigarette awareness, use, and harm perception

amongst adults were studied (Xu, Guo, Liu, Lie, & Wang, 2016). This meta-analysis

found that the majority of individuals had the perception that e-cigarettes were safer than

conventional cigarettes. 37% of participants who smoked e-cigarettes, believed that e-

cigarettes were a safer alternative than conventional cigarette smokers. In addition,

current smokers demonstrated a higher interest to try e-cigarettes than former smokers

and non-smokers. Xu et al’s (2016) study purported that the lowest prevalence of

healthier perceptions of e-cigarettes were amongst current e-cigarette users. It appeared

evident that people perceived e-cigarettes to be safer than conventional cigarettes in this

study.

E-cigarette users view vaping as a safer alternative than non-users do for many

reasons. Smokers may not have been educated on e-cigarettes not being safe nor being

any healthier. Individuals who are exposed to tobacco advertisements are particularly at-

risk for attempting first time e-cigarette use without knowing the health effects (Nicksic,

Snell, Rudy, Cobb & Barnes, 2017). Tobacco advertisements are glamorized to attract

more consumers. All negative health facts on e-cigarettes are not displayed in smokeless

tobacco advertising. Furthermore, young adults are more receptive to marketing and are

more likely to have positive perceptions on e-cigarettes that they are less harmful

(Pokhrel, Fagan, Kehl & Herzog, 2015). Therefore, tobacco companies are succeeding in

marketing e-cigarettes to the public without disclosing negative health effects. Thus,
 15
without being properly educated on e-cigarettes, users are not aware of the potentially

dangerous health effects. Since these studies include statistics of individuals’ perceptions

of e-cigarettes, other studies will be reviewed to highlight reasons why conventional

cigarette smokers switch to e-cigarettes.

Conventional Cigarette Users’

Perceptions on E-Cigarettes

Since smoking tobacco is the leading cause of preventable death in the United

States (CDC, 2018), many adult cigarette smokers want to quit smoking. The National

Health Interview Survey, an annual, nationally representative, in-person survey of the

non-institutionalized United States civilian population, reported that between the years of

2000 and 2015, there had been an increase of cessation attempts (from 49.2% to 55.4%),

recent smoking cessation (5.7% to 7.4%), receipt of health professional advice to quit

smoking (52.4% to 57.2%), and the use of cessation counseling tools and/or medication

(21.9% to 31.2%). Moreover, the survey concluded that approximately three in five

adults who had ever smoked had successfully quit (Babb, Malarcher, Schauer, Asman, &

Jamal, 2017). There are several resources available to aid smokers in the cessation of

cigarettes; however, given that e-cigarettes may look more alluring and pleasant, some

tobacco smokers resort to e-cigarettes to aid in the reduction or cessation of conventional

cigarettes (Pokhrel & Herzog, 2015). Cigarette smokers are more likely to smoke e-

cigarettes instead of utilizing smoking cessation treatments that are evidenced-based

(Choi & Forster, 2013). The FDA and the U.S. Preventive Services Task Force have not

approved e-cigarettes as a smoking cessation aid (CDC, 2018). A recent study concluded
 16
that conventional cigarette smokers do believe that e-cigarettes could help them reduce or

quit conventional cigarettes. In addition, the same group of participants who were

exposed to tobacco product advertising, while receiving coupons for tobacco products,

was more likely to try e-cigarettes for the first time (Nicksic, Snell, Rudy, Cobb &

Barnes, 2017). Similarly, conventional cigarette smokers appear to have a misconception

that e-cigarettes aid in the reduction or cessation of smoking tobacco cigarettes; therefore,

their perceptions of e-cigarettes are not as negatively correlated compared to the truth of

e-cigarettes.

Volesky et al. (2016) explored the perceptions of e-cigarettes from a cigarette

smokers’ perspective, by conducting an online survey on 242 participants. The

participants were current smokers who had smoked 100 or more cigarettes in their

lifetime. The results of the survey demonstrated that current and former cigarette smokers

had positive perceptions of e-cigarettes. Three-quarters of respondents strongly agreed

that e-cigarettes aid in the cessation of conventional cigarettes, while being less harmful.

In this study, Volesky et al. (2016) concluded that cigarette users who perceived e-

cigarettes as being harmless were more likely to use e-cigarettes around other individuals.

This finding highlighted that since cigarette users perceived e-cigarettes to be safer, they

appeared comfortable enough to use e-cigarettes around others without knowing that

vapor is considered secondhand smoke and can affect others around them negatively.

Data from cigarette smokers was collected from a cohort study completed by Choi

and Forster (2013). This study revealed that participants who were current or former

conventional cigarette smokers, or dual users of e-cigarettes and conventional cigarettes,

 17
felt that they could use e-cigarettes where smoking is otherwise prohibited. The study led

by Choi and Forster (2013) to suggest that cigarette smokers had higher odds of knowing

the characteristics of an e-cigarette, whereas dual users considered e-cigarettes as a

bridging product where they only used e-cigarettes in places where conventional

cigarettes were not allowed. These studies demonstrated that cigarette smokers perceive

e-cigarettes as harmless since they are comfortable in using the device in public places

where conventional cigarettes are prohibited.

Pokhrel, Fagan, Little, Kawamoto, and Thaddeus (2013) completed a similar

study where they assessed cigarette smokers’ perceptions on attempts to cease smoking

conventional cigarettes while using e-cigarettes as a cessation aid. Participants in this

study perceived e-cigarettes as cessation aids and felt that e-cigarettes were just as

effective as FDA-approved cessation tools. Findings in this study indicated that cigarette

smokers who used e-cigarettes to quit conventional smoking habits reported to have

higher motivations to quit. Still, cigarette smokers perceived e-cigarettes positively in a

manner that increased their motivation to quit conventional cigarettes.

Studies have demonstrated that conventional cigarette smokers perceived vaping

through the use of e-cigarettes as less harmful than conventional cigarettes in many ways.

Conventional cigarette smokers appeared to perceive e-cigarettes as less harmful than

conventional cigarettes when they smoke the device in public places where tobacco

cigarettes are otherwise prohibited. In addition, e-cigarettes users had the misconception

that electronic cigarettes were effective cessation tools, even though the FDA and the

U.S. Preventive Services Task Force had not confirmed that e-cigarettes are an effective
 18
and safe alternative to conventional smoking cessation tools. In some cases, e-cigarettes

had a positive impact on the psychological effects on traditional cigarette smokers where

they felt highly motivated to quit smoking cigarettes. These studies highlighted how

conventional cigarette smokers and e-cigarette users shared similar opinions in which

they perceived e-cigarettes to be less harmful than their conventional counterparts.

Non-Smokers Unfavorable Opinions

of E-Cigarettes

There is a common misconception of the difference between vapor and smoke.

Some smokers believe that e-cigarettes are safer than conventional cigarettes due to the

device releasing vapor versus smoke (Case et al., 2016). In actuality, the aerosol in e-

cigarettes contains nicotine and heavy metals that people within the vicinity are exposed

to through second hand smoke (USDHHS, 2016; Marcham & Springston, 2017).

Whether it is vapor or smoke, non-smokers may view it as harmful; therefore, they have a

less favorable opinion about e-cigarettes when being used around them.

Martínez-Sánchez et al. (2014) completed a cross-sectional study that assessed the

attitudes toward e-cigarette use in indoor workplaces and selected public and private

venues. The study took place in Barcelona, Spain with 736 participants who were adults

currently living in the city. Results concluded that 45% disagreed with the use of e-

cigarettes in any indoor public places. Of that 45%, 52.3% were non-conventional

cigarette smokers, former cigarette smokers, never having used e-cigarettes. Non-

smokers demonstrated the highest percentages of disagreement with the use of e-

cigarettes in schools, hospitals, health care centers, and hospitality venues. The lowest
 19
percentage of disagreement for using e-cigarettes was found in private venues such as

homes and private vehicles. In contrast, the study found that the least disagreement for

the use of e-cigarettes in public and private places were among cigarette smokers and e-

cigarette users. The largest disagreement for e-cigarette use in public places was from

non-smokers; non-smokers demonstrated concern for e-cigarette use in public places

rather than private places.

Similarly, Case et al. (2014) investigated non-using e-cigarette college students

about their perceptions of e-cigarette use in public; they reported having negative or

neutral attitudes toward e-cigarettes. One participant stated that she did not have a

positive opinion on the topic but felt that any type of smoking should be prohibited on

campus. Another participant, who was also a non-user of e-cigarettes, stated that she did

not feel that e-cigarette smoking should be allowed on campus. This participant was

aware that e-cigarettes contained chemicals that were harmful to the smoker and

individuals around them; however, she completed her statement by highlighting that there

are people on campus who are fit and active, and it is not healthy for individuals to be

using e-cigarettes around the campus population. Both participants in this study appeared

to be bothered by e-cigarette use that they wanted e-cigarettes to be prohibited on

campus. They both appeared concerned about e-cigarette vapors and the impact it had on

another individuals’ exposure.

To investigate the dangers of e-cigarette vapor, a survey of 100 general

practitioners and tobacco counselors at a facility was conducted to explore their attitudes

and risk perceptions concerning e-cigarettes (Van Gucht & Baeyens, 2016). The
 20
participants had an average of more than 17 years of experience in the field, with

approximately 1% of the sample being cigarette smokers. This study demonstrated that

two-thirds of the sample agreed that e-cigarettes were harmful to individuals within the

vicinity of the vapor. Approximately 8 out of 10 respondents disagreed with allowing the

use of e-cigarettes in enclosed public places where smoking is prohibited. Additionally,

general practitioners and tobacco counselors were also aware of the health effects that e-

cigarettes pose, including the risk of cancer and how e-cigarettes are considered

carcinogenic. The participants’ perceptions on e-cigarettes were negative towards the

health risks of smokers. They discussed that e-cigarettes would cause renormalization of

smoking habits and may also be viewed as an alternative to conventional cigarettes. The

participants expressed that renormalization of e-cigarettes may lead the electronic devices

to be acceptable to youth; therefore, leading to an increase of conventional smoking.

Non-smokers appeared bothered or annoyed more by e-cigarette vapor than e-

cigarette users. Studies have found that non-smokers disagreed with e-cigarette use in

public places (Martínez-Sánchez et al., 2014). Moreover, when a non-smoker was asked

of her perception of e-cigarette use on campus, she responded by saying that she

preferred e-cigarettes to be prohibited on campus since the exposure of vapor can affect

individuals within the vicinity via second-hand smoke. Non-smokers were aware that the

aerosol of the e-cigarettes contained harmful chemicals within secondhand smoke. Due to

these perceptions, general practitioners and tobacco counselors at a health facility were

interviewed to confirm the dangers of vapor. More than half of the participants agreed

that e-cigarettes should be banned from public places (Van Gucht & Baeyens, 2016). In
 21
addition, they were aware that e-cigarettes contained harsh chemicals such as carcinogens

that lead to cancer. Overall, when health professionals agreed that e-cigarettes should be

prohibited due to second hand smoke, it was safe to say that non-smokers did not want e-

cigarette use in public because they can be negatively affected by the vapor released from

e-cigarettes.

Opinions of Friends and Family

When an individual non-smoker who has friends or family members that use e-

cigarettes, they appear to have varied perceptions of the health risks to which they are

exposed. Abu-Helalah et al. (2015), completed a cross-sectional study that explored

perceptions and attitudes toward cigarettes and hookah amongst adults in Jordan. The

study gained valuable insight from non-smokers who had family members who smoked

cigarettes and hookah in Jordan. Hookahs are water pipes used to smoke tobacco, coming

in an array of flavors similar to that of e-cigarettes, while having similar health risks as

cigarette smoking (American Lung Association, 2007). The researchers asked a total of

874 participants about accepting a family members’ smoking of hookah. The results

demonstrated that 61.7% of participants disagreed with accepting family members who

smoke hookah. In the same manner, 64.2% of participants disagreed with the statement of

accepting a family member smoking cigarettes. Attitudes of parents toward their sons and

daughters smoking were also apparent, as 80% of participants disagreed with the

statement of accepting their sons and daughters engaging in smoking cigarettes or

hookah. Even parents who smoked hookah themselves had strong disagreements about

their sons or daughters smoking hookah. In the study, when non-smokers were asked
 22
about their perception on smoking, they indicated that smoking causes early death.

Although smoking rates are high amongst Jordanians, most participants demonstrated a

significant amount of concern among family members’ smoking status, even if the

parents smoked themselves. Whether a family member smokes or not, smoking does not

appear to be acceptable and participants did not have any positive perceptions towards

smoking amongst family members.

A similar study was completed by Chen, Ho, Au, Wang, and Lam (2015) on how

secondhand smoke from cigarettes from family members at home can cause unhappiness

in children. It is known that non-smokers’ perceptions of having family members who

smoke and secondhand smoke in general is typically negative. Researchers completed a

survey where preteens shared their opinions on why secondhand smoke from cigarettes

has negative reactions. Preteens in the survey stated that secondhand smoke was

“unpleasant or gross,” had made them “coughed or chocked,” “dizzy,” and “wanted to

throw up” respectively (Lessov-Schlaggar et al., 2011). Given the negative impact of

tobacco use and the dislike of tobacco use by non-smokers, the associations of smoking

in the household and secondhand exposure in relation to family unhappiness was studied

using cross-sectional data from primary school students in Hong Kong. Results

concluded that family smoking, secondhand exposure at home, and tobacco-related

unpleasant experience were significant in the household of children exposed to cigarettes.

Children between the ages of 7 and 12 stated that it was hard to avoid the second-hand

smoke at home and hoped that the family member could eventually quit smoking.

Smoking and secondhand smoke lead to dissatisfaction in non-smoking family members

 23
for many reasons. The participants claimed that smoking and secondhand smoke caused

coughing and eye irritation, as well as the exacerbation of negative health effects when

being exposed to secondhand smoke. In addition, participants also appeared concerned

about the cost of cigarettes and how this can be a financial burden to the family.

In a similar qualitative study, a participant who had similar concerns stated, “How

can they [smokers] use money for cigarettes? It’s like taking food off the table,” (Yousey,

2007, p. 14,565). Chen et al. (2015) added that an avoidable expenditure that brings harm

may easily displease non-smoking family members. When there is an unpleasant

experience regarding a tobacco-related topic, it is evident that there is some

dissatisfaction from non-smoking family members; therefore, dissatisfaction may lead to

family unhappiness. In the same study, researchers found that homes that were not

exposed to secondhand smoke or tobacco-related products were associated with increased

family happiness. Non-smokers in the family did not experience coughing and eye

irritation due to the lack of second-hand smoke. Additionally, there was no need for

family members to be concerned about their health of being exposed to second-hand

smoke. More importantly, family members did not have to worry about the health of

smoking family members. When there are no smokers in a household, additional money

is not spent on cigarettes; moreover on food or other expenses that are important for the

family. This study demonstrated that when family members were exposed to second-hand

smoke or tobacco-related products in the household, non-smoking family members

showed dissatisfaction. Whether the dissatisfaction same from the concern of the

smokers’ health or the non-smokers’ health, the cost expense of cigarettes, or the physical
 24
negative health effects, this led to an increase in unhappiness within the family household

of smokers.

In general, non-smokers are more likely to be affected by the presence of smoke

or vapors around them than smokers. For instance, the attitude of parents whose sons and

daughters smoked in their presence bothered the parents, with the parents expressing how

it bothered them because they did not like thinking about any negative health effects

(Abu-Helalah et al., 2015). Even if the parents were smokers themselves, their sons and

daughters’ smoking was not be accepted due to their concerns of health and safety of

cigarettes. Studies have concluded that family members who smoke in the household

bring unhappiness to other family members (Chen et al., 2015). Due to non-smokers in a

household having strong perspectives on secondhand smoke and tobacco-related

products, non-smokers demonstrated a significant amount of dissatisfaction which led to

an increase of unhappiness in the house. Whether it is the aerosol from e-cigarettes or

smoke from conventional cigarettes, those who have friends and family who smoke will

be irritated with the use of tobacco-related products around them.

Stress and the Use of E-Cigarettes

and Conventional Cigarettes

Young adults may experience stress as a result of beginning college. Students

make adjustments from living with parents to moving independently, adjusting to

autonomy, experiencing changing social networks, and facing new academic challenges

that create stressful transitions into young adulthood (Filipkowski, Heron, & Smyth,

2016). Students may use conventional cigarettes or e-cigarettes to ease their stress caused
 25
by the transition to college. Since, e-cigarettes are marketed as safe and socially

acceptable, students may prefer e-cigarettes over conventional cigarettes in order to be

accepted by their peers (Berg et al., 2013). Moreover, studies have concluded that college

students are more likely to use alcohol and cigarettes in order to cope with transitional

stressors (Locke, Shilkret, Everett, & Petry, 2015).

Sa, Seo, Nelson, and Lohrmann (2013) completed a cross-sectional non-

experimental design using an online survey to assess 1,201 South Korean international

students who studied in the United States. The purpose of this study was to explore the

prevalence of cigarette smoking, differences in smoking for students living on campus or

off campus and determining future predictors of smoking amongst international students.

Results demonstrated that almost half of the respondents had smoked more than 100

cigarettes in their lifetime. Students living off campus smoked more cigarettes than

students living on campus. Students who lived off campus have more opportunities to

smoke as they transition home. Further, smoking had increased in half of the current

participants and one-fourth of the students living on campus. Stress relief was found to be

the primary reason for increased smoking amongst the students who lived off campus,

whereas students living on campus smoked to reduce body weight or to relieve

homesickness (Sa et al., 2013). In relation to the predictors of smoking, the following

themes emerged; students living off campus, students living alone, social influences,

males living in the United States living less than three years, females living in the United

States with longer duration of residence, high level of acculturative stress, moderate to
 26
high levels of anxiety and depression, and current smokers being in an environment

where a tobacco-free policy was not enforced.

This study was completed on international students who had more of a transitional

impact since they were from an overseas country. South Korean international students

appeared to already be facing particular stressors by experiencing homesickness. Another

study confirmed how international students experience stress and anxiety due to the

separation from their familiar environment; however they found effective ways to cope

with homesickness rather than smoking (Szabo, Ward, & Jose, 2016).

Park, Lee, Shearston, and Weitzman (2017) completed a study that focused on the

patterns of e-cigarette use and levels of psychological distress. Smokers with higher

levels of psychological distress were at an increased risk of e-cigarette use. Further, a

positive correlation was associated between higher levels of psychological distress and an

increased use of both e-cigarettes and cigarettes. Similar studies have been conducted

where researchers suggested that prevention interventions on mental health should

consider that cigarette use may provoke depressive symptoms (Bares, 2014). Park et al.

(2017) provided a similar suggestion stating that clinicians should be aware of mental

health issues in their patients who use e-cigarettes since they are susceptible of greater

psychological distress.

In summary, empirical studies have suggested that those with stressors are more

likely to use e-cigarettes or smoke conventional cigarettes. Studies were completed

amongst college students who had typical stressors and their way of coping with the said

stressors. Furthermore, the patterns of e-cigarette use, and levels of psychological distress
 27
were positively correlated suggesting that higher levels of psychological distress led to

the increase use of e-cigarettes.

Self-Esteem and the Use of E-Cigarettes

and Conventional Cigarettes

While previous studies have focused on stressors that individuals encounter when

smoking conventional cigarettes or e-cigarettes, a subset of studies has been completed

on the association of self-esteem and smoking. The association between stress and self-

esteem in adolescent smoking were examined (Carters & Byrne, 2013). Low stress is

likely to decrease the risk of smoking to the extent that it increases school self-esteem

among adolescents. In other words, adolescents with high stress are at risk of smoking

because their self-esteem can affect them negatively. In connection with previous studies,

college students that were trying to cope with transitional stressors were more likely to

use alcohol and cigarettes (Locke et al., 2015). Indeed, stress does not directly lead to

smoking, but rather influences one’s self-esteem, which places the individual at a higher

risk for smoking (Carters & Byrne, 2013). Students with low self-esteem are at a higher

risk for smoking in order to cope with their problems; similarly, individuals who smoke

are vulnerable to psychological distress (Park et al., 2017).

Saari, Kentala, and Mattila (2015) conducted a longitudinal cohort study on the

relationship between adolescent self-esteem and smoking. Self-esteem and smoking

habits were monitored from the ages of 16 to 29, with results indicating that adolescents

who had low levels of self-esteem were more likely to smoke as adults. It is interesting to

note that adolescent self-esteem was not associated with adolescent self-report of
 28
smoking. A similar study was completed by Joffer et al. (2014), where the authors

focused on predicting factors found in early adolescence that allowed for smoking in later

adolescence. The factors predicted smoking in later adolescence were influenced by

attitudes towards smoking, family and intrapersonal factors, gender, binge drinking,

smoking, and the use of smokeless tobacco. The study suggested that the predictive value

of attitudes and strengthening one’s self-esteem during their first six school years

influenced smoking behavior during adolescence. Saari et al. (2015) shared similar

factors that predicted smoking in later life. Both studies shared the same interest on how

self-esteem was associated with smoking. Above all, smoking amongst adolescents was

linked to self-esteem, and both studies confirmed that low self-esteem was associated

with smoking in adult life.

Researchers conducted various studies that were associated with smoking and

mental health, especially among adolescents and college students (Sa et al., 2013; Carters

& Byrne, 2013; Joffer et al., 2014; Park et al., 2014; Locke et al., 2015; Saari et al.,

2015). Mantler, Irwin, Morrow, Hall, and Mandich (2015) conducted a study related to

self-esteem and smoking with patients who attempted quitting cigarettes with the help of

a life coach, and how this effort affected the patients’ self-esteem levels. The primary

focus of this study included motivational interviewing via co-active life coaching and its

impact on smoking behaviors, personal competency, changes in perceptions of identity,

smoking, and quitting. The study also examined the effect of the intervention itself on 40

smokers between the ages of 19 and 25. Researchers randomly assigned 8 to 10

participants to intervention groups and sessions that were held for 30 minutes with a
 29
Certified Professional Co-Active Coach via telephone or online. Data was collected

during baseline, immediate post-intervention, at intervals of 3, 6, and 12-months after the

intervention. The results of this longitudinal study concluded that participants who

received interventions demonstrated decreases in smoking behaviors and greater

increases in personal competence, self-esteem, and self-efficacy. Participants’ results

improved significantly from baseline to post-intervention. Mantler et al. (2015) suggested

that applying motivational interviewing via co-active life coaching can be effective to

smokers who want to quit. In addition, this type of cessation aid can improve a patient’s

personal competence, which is a combination of self-esteem and self-efficacy.

Simultaneously, a smoker’s self-esteem can increase with the help of a cessation aid; in

the study of Mantler et al. (2015), the cessation aid was motivational interviewing via co-

active life coaching. Smokers who eliminate smoking from their daily lives have a higher

chance of increasing their self-esteem.

Cessation to Vape or Smoking

Studies have been completed that examined the level of difficulties to exclusively

quit cigarettes and e-cigarettes, to determine which product is harder to quit. Pasquereau,

Guignard, Andler, and Nguyen-Thanh (2017) conducted a longitudinal study that

determined the length of time that a smoker did not smoke or vape when attempting to

quit. Participants included 2057 individuals who identified as conventional cigarette

smokers or were dual users of both conventional and electronic cigarettes. When the

study was reassessed during a six-month follow up, results concluded some reduction in

smoking cigarettes, with some smokers switching from conventional cigarettes to

 30
electronic during the same period. Although, approximately 10% of the cigarette smokers

in this study ceased smoking cigarettes within the six-month follow-up period, including

0.8% in the group that used e-cigarettes, and 9.5% that did not use either tobacco or e-

cigarettes. In addition, 89.7% of the participants still smoked cigarettes, and 2.4% in that

group became regular electronic cigarette smokers. Furthermore, among dual users who

had previously attempted to quit, 14.5% stopped smoking cigarettes, with 9.6% of that

group quitting both cigarettes and e-cigarettes. However, it should be noted that 4.9% of

dual smokers switched to e-cigarettes. Simultaneously, 43.2% ceased smoking e-

cigarettes, and 42.3% continued to associate as dual users. Researchers concluded that

dual users were likely to make an attempt to quit, and during the time of quitting, the

number of cigarettes was reduced to half the number of cigarettes initially smoked.

Yuyan et al. (2016) studied e-cigarette smokers who had previously attempted to

quit, determining how long they successfully ceased e-cigarette smoking. A longitudinal

study assessed 5,255 participants who smoked electronic or conventional cigarettes.

Within the group, 2,454 individuals participated in the one year follow up assessment

Results showed that 21.6% were exclusive cigarette smokers who ceased smoking for

more than 30 days, while only 11% of e-cigarette smokers ceased vaping for more than

30 days. Furthermore, researchers concluded that cigarette smokers who switched to e-

cigarettes during their attempt to quit were less likely to quit electronic cigarette usage for

more than 30 days. Similar to the previous research of Pasquereau et al. (2017), cigarette

smokers who attempted to quit were more likely to switch to e-cigarettes. Those smokers

were still consuming nicotine but in a different way, which appeared no different from
 31
smoking conventional cigarettes. The Yuyan et al. (2016) study demonstrated that there

were more cigarette smokers than electronic cigarette users who ceased using the product

for more than 30 days.

Polosa, Caponnetto, Cibella, and Le-Houezec (2015) completed a pilot study that

was aimed at cigarette smokers who were provided e-cigarettes to examine whether the

number of cigarettes was reduced. The participants included 71 adult smokers at the

beginning of the survey, with 49 participants completing the 6- and 12-month follow-up.

At the six month follow up, results demonstrated that the number of cigarettes smoked

per day decreased to a mean of 24.9 to 4.0. At the 12-month follow up, the number of

cigarettes per day decreased to a mean of 2.6. Approximately 40% of participants were

successful at quitting; 25.4% reduced the number of cigarettes smoked; 33.8% kept the

habit of smoking, and 31% were unsuccessful at completing the follow up. Nevertheless,

the study highlighted that 66.2% of the participants who used e-cigarettes to help aid in

quitting smoking cigarettes were successful whether the number of cigarettes decreased,

or they ceased smoking permanently. Polosa et al. (2015) concluded that success rates of

smoking cessation appeared higher compared to those who continued smoking behaviors.

Researchers did observe the changes in nicotine strength during the time of the study, as

participants were lowering the nicotine strength from their e-cigarettes from 12 to 18

mg/mL to as low as 4 to 9 mg/mL. When nicotine dependence appeared to decrease over

time with e-cigarette use, this indicated a way for smokers to gradually cease smoking or

reduce the amount of nicotine.

 32
Previous studies examined the length of time away from cigarettes and e-

cigarettes after a smoker made an attempt to quit (Polosa et al., 2015; Yuyan et al., 2016;

Pasquereau et al., 2017). The Pasquereau et al. (2017) study concluded that dual users

were likely to make an attempt to quit, whereas it appeared harder for cigarette smokers

to quit due to switching over to use e-cigarettes. In contrast, the Yuyan et al. (2016) study

highlighted that cigarette smokers were the group that stayed away from nicotine

products for more than 30 days compared to that of their e-cigarette smoking

counterparts. Finally, the Polosa et al. (2015) study concluded that cigarette smokers had

higher successful cessation rates when e-cigarettes were used to aid in the cessation of

conventional smoking. Overall, the difficulties of quitting conventional cigarettes

appeared higher than that of electronic cigarettes. Dual users appeared more likely to

make an attempt to quit due to their use of e-cigarettes as an aid to quit smoking.

Additionally, former cigarette users who switched to e-cigarettes and e-cigarette users

found it difficult to quit. Smokers can lower the amount of nicotine in e-cigarettes but

that only indicates they are reducing the amount of nicotine and is therefore not

considered a form of quitting. Thus, without the help of e-cigarettes, cigarette smoking

appears harder to quit or reduce.

 33
CHAPTER 3

METHODOLOGY

Participants

College students were recruited from a four-year university in Southern

California. Approval for this study was obtained from the Institutional Review Board

(IRB) at California State University, Dominguez Hills. The sample consisted of 550

individuals (62% female) Demographic background was also collected and was broken

down into the following: e-cigarette users (7%), conventional cigarette users (5%), dual

users (5%), and non-user (83%). The ethnic make-up of the sample was Hispanic (n=316;

58.8%), Caucasian/White (n=70; 13%), African-American (n=51; 9.4%), and

Asian/Pacific Islander (n=51; 9.4%). The participants were recruited via Blackboard

using an online announcement. Prior to posting the Blackboard announcement, the

researcher first contacted various professors from the psychology department, requesting

permission to utilize one of their current courses for recruitment. After permission was

granted, a research assistant posted a Blackboard announcement detailing the purpose of

the study. The announcement described the study as an online survey measuring people’s

perceptions of electronic cigarettes and tobacco use. After consent was obtained, the

participants were able to complete the online survey. The survey included 273 questions

and took 30 to 45 minutes to complete. In addition, depending on the course, each

participant was provided extra credit or course credit for participating in the study if they

completed the entire survey.

 34
Respondents were asked to report demographic information, including their age,

gender, ethnicity, primary language spoken, current marital status, current employment

status, total household income, number of individuals in their household, highest level of

education completed, and current class standing within the university. Respondents were

also asked about their perception, level of stress, self-esteem, and cessation in regard to

the use of both e-cigarettes and conventional cigarettes. For example, respondents were

asked about their perception of how harmful it is breathing other peoples’ e-cigarette

smoke, whether they saw themselves as successful in either a true or false statement,

when they had last attempted to quit smoking or vaping, and the length of time they

ceased smoking from either traditional cigarettes or e-cigarettes.

Measures

Rosenberg Self-Esteem Scale

Rosenberg’s Self-Esteem Scale was used to measure self-esteem. This scale

comprised of 10 questions that were summed to obtain the final self-esteem calculation

for each subject. Each of the questions that comprised the self-esteem scale were scored

on a Likert scale of 1 to 5; 1 indicating strongly disagree, 2 indicating disagree, 4

indicating agree, and 5 indicating strongly agree.

The internal consistency reliability for the self-esteem scale was very strong, as

indicated by Cronbach’s Alpha. Cronbach’s Alpha considered any score that was high as

being reliable. In the Rosenberg Self-Esteem Scale, reliability was indicated at α=.835.
 35
Perceived Stress Scale

The Perceived Stress Scale was used to measure stress. The scale comprised of

nine questions that were summed to obtain the final stress calculation for each subject.

Each of the questions that comprised of the stress scale were scored on a Likert scale of 1

to 5; 1 indicating never, 2 indicating almost never, 3 indicating sometimes, 4 indicating

fairly often, and 5 indicating very often.

The internal consistency reliability for the perceived stress scale was strong, as

demonstrated by Cronbach’s Alpha. In the Perceived Stress Scale, the reliability was

α=.849.

Data Analysis Procedure

The following statistical tests were used to test all of the research questions and

corresponding hypotheses. All of the analyses were completed using the Statistical

Package for the Social Sciences, Version 24.

The first hypothesis evaluated the relationship between the manners of e-cigarette

users’ perceptions of smoking versus that of non-users. To test the first hypothesis, an

independent t-test was used. A t-test was completed to determine if there were differences

between the groups of e-cigarette users and non-users on the dependent variable

perception of safety. Respondents were asked how harmful they felt about breathing

another person’s e-cigarette vapor. Answers ranged from very harmful to one’s health to

not harmful to one’s health and refuse to answer.

The second hypothesis evaluated conventional cigarette users’ perceptions of

smoking. To test the second hypothesis, an independent t-test was used. A t-test was
 36
completed to determine if there were statistical differences between the groups of

conventional cigarette users and non-users in relation to the dependent variable

perceptions of the safety of e-cigarette smoking.

The third hypothesis evaluated non-smokers that have less favorable opinions that

e-cigarette users of e-cigarette use in public places. To test the third aim, an independent

t-test was used. A t-test was completed to determine if there were statistical differences

between the groups of non-users and e-cigarette users in relation to the dependent

variable of irritation. Respondents were asked how much e-cigarette vape bothered them

when in its presence. In addition, respondents were asked how likely they were to make a

face, a coughing noise, a loud comment, or some other signal to get the smoker to realize

that their e-cigarette usage bothered them when used in a non-smoking area of a public

place.

The fourth hypothesis evaluated participants who have friends and family who

smoke conventional cigarettes or e-cigarettes to determine if they have less favorable

opinions with e-cigarette use around them than non-smokers who do not have friends and

family who smoke. To test this hypothesis an independent t-test was used. A t-test was

completed to determine if there were statistical differences between the groups of friends

and family who smoke conventional cigarettes and friends and family who smoke e-

cigarettes in relation to the dependent variable of irritation. Again, respondents were

asked how much e-cigarette vape bothered them when in their presence. In addition,

respondents were asked how likely they were to make a face, a coughing noise, a loud
 37
comment, or some other signal to get the smoker to realize that e-cigarette usage bothered

them when used in a non-smoking area of a public place.

The fifth hypothesis evaluated individuals with high stress and if they were more

likely to use e-cigarettes or conventional cigarettes. To test the fifth hypothesis, a

correlation matrix with the variables non-user, e-cigarettes only, conventional cigarettes

only, and dual users was used. The stress scale was used to understand any relationships

between the variables. An ANOVA was conducted to determine if there were differences

between the groups of e-cigarette users, conventional cigarette users, dual users, and non-

users in relation to the dependent variable stress scale.

The sixth hypothesis evaluated individuals with low self-esteem and if they were

more likely to use e-cigarettes or conventional cigarettes. To test the sixth hypothesis, an

ANOVA was conducted to determine if there was a difference between the groups in

relation to the dependent variable of the Rosenberg Self-Esteem Scale.

The seventh hypothesis evaluated the relation of cessation to the length of time a

person has stayed off conventional cigarettes or e-cigarettes when attempting to quit

smoking. To test the seventh aim, a correlation matrix was completed with the variables

non-users, e-cigarettes only, conventional cigarettes only, dual users in relation to

quitting, how long they stayed off e-cigarettes, quitting, and the length of time they

ceased using conventional cigarettes This aided in better understanding the relationships

between the variables.

In addition, a two-factor mixed ANOVA was used where:

 38
1. The dependent factor was difficulty in quitting and length of time they ceased
e-cigarette use versus quitting and length of time they ceased conventional
cigarette use.

2. The independent factor is user groups (e-cigarette user, conventional cigarette

user, dual users) who answered both questions.

The test determined if there was a difference in the mean of the two questions of

quitting and length of time they ceased e-cigarette or traditional cigarette use, if there was

a difference in the mean by the independent groups (e-cigarette user, conventional

cigarette user, and dual users), and if there was any interaction between the two factors.
 39
CHAPTER 4

RESULTS

Preliminary Analyses Regarding

Sample Characteristics

Sample Characteristics

Table 1 shows sample demographics for usage groups e-cigarette users (n = 38),

conventional cigarette users (n = 26), dual users (n = 26), and non-smokers (n = 440). In

addition, the gender of the sample is listed as well.

Table 1

Sample Demographic Characteristics

Frequency Valid %

EC User 38 7.2

CC Users 26 4.9

Dual User 26 4.9

Non-User 440 83

Gender

Males 204 37.8

Females 336 62.2

The age of the total sample ranged from 18 to 62 years of age (M = 23. SD =5.9,

61% female). The average age was 23.03 years (SD = 5.9) for the usage groups. Of the
 40
550-total sample, 336 (61.1%) were females and 204 (37.1%) were males, and 10 were

not specified by the participants. Table 2 shows the ethnic make-up of the sample, which

were Hispanic (n=316; 58.8%), Caucasian/White (n=70; 13%), African American (n=51;

9.4%), Asian/Pacific Islander (n=51; 9.4%), and the rest of the ethnic population was

specified as other.

Table 2

Ethnic Make-Up Sample

Ethnicity Frequency Valid %

Hispanic 316 58.8

Caucasian/White 70 13

African-American 51 9.4

Asian/Pacific Islander 51 9.4

Table 3 shows the current class standing from the sample population. All of the

participants were in their undergraduate program except three, who were completing their

Post Baccalaureate and Master’s program. Of the undergraduate program participants,

203 (43.5%) were Juniors, 101 (21.6%) were Seniors, 100 (21.4%) were Sophomores,

and 60 (12.8%) were Freshmen.

 41
Table 3

Current Class Standing

Current Class Frequency Valid %

Junior Undergraduate 203 43.5

Senior Undergraduate 101 21.6

Sophomore Undergraduate 100 21.4

Freshman Undergraduate 60 12.8

Post 3 .6
Baccalaureate/Graduate

Regarding household income, 53.5% of the sample made less than $30,000, and

the rest (46.5%) identified a household income of $30,000 or more. Overall, this

represented the sample of demographics of college students at California State

University, Dominguez Hills.

Initial analyses were conducted to examine the equivalency of demographic

variables across the usage groups of e-cigarette users, conventional cigarette users, dual

users, and non-smokers. An ANOVA, where the dependent variable was age and the

independent variable were the usage groups, found that there were significant differences

between the groups. A one-way ANOVA was conducted with age at the dependent

variable and the usage groups as the independent variables. The analysis was significant;

Levene’s statistic showed that the assumption of homogeneity of variance was violated,

so Robust test was assessed (F-Welch (3, 56.3) = 7.1, p = 0.00). Bonferroni post-hoc
 42
analysis determined that the mean age of the conventional cigarette users ( M = 27.1, SD

= 8.1 ) was higher than non-smokers ( M = 22.9, SD = 6.0), and the e-cigarette users (M

= 21.2, SD = 2.8).

A Chi-Square Test was conducted between gender and the usage groups which

found significant difference in proportions χ² (3, N = 520) = 9.3, p .03. Pearson Chi-

Square indicated that there was a significant difference in gender. In particular, the

percentage of males (65.4%) was very high in the dual user groups compared to other

groups (non-smoker 36.5%, e-cigarette users 36.8%, and conventional cigarette users

46.2%). In contrast, the percentage of females (34.6%) was significantly low in the dual

user groups compared to other groups (non-smoker 63.5%, e-cigarette users 63.2%, and

conventional cigarette users 53.8%).

To find the difference in proportions between ethnicity and the usage groups, a

Chi-Square Test was used to assess the difference in proportions between ethnicity and

the usage groups. Pearson Chi-Square indicated that there was a significant difference

between ethnicity and the usage groups (χ² (18, N = 520) = 39.4, p .00). The percentage

of Hispanics in the dual usage groups (19.2%) was much lower than the percentage of

Hispanics in non-smokers (62.8%), e-cigarette users (55.3%), and conventional cigarette

users (84.6%). In Asians, under dual use, the percentage was significantly higher (30.8%)

than the other groups; non-smoker (8.4%), e-cigarette users (10.5%), and conventional

cigarette users (3.8%). Furthermore, in the Caucasian group, dual use (34.6%) and

conventional cigarette use (26.9%), were significantly low compared to the other groups;

non-smokers (10.7%) and e-cigarette users (15.8%).

 43
The Chi-Squared Test was conducted to find the difference in proportions for the

following demographics by usage groups: Marital Status, Work Status, and Household

Income. None of the analyses were significant. Pearson Chi-Square indicated that there

was no significant difference between all three demographics by usage groups. There was

no significant difference in proportions between: Marital Status (χ² (12, N = 520) = 7.1, p

= .85) and usage groups, Work Status (χ² (18, N = 520) = 10.1, p = .93) and usage groups,

Household Income (χ² (33, N = 520) = 33.7, p = .43) and usage groups.

Perceptions of E-Cigarettes Between

Various Groups

Hypothesis 1A proposed that e-cigarette users will perceive vaping as safer than

non-users. An independent t-test found that there was a significant difference between e-

cigarette users and non-users in their perception of the safety of vaping (t(73) = -2.8, p =

.00). The mean safety rating for e-cigarette users (M = 2.5, SD = .6) was higher than non-

smokers (M = 2.0, SD = .71). In order to rule out that age was the actual driver for the

difference between e-cigarette users and non-users, ANCOVA confirmed that this

difference was significant even when age was added as a covariate (F (2, 72) = 4.160, p =

.02).

Hypothesis 1B proposed that conventional cigarette users will perceive vaping as

safer than non-users. An independent t-test found that there was no significant difference

between conventional cigarette users and non-users in their perception of the safety of

vaping (t(73) = -1.2, p = .25). The ANCOVA using age as the covariate confirmed that

there was no significant difference between these groups (F(2, 72) = .67, p = .52).
 44
Hypothesis 1C proposed that non-smokers have less favorable opinions of e-

cigarettes than e-cigarette smokers. An independent t-test was completed to determine if

non-smokers were less bothered by the use of e-cigarettes in their presence than e-

cigarette smokers. The mean level of irritation with vaping in their presence for non-

smokers (M = 2.9, SD = 1.2) was stronger (lower) than e-cigarette users (M = 4.2, SD =

.97). The analysis was significant. An independent t-test found that non-smokers were

significantly bothered by e-cigarette use in their presence than e-cigarette users (t(444) =

-6.0, p = .00). In order to rule out that age was the actual driver for the difference between

non-smokers and e-cigarette users, ANCOVA confirmed that this difference was

significant even when age was added as a covariant (F(2, 493) = 21.83, p = .00).

The mean likelihood of making a disapproving gesture when e-cigarette use was

in their presence among non-smokers (M = 3.1, SD = 1.4) was stronger (lower) than e-

cigarette users (M = 3.9, SD = 1.4). An independent t-test found that non-smokers were

significantly more likely to make a disapproving gesture when e-cigarette use was in their

presence (t(444) = -3.3, p = .00). In order to rule out that age was the actual driver for the

difference between e-cigarette users and non-users, ANCOVA confirmed that this

difference was significant even when age was added as a covariant (F (2, 493) = 7.19, p =

.00).

Hypothesis 1D proposed that those who have friends and family who smoke

conventional cigarettes or e-cigarettes, had less favorable opinions about e-cigarette use

around them compared to those who did not have friends and family who smoked or

vaped. The mean level of irritation with vaping in their presence for those with friends
 45
and family who did not smoke or vape (M = 3.1, SD = 1.3) was stronger (lower) than

those who have friends and family who smoked or vaped (M = 3.5, SD = 1.4). An

independent t-test found that those who did not have friends and family who smoked or

vaped were significantly bothered by e-cigarette use in their presence than those who had

friends and family who smoked or vaped (t(171.21) = -2.9, p = .00). In order to rule out

that age was the actual driver for the difference between non-smokers and e-cigarette

users, ANCOVA confirmed that this difference was significant even when age was added

as a covariant (F = 10.16, p = .00).

The mean likelihood of making a disapproving gesture when e-cigarette use was

in their presence among those who did not have friends and family who smoked or vaped

(M = 3.2, SD = 1.4) was stronger (lower) than those who had friends and family who

smoked or vaped (M = 3.7, SD = 1.4) in their presence. An independent t-test found that

those with friends and family who did not smoke or vape were significantly more likely

to (Q74) make a disapproving gesture when smoke or vape use was in their presence

(t(502) = -3.3, p = .00). In order to rule out that age was the actual driver for the

difference between non-smokers and e-cigarette users, ANCOVA confirmed that this

difference was significant even when age was added as a covariant (F (2, 501) = 5.55, p =

.00).

Psychological Conditions and the

Likelihood to Smoke

Hypothesis 2A proposed that those with higher levels of stress were more likely

to use e-cigarettes or conventional cigarettes. A one-way ANOVA was carried out to

 46
determine if mean levels of stress were higher among e-cigarette or conventional

cigarette users. The analysis was not significant. An ANOVA determined that there were

no significant differences in stress levels in any of the groups (F (3, 502) = .96, p = .41).

These results did not support the hypothesis that those with more stress were more likely

to use e-cigarettes or conventional cigarettes. A follow up ANCOVA showed that even

though stress did not significantly affect the independent variable, there was a significant

difference in stress due to age (F(4, 501) = 4.60, p = .00).

Further, Pearson Correlation showed no relationship between stress and usage

groups which was consistent with the findings from ANOVA. All of the Pearson

Correlation coefficients between stress and user groups were <.07. None of these were

significant at the p < .05 level (see Appendix B).

Hypothesis 2B proposed that those with lower self-esteem were more likely to use

e-cigarettes or conventional cigarettes compared to those with higher self-esteem. A one-

way ANOVA was carried out to determine if mean levels of self-esteem were higher

among e-cigarette or conventional cigarette users (F (3,500) = .31, p = .81). The analysis

was not significant. These results did not support the hypothesis that those with lower

self-esteem were more likely to use e-cigarettes or conventional cigarettes. The

ANCOVA using age as the covariate confirmed that there was no significant difference

between these groups (F (4, 499) = .37, p = .83).

 47
Cessation between E-Cigarettes
and Conventional Cigarettes

A Pearson Correlation Test was conducted between each group of users and the

amount of time they attempted to quit e-cigarettes. Results showed that non-smokers (r =

.30, p = .01, N = 69) who have smoked e-cigarettes in the past were positively associated

with quitting for longer periods of time. In contrast, e-cigarette users who had smoked e-

cigarettes (r = -.39, p = .00, N = 69) in the past were negatively associated with quitting

for longer periods of time. This demonstrated that e-cigarette smokers quit for shorter

periods of time. The other variables of conventional cigarette users and dual users were

not significantly correlated with quitting for longer periods of time.

Additionally, a Pearson Correlation Test was conducted between each group of

users and the amount of time they had attempted to quit conventional cigarettes. Results

showed that there was no relationship between user groups and the amount of time they

attempted to quit conventional cigarettes.

 48
CHAPTER 5

DISCUSSION

The purpose of this proposed research was to investigate the perceptions of e-

cigarettes and conventional cigarettes held among college students. It was hypothesized

that e-cigarette users would perceive e-cigarette use as a safer alternative of smoking than

that of non-users. It was also hypothesized that conventional cigarette smokers would

also perceive e-cigarette use as a safer alternative than conventional cigarette use, and

that non-smokers would have a less favorable opinion of e-cigarette smoking in public

places than that of e-cigarette users. A final hypothesis also stated that individuals who

had family and friends who smoked conventional cigarettes or e-cigarettes would have a

less favorable opinion with e-cigarette use around them than that of non-smokers who did

not have friends and family who use conventional or electronic cigarettes. This proposed

research also investigated the use of e-cigarettes and conventional cigarettes in relation to

stress, self-esteem, and the likelihood to use these products. It is further hypothesized that

individuals who experienced stress were more likely to use e-cigarettes than conventional

cigarettes. Similarly, students with low self-esteem were more likely to use e-cigarettes or

conventional cigarettes. A secondary purpose to this study was to determine the cessation

towards e-cigarettes and conventional cigarettes amongst college students. It was finally

hypothesized that it was more difficult to quit conventional cigarettes than e-cigarettes.
 49
Perceptions of E-Cigarettes

Findings confirmed the hypothesis that e-cigarette users perceive e-cigarette use

as a safer alternative of smoking than non-users a significant difference between the two

groups. Findings are consistent with prior research. For instance, Case et al. (2016), did a

formative study on the perceptions of e-cigarettes among undergraduate students that are

either e-cigarette users or non-users. Study found that e-cigarette users believed that e-

cigarettes were less harmful than conventional cigarettes whereas non-users reported

having negative or neutral attitudes toward e-cigarette use. In this situation, a non-user

stated that e-cigarette use should be prohibited from campus because of the exposure to

the chemicals in vapors. Further e-cigarette users perceived that e-cigarette use are

approved by their peers. In contrast, non-users perceived that none of their peers or their

family would approve of e-cigarettes because of the negative social stigma associated

with use. Therefore, there was a significant difference between e-cigarette users and non-

users in their perceptions of e-cigarette use in this current study and previous literature

review.

Findings confirmed the hypothesis that conventional cigarette smokers would

perceive e-cigarette use as a safer alternative than non-users showed no significant

difference between the two groups. Findings are consistent with the results of the study.

For example, the research from Volesky et al. (2016), found that more than three-quarters

of the participants who are current and former cigarette smokers had positive perceptions

on e-cigarettes. Participants who had positive perceptions on e-cigarettes stated that e-

cigarettes were an effective way to quit smoking, improve their health, and were
 50
considered harmless. Furthermore, a cohort study completed by Choi and Forster (2013)

found that current or former conventional cigarette smokers also had positive perceptions

of e-cigarettes. More than half of the participants (52%) in their study agreed that e-

cigarettes were less harmful than cigarettes. The remaining participants mentioned that e-

cigarettes could be used as a cessation tool and were therefore considered less addictive

than cigarettes. Literature reviews demonstrated conventional cigarette smokers and non-

users having had similar perceptions; e-cigarettes are safe to use. Whether it was

conventional cigarette smokers or former conventional smokers who did not smoke

cigarettes, studies found that there were no differences in their perceptions of vaping.

In the present study, participants who were cigarette users’ and non-smokers’

were given the question about the perception of safety of vaping. Both usage groups,

cigarette users’ and non-smokers’ answers showed no significant difference. Since both

usage groups do not use e-cigarettes, their answers could be generalized to what they

already know about e-cigarettes. Therefore, the results showed no significant difference

between both usage groups due to the generalization of the answers about e-cigarettes.

Findings confirmed the hypothesis that non-smokers had less favorable opinions

of e-cigarettes than e-cigarette smokers. Non-smokers were significantly bothered by e-

cigarette use in their presence, more so than e-cigarette users. In addition non-smokers

were significantly more likely to make disapproving gestures when e-cigarette use was in

their presence. Findings are consistent with prior research. Take the research of Martínez-

Sánchez et al. (2014), a study assessed attitudes toward e-cigarette use in indoor

workplaces and selected public and private venues. Half of the participants, consisting of
 51
non-users, disagreed with the use of e-cigarettes in any indoor public places. The highest

percentage of disagreement with the use of e-cigarettes in schools, hospitals, health care

centers, and hospitality venues were from non-smokers. Furthermore, half of the

participants were not in favor of the sale and marketing of e-cigarettes. This highlights

how non-users are bothered by the use and sale of e-cigarettes in public places. In a

similar fashion, an online questionnaire studied the perceptions of attitudes and risk in

relation to general practitioners and tobacco counselors (Van Gucht & Baeyens, 2016).

More than 80% of the respondents agreed that e-cigarette use should be prohibited in

public places since people within the vicinity of vapor are exposed to second-hand

smoke. Given these findings from literature reviews, non-smokers had less favorable

opinions of e-cigarette smoking in public places than their e-cigarette using counterparts.

Moreover, studies showed that non-smokers were significantly more likely disapprove

when e-cigarette use was in their presence.

The present study showed an exceptional high number of non-smokers having

unfavorable opinions about e-cigarettes. Previous study from Case et al. (2016), the

college students in their sample population were aware of the dangers of e-cigarettes and

had less unfavorable opinions about them. Similar to the current study, college students

who were non-users may have been aware of secondhand smoke from e-cigarette

therefore, they have unfavorable opinions about e-cigarette use in public places. For these

reasons, the results in the current study, the non-smokers were significantly bothered by

e-cigarette use in their presence, especially on their college campus.

 52
Findings confirmed the hypothesis that individuals who had family and friends

who smoked conventional cigarettes or e-cigarettes would have a less favorable opinion

with e-cigarette use around them than non-smokers who do not have friends and family

who use conventional cigarettes or e-cigarettes. Those who did not have friends and

family who smoked or vaped were significantly bothered by e-cigarette use in their

presence than those who had friends and family who smoked or vaped. Additionally

those with friends and family who did not smoke or vape were significantly more likely

disapprove when smoke or vape use was in their presence. The likelihood of making a

disapproving gesture when e-cigarette use was in their presence among those who did not

have friends and family who smoked or vaped was stronger than those who had friends

and family who smoked or vaped in their presence. Findings are consistent with prior

literature reviews. Specifically, Abu-Helalal et al. (2015), gained insight from non-

smokers who had family members who smoked cigarettes and hookah. More than half of

the participants in their study who had family members who smoked had a hard time

accepting that a family member smoked hookah or conventional cigarettes. The attitudes

of parents whose sons and daughters that smoked were negative as well. Furthermore,

parents who smoked hookah themselves had strong disagreements about their sons or

daughters smoking hookah. This is an example of those who had family members who

smoked had less favorable opinions of smoking; those who smoked and had family

members that smoked, also had less favorable opinions of those who smoked.

Furthermore, Chen et al. (2015) also confirmed the findings by researching opinions from

participants who had family members who did smoke. Children between the ages of 7
 53
and 12 who were exposed to secondhand smoke claimed that the smoke caused coughing

and eye irritation. Furthermore, children of smokers were dissatisfied of their family

members that smoked stating that it led to family unhappiness. On the contrary, homes

that were not exposed to secondhand smoke or tobacco-related products were associated

with increased family happiness.

Non-smokers in the family did not experience coughing and eye irritation whereas

smoker’s family members did. This is an example of those who have family members

who smoked were bothered by smoke in their presence and more likely made a

disapproving gesture. In this case, family members were dissatisfied. Individuals who had

family and friends who smoked conventional cigarettes or e-cigarettes had a less

favorable opinion with e-cigarette use around them than non-smokers who did not have

friends and family who used conventional cigarettes or e-cigarettes.

Psychological Conditions Due to Conventional

Cigarettes and E-Cigarettes

Findings confirmed the hypothesis that individuals who experienced high stress

were more likely to use e-cigarettes or conventional cigarettes no significant difference in

stress in any of the groups. Furthermore, there was no relationship between stress and

usage groups which was consistent with the findings. Findings are not consistent with

prior research. Previous literature reviews has shown that students with high stress were

more likely to use e-cigarettes or conventional cigarettes. For example, a cross-sectional

non-experimental design using an online survey assessed South Korean international

students who studied in the United States (Sa et al., 2013). This study found that smoking
 54
behaviors amongst international students living on campus were considered a stress

relief. Students in this study increased their amount of smoking due to higher levels of

stress. In summation, this study found consistent findings that cigarette smoking was

strongly associated with stress.

Another empirical study found that patterns of e-cigarette use were positively

correlated with the levels of psychological distress (Park et al., 2017). In this study,

results showed a positive correlation that was associated between higher levels of

psychological distress and an increased use of both e-cigarettes and conventional

cigarettes. Even though empirical studies had shown that individuals who experienced

high levels of stress were likely to use e-cigarettes or conventional cigarettes, this current

study could not correlate high stress to an increased likelihood of participating in

smoking behaviors. Further, according to the data given from the participants at the

University, Pearson Correlation showed no relationship between stress and usage groups

which was consistent with the findings from ANOVA.

The present study was a novel attempt to investigate whether college students

who experience high stress were more likely to use e-cigarettes or conventional

cigarettes. The lack of a statistically significant difference and finding no associations

between stress levels and the use of e-cigarettes or conventional cigarettes could be the

samples taken from different participants. In the current study, local college students at a

specific four year University were observed. Previous research by Sa et al. (2013) on

international students represents a different population compared to the current study.

Further, the study was a non-experimental design which makes their sample less
 55
representatives. Another study in the literature review, Park et al. (2017) differed from

the current study because it had a formidable sample. Their sample size of 36,697 (628

for the subgroup of current and former e-cigarette users) was larger than the current study

of 550 (38 for the subgroup of e-cigarette users) which gives it more power to find a

difference between these groups. The difference in sample size in Park et al. (2017) and

the difference in audience surveyed in Sa et al. (2013) could account for the current study

differing conclusion.

Further, another hypothetical reason to the lack of a statistically significant

difference between stress levels and the use of e-cigarettes or conventional cigarettes

could be the given time of survey. The survey was distributed in late September when

class had already been in session for over one month. By this time, students have already

been acclimated to their classes and feel comfortable about the classes. Previous studies

have found factors that lead to stress in students were during the transition period where

students had problems adapting to their new environment (Bhujade, 2017). In addition,

the current study sample demographics show the highest class standing were juniors and

next were seniors from undergraduate programs. This could be evident that the

participants in this current study had more than two years of education and being in the

school environment were not fairly new. Therefore, the results showed no associations to

stress levels and the use of smoking or vaping because the participants demonstrated no

sign of stress at the time the survey was given.

Findings confirmed the hypothesis that those with lower self-esteem were more

likely to use e-cigarettes or conventional cigarettes no significant difference in self-

 56
esteem in any of the groups. In addition, there was no relationship between self-esteem

and usage groups. Findings are not consistent with prior research. Previous studies found

that those with lower self-esteem were more likely to use e-cigarettes or conventional

cigarettes. Specifically, a longitudinal cohort study on adolescents experiencing low self-

esteem and the predictability of smoking found that self-esteem was positively associated

with smoking in adulthood (Saari et al., 2015). Self-esteem did not affect the adolescent

at the current time, but it affected them later in their adulthood. Within the same topic of

self-esteem, Joffer et al. (2014) found factors that predicted smoking in later adolescence.

Researchers suggested that the predictive value of attitudes and strengthening of one’s

self-esteem during their first six school years influenced smoking behavior during

adolescence. Although previous literature supported that those with lower self-esteem

were more likely to use e-cigarettes or conventional cigarettes, it was unable to be met

within this current study.

A possible explanation for this result of no relationship between low self-esteem

and the likelihood to use cigarettes or e-cigarettes could be that the different scales were

distributed compared to each study. Previous research from Saari et al. (2015) used

Lawrence Self-Esteem Questionnaire (LAWSEQ). Joffer et al. (2014) used their own

questionnaire which differs from the current study (which used the Rosenberg’s Self-

Esteem Scale) and the Saari et al. (2015) study (which used the LAWSEQ). Further, the

participants from Saari et al. (2015) study were from Finland. This could account for the

difference in the current study which takes place in United States. The difference in the
 57
types of self-esteem measures and the country of origin could be the reasons for the

differing result.

Another possible explanation for this result of no relationship between low self-

esteem and the likelihood to use cigarettes or e-cigarettes could be that the students from

the sample population may not have smoked or tried cigarettes during their adolescent

years; therefore, they may have a sufficient amount of self-esteem at the time the survey

was taken. Previous research has indicated that adolescents who experience low self-

esteem can be a predictability of smoking later in adulthood (Saari et al., 2015). The

current study shows that more than half of the participants are not smokers. This could be

an indicator that they have higher self-esteem, or their self-esteem levels were

sufficiently high during adolescence that they do not use any smoking products during

their adulthood. The participants’ high self-esteem during adolescence may have

influenced the results of this study, which found no associations between low self-esteem

and the use of cigarettes or e-cigarettes.

The Difficulties of Quitting Conventional

Cigarettes versus E-Cigarettes

Findings confirmed the hypothesis that it was more difficult to quit conventional

cigarettes than e-cigarettes. First, a Pearson Correlation Test was conducted between each

group of users and the amount of time they attempted to quit e-cigarettes. Results

demonstrated that non-smokers who had smoked e-cigarettes in the past were positively

associated with quitting for a longer period of time. E-cigarette users who had smoked e-

cigarettes in the past were negatively associated with quitting for a longer period of time.
 58
Furthermore, conventional cigarette users and dual users were not significantly correlated

with quitting for longer periods of time for e-cigarettes. Non-smokers appeared to abstain

from e-cigarette use longer than smokers. The current study’s findings were consistent

Yuyan et al. (2016) which demonstrated that the success rates for e-cigarette cessation

were higher among non-users than e-cigarette users. The taste, the expense and the look

and feel of the device were motivating factors to stop vaping among non-users compared

to that of e-cigarette users (Biener & Hargraves, 2015).

Finally, a Pearson Correlation Test was conducted in this current study between

each group of users and the amount of time they attempted to quit conventional

cigarettes. Results showed that there was no relationship or any significant difference

between user groups (e-cigarette users, conventional cigarette users, and dual users) and

the amount of time they attempted to quit conventional cigarettes. In the attempt to quit

smoking cigarettes from cigarette users, the Yuyan et al. (2016) study showed that some

individuals switched to e-cigarettes as an aid to stop smoking conventional cigarettes.

Those who switched to e-cigarettes as a cessation tool appeared to be dependent on e-

cigarettes. Therefore, Yuyan et al (2016) concluded that there were more cigarette

smokers than e-cigarette smokers who ceased using the product for more than 30 days.

Although cigarette smokers abstained from smoking conventional cigarettes, they

replaced their smoking behaviors to include that of vaping. For these reasons, cigarette

smokers had higher rates of abstaining from conventional cigarettes because they found

other smoking alternatives. The Polosa et al. (2015) study confirmed the manner in which

conventional cigarette smokers decreased or ceased their cigarette smoking habits with
 59
the help of e-cigarettes. The nicotine strength in the e-cigarettes was gradually lowered so

smokers were able to wean off nicotine over time. Similarly to the current study,

Pasquereau et al (2017) found no differences in smoking cessation trends between

conventional cigarette smokers and dual users. The cigarette smokers switched over to e-

cigarettes decreasing their consumption of conventional cigarettes to half. Similarly, dual

users reduced the consumption of cigarettes initially smoked while smoking e-cigarettes.

In this case, dual users were more likely to attempt to quit, whereas cigarette smokers still

continued to smoke by switching to e-cigarettes.

Findings confirmed the hypothesis that it was more difficult to quit smoking

conventional cigarettes than e-cigarettes. Previous studies showed that smokers who

attempted to quit conventional cigarettes were likely to switch to e-cigarettes; therefore

quitting conventional cigarettes was not as difficult compared to vaping (Polosa et al.

2015; Yuyan et al. 2016; Pasquereau et al. 2017). Only non-users appeared to stay off e-

cigarettes longer than e-cigarette users when attempting to quit vaping (Yuyan et al,

2016). Therefore the hypothesis was not met as it has been concluded that it is more

difficult for e-cigarette users to quit vaping compared to conventional cigarette smokers

who are able to quit smoking tobacco cigarettes.

The current study differs from the three previous studies (Polosa et al. 2015;

Yuyan et al. 2016; Pasquereau et al. 2017) in that these previous studies only look at

conventional cigarette smokers or e-cigarette users, whereas the current study looks at

both by comparing e-cigarette users to conventional cigarette users. The previous studies

do not compare these two groups whereas they look at one or the other.
 60
Further, a potential explanation for this outcome within the current study agrees

with previous research of conventional cigarette smokers being able to quit cigarettes for

longer periods of time by switching to e-cigarettes (Polosa et al., 2015; Yuyan et al.,

2016; Pasquereau et al., 2017). This current study demonstrates how e-cigarette users

showed a negative correlation for quitting for longer periods of time to those similar to

the Yuyan et al. (2016) study. The participants in the current study who were former

cigarette smokers and switched to e-cigarettes may be hesitant to return to cigarettes.

Since e-cigarettes seem more appealing and carry the misconception that they are an aid

to cessation of conventional cigarettes (Volesky et al., 2016; Choi & Forster, 2013; Xu et

al., 2016; Case et al., 2016 ), e-cigarette users in the current study may have decided to

use e-cigarettes as an alternative to conventional cigarettes. Therefore the results in the

current study showed a negative correlation between e-cigarette users and quitting for

longer periods of time.

Limitations

At the time of this current study, e-cigarettes were fairly new to the public. Not all

participants of the study may have had a strong knowledge or an exposure towards e-

cigarettes. Some participants may not have tried e-cigarettes to where they may have

attempted to abstain for 30 days or more. Depending on the marketing and advertising of

e-cigarettes near the university, or if any of the participants’ friends and family used e-

cigarettes, respondents could have little knowledge of e-cigarettes, therefore not being

able to fully answer the questions in the manner in which they were attended. This could

have impacted the validity and reliability of the data.

 61
A secondary limitation could be that of the geographical location in which this

study took place. The sample provided may not be generalized to other regions of the

United States due to different variables including socio-economic factors, employment

factors, individuals who live in areas that have high crimes; college students may

experience different stressors than other people, and so forth. There can be several factors

that can hinder the participant’s response due to these variables.

Finally, the participants may not have been open and forthright about their use

and personal smoking history. For example, some participants may have differing

definitions of what it means to be a smoker, social smoker, or non-user. This study did

not provide definition of these terms for the participants; instead, these terms were

applied based on the answers received. Additionally, participants may not have been open

about their use due to cultural reasons. Perhaps some participants may have opted to keep

their smoking history personal even though the survey stated that participation is

anonymous.

Significance of the Study to the

Field of Clinical Psychology

As smoking concerns and health benefits continue to rise, individuals do not

appear as educated; therefore, this study demonstrated a need for further investigation

regarding e-cigarettes and conventional cigarettes. Knowledge of the health and

psychological effects of e-cigarettes are detrimental since there have appeared to be many

misconceptions towards e-cigarettes. Further studies of e-cigarettes and conventional

 62
cigarettes can benefit the consumers by knowing the facts and truth about vaping and

smoking.

Additionally, this study can be significant to the field of clinical psychology as it

provides a current snapshot as to smoking behaviors, perceptions, and education levels of

individuals. This in turn, can provide information to the field of clinical psychology and

can aid in improving both education and cessation programs aimed towards conventional

cigarettes and e-cigarette users.

Recommendations

Studies have shown that e-cigarettes are just as harmful as conventional

cigarettes. Therefore, it is recommended that there should be more resources to spread

awareness about the dangers of e-cigarettes. Just like conventional cigarettes are sold

with warning labels on the cigarette packages, so should e-cigarettes. Smoke shops and

convenience stores that sell e-cigarettes should have posters with warning labels visible

to the consumers.

More research on e-cigarettes and conventional cigarettes should be

recommended so that consumers are aware of the dangers of e-cigarettes and

conventional cigarettes. Furthermore, more research on smoking products can educate

consumers so that they will know the truth and not carry on common misconceptions

identified in this study that most smokers and vapers have.

 63
Recommendations for Future Research

It is recommended that future research would benefit from focusing on

individuals outside of college. The more data that is collected, the validity on the research

would be stronger; therefore, the data would be more valid and reliable. It is also

recommended for future research to be more qualitative in nature in order to better

understand individual’s perceptions and experiences with smoking behaviors. Finally,

future studies should focus on smoking behaviors; ensuring that researchers account for

an individual’s truthfulness of their personal smoking behaviors. For example,

researchers can clearly define social smoking, regular smoking, and non-smoking before

they complete a survey or interview. Additionally, being clear on the description of e-

cigarettes is equally important, as there are many different types of smoking devices that

are being released to the public.

Summary

The purpose of this research was to investigate the perceptions of e-cigarettes and

conventional cigarettes amongst college students. Most of the hypotheses in this study

were not met. The hypothesis that was met was related to concerns and less favorable

opinions of others around e-cigarette and conventional cigarette use. This study found

that there was no difference in the perception between conventional cigarette smokers

and e-cigarette users. Furthermore, the use of e-cigarette or conventional cigarette had no

psychological effects, and it appeared that it was easier to quit conventional cigarettes

compared to e-cigarettes.
 64
Although most hypotheses in this study had not met, previous studies and within

the literature supported the hypotheses in this study. Further research is recommended as

it can be helpful to the field of clinical psychology.

REFERENCE
 66

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APPENDIX

SURVEY
 80

Consent Form

California State University, Dominguez Hills

Consent to Act as a Research Subject

Electronic Cigarette Use on Intrapersonal Factors Among College Students

You are being asked to participate in a research study. Before you give your consent to
volunteer, it is important that you read the following information and ask as many
questions as necessary.

Investigators: Carl Sneed, Ph.D., Bryant Portillo, B.A., Christopher Odudu, B.A.,
Logan Baughman III, B.A., Andrew Soto, B.A.

California State University, Dominguez Hills

Psychology Department (310) 243-3463

Purpose of the Study: This study is designed to gain a better understanding of electronic
cigarette users’ and non-users’ attitudes towards electronic cigarette use and seeks to
gain an overall understanding of how e-cigarette use influences an individual’s perceived
stress, self-esteem, hope, and emotional intelligence.

Description of the Study: As a participant, you will be asked to participate and complete
in an approximately 30-45 minute long survey (depending on your current usage of
cigarettes and electronic-cigarettes) that contains questions regarding your thoughts and
feelings towards electronic cigarettes and its use. To determine if you are eligible to
participate, you will be asked if you are 18 years of age or older. If your response
indicates that you are not eligible, the information obtained during screening will be
omitted from the study and shredded to protect your privacy.

Risks or Discomforts: Due to the personal nature of the questions that will be included in
the questionnaire, the questions asked, and/or the discussion could be emotionally
upsetting to you as a participant. If you begin to feel uncomfortable, you may discontinue
 81

participation at any time, either temporarily or permanently, and it will not affect your
relationship with the researcher” or the school, or the job, etc. as appropriate

Benefits of the Study: By participating in this study, you may potentially, if eligible,
receive extra credit for your class. This is entirely dependent on your professor.
Additionally, discussion of these issues may help to clarify your own attitudes on this
topic. Lastly, results from this study will be used to expand on the literature and
knowledge of electronic cigarette use and their social acceptability.

Confidentiality: The records of this study will be kept private. Data will be stored in a
computer hard-drive and kept password-protected. Any report of this research that is
made available to the
public will not include your name or any other individual information by which
you could be identified.

Incentives to Participate: As previously stated, it may be possible, but not guaranteed,

that you will receive extra credit for participating in this study. Again, this is entirely
dependent on your professor. If you are unclear, please address this concern to your
professor.

Voluntary Nature of Participation: Participation in this study is voluntary. Your choice of

whether or not to participate will not influence your future relations with California State
University, Dominguez Hills. If you decide to participate, you are free to withdraw your
consent and to stop your participation at any time without penalty or loss of benefits to
which you are entitled.

Questions about the Study: If you have any questions about this study or your
rights as a participant, you may call the investigator Bryant Portillo at (310) 686-
2918 or bportillo3@toromail.csudh.edu or the professor Dr. Carl Sneed at
csneed@csudh.edu, or the Institutional Review Board for the Protection of Human
Subjects at CSUDH, 310-243-3756.
 82

1. Do you agree to the above terms? By clicking Yes, you consent that you are willing to
answer the questions in this survey.

Yes

No

Demographics

*2. What is your age?

*3. What is your gender?

Female

Male

*4. How would you classify your ethnicity? (Choose one)

Arab

Asian/ Pacific Islander

Black

Caucasian/ White

Hispanic/Latino

Other (please specify)

*5. What is your primary language?

English

Spanish

Other (please specify)

*6. What is your current marital status?

 83

Single

Married

Divorced

Widowed

Separated

* 7. Are you currently...?

Employed for wages

Self-employed

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Out of work but not currently looking for work

A homemaker

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Other (please specify)

* 8. What is your total household income?

Less than $10,000

$10,000 to $19,999

$20,000 to $29,999

$30,000 to $39,999
 84

$40,000 to $49,999

$50,000 to $59,999

$60,000 to $69,999

$70,000 to $79,999

$80,000 to $89,999

$90,000 to $99,999

$100,000 to $149,999

$150,000 or more

* 9. How many people are in your household?

* 10. What is the highest level of education you have completed?

High school diploma/GED

Some college

Vocational/technical school

Currently enrolled in college/university

Bachelor's degree

Master's degree

Doctoral degree

Professional degree

* 11. What is your current class standing in college/university?

Freshman (1st year)

Sophmore (2nd year)

 85

Junior (3rd year)

Senior (4th year +)

Post baccalaureate program

Master's program

Doctoral program

Instructions: Indicate the extent to which each question applies to you using the following
response choices available.

* 12. I know when to speak about my personal problems to others.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

* 13. When I am faced with obstacles, I remember times I faced similar obstacles and
overcame them.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

* 14. I expect that I will do well on most things I try.

 86

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

* 15. Other people find it easy to confide in me.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

* 16. I find it hard to understand the nonverbal messages of other people.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

* 17. Some of the major events of my life have led me to re-evaluate what is important
and not important.

Strongly Disagree

Disagree
 87

Neutral

Agree

Strongly Agree

* 18. When my mood changes, I see new possibilities.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

* 19. Emotions are some of the things that make my life worth living.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

* 20. I am aware of my emotions as I experience them.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree
 88

* 21. I expect good things to happen.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

* 22. I like to share my emotions with others.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

* 23. When I experience a positive emotion, I know how to make it last.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

* 24. I arrange events others enjoy.

Strongly Disagree
 89

Disagree

Neutral

Agree

Strongly Agree

* 25. I seek out activities that make me happy.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

* 26. I am aware of the nonverbal messages I send to others.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

* 27. I present myself in a way that makes a good impression on others.

Strongly Disagree

Disagree

Neutral

Agree
 90

Strongly Agree

* 28. When I am in a positive mood, solving problems is easy for me.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

* 29. By looking at their facial expressions, I recognize the emotions people are
experiencing.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

* 30. I know why my emotions change.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

* 31. When I am in a positive mood, I am able to come up with new ideas.

 91

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

* 32. I have control over my emotions.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

* 33. I easily recognize my emotions as I experience them.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

* 34. I motivate myself by imagining a good outcome to tasks I take on.

Strongly Disagree

Disagree
 92

Neutral

Agree

Strongly Agree

* 35. I compliment others when they have done something well.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

* 36. I am aware of the nonverbal messages other people send.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

* 37. When another person tells me about an important event in his or her life, I almost
feel as though I have experienced this event myself.

Strongly Disagree

Disagree

Neutral

Agree
 93

Strongly Agree

* 38. When I feel a change in emotions, I tend to come up with new ideas.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

* 39. When I am faced with a challenge, I give up because I believe I will fail.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

* 40. I know what other people are feeling just by looking at them.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

* 41. I help other people feel better when they are down.
 94

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

* 42. I use good moods to help myself keep trying in the face of obstacles.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

* 43. I can tell how people are feeling by listening to the tone of their voice.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

* 44. It is difficult for me to understand why people feel the way they do.

Strongly Disagree

Disagree

Neutral
 95

Agree

Strongly Agree

The questions in this scale ask you about your feelings and thoughts during the last
month. In each case, you will be asked to indicate how often you felt or thought a certain
way based on the following response choices available.

* 45. In the last month, how often have you been upset because of something that
happened unexpectedly?

Never

Almost Never

Sometimes

Fairly Often

Very Often

* 46. In the last month, how often have you felt that you were unable to control the
important things in your life?

Never

Almost Never

Sometimes

Fairly Often

Very Often

* 47. In the last month, how often have you felt confident about your ability to
handle your personal problems?

Never
 96

Almost Never

Sometimes

Fairly Often

Very Often

* 48. In the last month, how often have you felt that things were going your way?

Never

Almost Never

Sometimes

Fairly Often

Very Often

* 49. In the last month, how often have you found that you could not cope with all the
things that you had to do?
Never

Almost Never

Sometimes

Fairly Often

Very Often

* 50. In the last month, how often have you been able to control irritations in your life?

Never

Almost Never

Sometimes
 97

Fairly Often

Very Often

* 51. In the last month, how often have you felt that you were on top of things?

Never

Almost Never

Sometimes

Fairly Often

Very Often

* 52. In the last month, how often have you been angered because of things that were
outside of your control?

Never

Almost Never

Sometimes

Fairly Often

Very Often

* 53. In the last month, how often have you felt difficulties were piling up so high
that you could not overcome them?

Never

Almost Never

Sometimes

Fairly Often
 98

Very Often

Instructions: Below is a list of statements dealing with your general feelings about
yourself. Please indicate how strongly you agree or disagree with each statement.

* 54. On the whole, I am satisfied with myself.

Strongly Disagree

Disagree

Agree

Strongly Agree

* 55. At times, I think I am no good at all.

Strongly Disagree

Disagree

Agree

Strongly Agree

* 56. I feel that I have a number of good qualities.

Strongly Disagree

Disagree

Agree

Strongly Agree

* 57. I am able to do things as well as most other people.

Strongly Disagree

Disagree
 99

Agree

Strongly Agree

* 58. I feel I do not have much to be proud of.

Strongly Disagree

Disagree

Agree

Strongly Agree

* 59. I certainly feel useless at times.

Strongly Disagree

Disagree

Agree

Strongly Agree

* 60. I feel that I'm a person of worth, at least on equal plane with others.

Strongly Disagree

Disagree

Agree

Strongly Agree

* 61. I wish I could have more respect for myself.

Strongly Disagree

Disagree
 100

Agree

Strongly Agree

* 62. All in all, I am inclined to feel that I am a failure.

Strongly Disagree

Disagree

Agree

Strongly Agree

* 63. I take a positive attitude toward myself.

Strongly Disagree

Disagree

Agree

Strongly Agree

Read each item carefully. Please select the response that best describes how you think
about yourself right now for each statement.

* 64. If I should find myself in a jam, I could think of many ways to get out of it.

Definitely False

Mostly False

Somewhat False

Slightly False

Slightly True

Somewhat True
 101

Mostly True

Definitely True

* 65. At the present time, I am energetically pursuing my goals.

Definitely False

Mostly False

Somewhat False

Slightly False

Slightly True

Somewhat True

Mostly True

Definitely True

* 66. There are lots of ways around any problem that I am facing now.

Definitely False

Mostly False

Somewhat False

Slightly False

Slightly True

Somewhat True

Mostly True

Definitely True
 102

* 67. Right now, I see myself as being pretty successful.

Definitely False

Mostly False

Somewhat False

Slightly False

Slightly True

Somewhat True

Mostly True

Definitely True

* 68. I can think of many ways to reach my current goals.

Definitely False

Mostly False

Somewhat False

Slightly False

Slightly True

Somewhat True

Mostly True

Definitely True

* 69. At this time, I am meeting the goals that I have set for.

Definitely False

Mostly False
 103

Somewhat False

Slightly False

Slightly True

Somewhat True

Mostly True

Definitely True

An electronic cigarette (also known as "e-cig" or "e-cigarette") is a cigarette-shaped

device containing a nicotine-based liquid that is vaporized and inhaled, used to simulate
the experience of smoking tobacco. In addition, more modified versions of electronic
cigarettes, such as "vape mods" or "vape pens", have been developed for accessibility,
cost-effectiveness, and personalization reasons.

Below are a few images that illustrate what an electronic cigarette, vape mod, or vape pen
might look like.
104
 105

For the following questions, you must choose at least one response from the available
choices for each question. Some questions may allow you to enter more than one
response from the choices available.

* 70. Before viewing the last page, had you heard of electronic cigarettes, also known as
"e-cigarettes" or "e-cigs"?

Yes, and I knew what they were

Yes, but I wasn't sure what they were or how they worked

No

Refuse to answer

* 71. Do you intend to use e-cigarettes or vape within the next 12 months?

Definitely not

Probably not

Unsure
 106

Probably

Definitely

* 72. How many of your good friends use e-cigarettes or vape?

0-20%

21-40%

41-60%

61-80%

81-100%

Refuse to answer

* 73. It bothers me if other use e-cigarettes or vape in my presence.

Strongly Disagree

Disagree

Agree

Strongly Agree

For the next two questions, if this has never happened to you, imagine what you would do
in the situation.
* 74. If someone was using an e-cigarette or vaping in a non-smoking area of a public
place, how likely are you to make a face, a coughing noise, a loud comment, or some
other signal to get him or her to realize that it is bothering you?

Very Likely

Somewhat Likely

Somewhat Unlikely
 107

Very Unlikely

I am not bothered by e-cigarette vapor

* 75. How likely are you to approach that person and point out that they are in a non-
smoking area?

Very Likely

Somewhat Likely

Somewhat Unlikely

Very Unlikely

I am not bothered by e-cigarette vapor

* 76. Does the vapor from e-cigarettes, vape mods, or vape pens, offend you in public?

Yes

Indifferent

No

Refuse to answer

* 77. Should there be a separate vaping section designated for e-cigarette users and
vapers?

Yes

Indifferent

No

Refuse to answer

* 78. Should teenagers be allowed to use e-cigarettes or vape?

Yes
 108

Indifferent

No

Refuse to answer

* 79. Do you think that e-cigarettes, vape mods, or vape pens, are trying to appeal to
people less than 18 years of age?

Yes

Indifferent

No

Refuse to answer

* 80. In bars and cocktail lounges, do you think that using e-cigarettes or vaping should
be allowed in all areas, allowed in some areas, or not allowed at all?

Allowed in all areas

Allowed in some areas

Not allowed at all

Refuse to answer

* 81. Do you think that using e-cigarettes or vaping is a habit, an addiction, neither, or
both?

Habit

Addiction

Neither

Both
 109

Don't know

Refuse to answer

* 82. Do you think that giving away free samples by e-cigarette companies should be...

Always allowed

Allowed under some conditions

Not allowed at all

Don't know

Refuse to answer

* 83. Do you think advertising of e-cigarette products should be...

Always allowed

Allowed under some conditions

Not allowed at all

Don't know

Refuse to answer

* 84. How often are you in the company of someone or exposed to using e-cigarettes or
vaping?

Have not noticed

Never

Seldom

Frequently

Refuse to answer
 110

* 85. Which of the following characteristics do you consider indicate that certain e-
cigarettes are less harmful than tobacco cigarettes? (You may choose more than one
response)

Nicotine levels

Specific terms or details in the brands' name (i.e., silver or black)

Size of the e-cigarette

Shape

Color

Other tastes or flavors (i.e., fruity or sweet flavor)

Refuse to answer

* 86. Have you observed others using e-cigarettes or vaping in bars/restaurants,

regardless of whether they were non-vaping areas or not?

Yes

No

I don't remember

Refuse to answer

* 87. How often are you exposed to e-cigarette vapor at your place of work?

Very rarely or never

Ocassionally

Less than one hour a day

1-6 hours a day

 111

More than 6 hours a day

Refuse to answer

* 88. Have people annoyed you by using an e-cigarette or vaping in front of you?

Yes

Indifferent

No

Refuse to answer

* 89. Do you feel bad for people who use e-cigarettes or vape?

Yes

Indifferent

No

Refuse to answer

* 90. Have people expressed to you why they use e-cigarettes or vape?

Yes

Indifferent

No

Refuse to answer

* 91. If so, do you feel bad for people after they tell you why they use e-cigarettes or
vape?

Yes

Indifferent
 112

No

Refuse to answer

* 92. In my opinion, vaping could be...

Beneficial

Harmful

Neither

Not sure yet

Refuse to answer

* 93. For what particular reason do you not use e-cigarettes or vape? (You may choose
more than one response)

Became/planning to become pregnant

Change in health status/diagnosed with health condition/other health concerns

Personal safety reasons

Cost reasons

Decided I was too old to use e-cigarettes or vape

Not able to meet family commitments/responsibilities

Encourage by family or friends

I don't enjoy it

Impact on pastimes and recreation/sports commitments

Seen TV advertising or heard radio advertising about its possible dangers

 113

Not able to meet work/study commitments

Other

Don't know

Refused

Not applicable

* 94. Do you suggest or encourage people to stop using e-cigarettes or vaping?

Yes

Indifferent

No

Refuse to answer

* 95. In regards to e-cigarette users and vapors, do you...

Suggest they vape less

Suggest they stop vaping

Suggest they vape more

Not care if they vape

Refuse to answer

* 96. The people I spend most of my time with use e-cigarettes or vape.

Yes

Indifferent

No

Refuse to answer
 114

97. It is difficult to disregard the urge to use e-cigarettes or vape.

Yes

Indifferent

No

* 98. Many of my friends and family engage in using e-cigarettes or vaping.

Yes

Indifferent

No

Refuse to answer

* 99. The majority of the people I associate with, socially, use e-cigarettes or vape.

Yes

Indifferent

No

Refuse to answer

* 100. Do you intend to smoke tobacco products within the next 12 months?

Definitely not

Probably not

Unsure

Probably

Definitely
 115

Refuse to answer

* 101. How many of your good friends smoke cigarettes?

0-20%

21-40%

41-60%

61-80%

81-100%

Refuse to answer

* 102. It bothers me if others smoke cigarettes in my presence.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

For the next two questions, if this has never happened to you, imagine what you would do
in the situation.

* 103. If someone was smoking in a non-smoking area of a public place, how likely are
you to make a face, a coughing noise, a loud comment, or some other signal to get
him or her to realize that it is bothering you?

Very likely

Somewhat likely
 116

Somewhat unlikely

Very unlikely

I am not bothered by tobacco smoke

* 104. How likely are you to approach that person and point out that they are in a non-
smoking area?

Very likely

Somewhat likely

Somewhat unlikely

Very unlikely

I am not bothered by tobacco smoke

* 105. Does the smoke from cigarettes offend you in public?

Yes

Indifferent

No

Refuse to answer

* 106. Should there be a separate smoking section designated for cigarette smokers?

Yes

Indifferent

No

Refuse to answer

* 107. Should teenagers be allowed to smoke cigarettes?

 117

Yes

Indifferent

No

Refuse to answer

* 108. Do you think that tobacco cigarette companies are trying to appeal to people less
than 18 years of age?

Yes

Indifferent

No

Refuse to answer

* 109. In bars and cocktail lounges, do you think that smoking cigarettes should be
allowed in all areas, allowed in some areas, or not allowed at all?

Allowed in all areas

Allowed in some areas

Not allowed at all

Refuse to answer

* 110. Do you think that smoking cigarettes is a habit, an addiction, neither, or both?

Habit

Addiction

Neither

Both
 118

Don't know

Refuse to answer

111. Do you think that giving away free samples by cigarette companies should be...

Always allowed

Allowed under some conditions

Not allowed at all

Don't know

Refuse to answer

* 112. Do you think advertising of cigarette products should be...

Always allowed

Allowed under some conditions

Not allowed at all

Don't know

Refuse to answer

* 113. How often are you in the company of someone who smokes or exposed to cigarette
smoke?

Have not noticed

Never

Seldom

Frequently

Refuse to answer
 119

* 114. Have you observed others smoking cigarettes in bars/restaurants, regardless of

whether they were non-smoking areas or not?

Yes

No

I don't remember

Refuse to answer

* 115. How often are you exposed to cigarette smoke at your place of work?

Very rarely or never

Occasionally

Less than one hour a day

1-6 hours a day

More than 6 hours a day

Refuse to answer

* 116. Have people annoyed you by smoking in front of you?

Yes

Indifferent

No

Refuse to answer

* 117. Do you feel bad for people who smoke cigarettes?

Yes

Indifferent
 120

No

Refuse to answer

* 118. Have people expressed to you why they smoke cigarettes?

Yes

Indifferent

No

Refuse to answer

* 119. If so, do you feel bad for people after they tell you why they smoke?

Yes

Indifferent

No

Refuse to answer

* 120. For what particular reason(s) do you not smoke cigarettes? (You may choose
more than one response)

Became/planning to become pregnant

Change in health status/diagnosed with health condition/other health concerns

Personal safety reasons

Decided I was too old to smoke

Not able to meet family commitments/responsibilities

Encourage by family or friends

 121

I don't enjoy it

Impact on pastimes and recreation/sports commitments

Seen TV advertising or heard radio advertising about its dangers

Not able to meet work/study commitments

Other

Don't know

Refused

Not applicable

Refuse to answer

* 121. Do you suggest or encourage people to stop smoking cigarettes?

Yes

Indifferent

No

Refuse to answer

* 122. In regards to cigarette smokers, do you...

Suggest they smoke less

Suggest they stop smoking all together

Suggest they smoke more

Not care if they smoke

Refuse to answer
* 123. The people I spend most of my time with smoke cigarettes.
 122

Yes

Indifferent

No

Refuse to answer

* 124. Most of the time, I am around people who smoke cigarettes.

Yes

Indifferent

No

Refuse to answer

* 125. It is difficult to disregard the urge to smoke cigarettes.

Yes

Indifferent

No

Refuse to answer

* 126. Many of my friends and family engage in smoking cigarettes.

Yes

Indifferent

No

Refuse to answer

* 127. The majority of the people I associate with, socially, smoke cigarettes.

Yes
 123

No

Refuse to answer

* 128. Have you used an electronic cigarette, vape pen, vape mod, or vaped, even one or
two puffs, in the past 30 days?

Yes

No

* 129. How soon after waking up do you use an e-cigarette or vape?

Within 5 minutes

6-30 mintues

31-60 minutes

Refuse to answer

* 130. Do you find it difficult to refrain from using e-cigarettes or vaping in public
places? (E.g., church, library, etc.)

Yes

No

Refuse to answer

* 131. Do you use e-cigarettes or vape frequently in the morning?

Yes

No

Refuse to answer

* 132. Do you use e-cigarettes or vape even if you are in bed sick most of the day?
 124

Yes

No

Refuse to answer

* 133. Why do you use e-cigarettes or vape? (You may choose more than one response)

Less harmful to my health

Less harmful to others

I prefer the taste

More affordable

E-cigarettes are less toxic than tobacco cigarettes

To deal with nicotine cravings

To quit smoking or avoid relapse

To deal with withdrawal symptoms

E-cigarettes or vaping are cheaper than tobacco cigarettes

To avoid bothering others with tobacco smoke

To deal with situations where I cannot smoke (at work, etc.)

To reduce tobacco consumption in preparation of a quit attempt

To reduce tobacco consumption with no intention to quit smoking

Unable to stop using

Refuse to answer

* 134. Can you remember why you tired your first e-cigarette or vaped for the first time?

To see what it was like

 125

All my friends vaped

Someone gave me one

I had seen advertising

All of the above

Refuse to answer

Other (please specify)

* 135. How many of your friends use e-cigarettes or vape?

0-20%

21-40%

41-60%

61-80%

81-100%

Refuse to answer

* 136. If your best friend/partner uses e-cigarettes or vapes, how often does he or she use?

Never

Infrequently

Occasionally

Regular

Refuse to answer

* 137. When you first started using e-cigarettes or vaping, did you think it was common
for people your age to use e-cigarettes or vape as well?
 126

Yes

No

Don't know/not sure

Refuse to answer

* 138. When you first started using e-cigarettes or vaping, did you believe that you can
become addicted to it?

Yes

No

Don't know/not sure

Refuse to answer

* 139. During the past 30 days, on how many days did you use e-cigarettes or vape?

1 or 2 days

3 to 5 days

6 to 9 days

10 to 19 days

20 to 29 days

All 30 days

Refuse to answer

140. When was the last time you used an e-cigarette or vaped? (Please choose one
response that best fits your situation)

Earlier today
 127

Not today but sometime during the past 7 days

Not during the past 7 days but sometime during the past 30 days

Refuse to answer

* 141. In the past 12 months, did you receive ads from an e-cigarette, vape mod or
vape pen company through... (You can choose more than one answer)

I did not receive ads from an e-cigarette, vape mod, or vape pen company

The mail

E-mail

The Internet

Social media websites

Refuse to answer

* 142. When you go to a convenience store, supermarket, or gas station, how often
do you see ads or promotions for electronic cigarettes, vape mod, or vape pen
products?

Never

Rarely

Sometimes

Most of the time

Always

Refuse to answer
 128

* 143. During the past 30 days, how often did you see an ad for e-cigarette, vape mod or
vape pen products that was outdoors on a billboard or could be seen from outside a
store?

Never

Rarely

Sometimes

Most of the time

Always

Refuse to answer

* 144. When you watch TV or go to the movies, how often do you see actors and
actresses using e-cigarette, vape mod, or vape pen products?

I do not watch TV or go to the movies

Never

Rarely

Sometimes

Most of the time

Always

Refuse to answer

* 145. During the past 12 months, how many times have you stopped using e-cigarettes
or vaping for one day or longer because you were trying to quit using?

I did not try to quit using e-cigarettes or vaping during the past 12 months

1 time
 129

2 times

3 to 5 times

6 to 9 times

10 or more times

Refuse to answer

* 146. Are you thinking about quitting the use of all e-cigarettes and vaping?

Yes, within the next 30 days

Yes, within the next 6 months

Yes, within longer than 6 months

I am not thinking about quitting the use of e-cigarettes and vaping

Refuse to answer

* 147. Inside your home (not counting decks, garages or porches) is e-cigarette or
vaping...

Always allowed

Allowed only at some times or in some places

Never allowed

Refuse to answer

* 148. In the vehicles that you and family members who live with you own or lease, use
of e-cigarettes and vaping is...

Always allowed

Sometimes allowed
 130

Never allowed

Refuse to answer

* 149. Do you think that breathing other peoples' e-cigarette vapor is...

Very harmful to one's health

Somewhat harmful to one's health

Not harmful to one's health

Refuse to answer

* 150. Have you ever used e-cigarettes or vaped to quit smoking tobacco cigarettes?

Yes, I have

No, I haven't

Refuse to answer

* 151. If you use e-cigarettes or vape, do you use less than when you were smoking
tobacco?

Yes, I use less

About the same

No, I use more

I never smoked tobacco cigarettes

Refuse to answer

* 152. Do you use or have you ever used an e-cigarette that contains nicotine?

Yes

No
 131

Refuse to answer

* 153. If you do or have used the cartridges containing nicotine, what was the amount of
nicotine you use or used?

.03

.06

.12

.18

I do not use nictone cartridges

Refuse to answer

* 154. Why did you switch from tobacco cigarettes to e-cigarettes or vaping?

Health reasons

Trying to quit smoking

Not interested in tobacco anymore

I never smoked tobacco cigarettes

Refuse to answer

* 155. Did you switch to using your current e-cigarette, vape mod, or vape pen because it
gives you a more satisfying "hit" than the previous tobacco cigarettes you tried?

Yes

No

Don't know
 132

Refuse to answer

* 156. How important is it for you to stay off tobacco cigarettes?

Very important

Important

Not important

Refuse to answer

* 157. When you started using e-cigarettes or vaping, was it your intention to quit
smoking?

Yes

No

Was not planning on it

Refuse to answer

* 158. Do you now use e-cigarettes or vape every day, some days, or not at all?

Every day

Some days

Not at all

Don't know

Refuse to answer
*
* 159. During the past 30 days, on how many days did you use e-cigarettes or vape?

0 days

1 or 2 days
 133

3 to 5 days

6 to 9 days

10 to 19 days

20 to 29 days

All 30 days

Refuse to answer

* 160. How true is this statement for you? "I feel restless and irritable when I don't use e-
cigarettes or vape for a while."

I do not use e-cigarettes or vape

Not at all true

Sometimes true

Often true

Always true

Refuse to answer

* 161. Are you seriously thinking about quitting the use of e-cigarettes or vaping?

Yes, within the next 30 days

Yes, within the next 6 months

Yes, within the year

Yes, but not within the year

No, I am not thinking about quitting the use of e-cigarettes or vaping

Refuse to answer
 134

* 162. If you decided to quit using e-cigarettes or vaping for good, how likely is it that
you would succeed?

Very likely

Somewhat likely

Somewhat unlikely

Very unlikely

Refuse to answer
*
* 163. During the past 12 months, how many times have you stopped using e-cigarettes or
vaping for one day or longer because you were trying to quit using e-cigarettes and
vaping for good?

I did not try to quit using e-cigarettes or vaping during the 12 past months

1 time

2 times

3 to 5 times

6 to 9 times

10 or more times

Refuse to answer

* 164. When you last tried to quit for good, how long did you stay off e-cigarettes and
vaping?

I have never tried to quit

Less than a day

1 to 7 days
 135

More than 7 days but less than 30 days

More than 30 days but less than 6 months

More than 6 months but less than 1 year

1 year or more

Refuse to answer

* 165. How old were you when you first tried an e-cigarette or vaped, even one or two
puffs?

* 166. During the past 30 days, on the days you used e-cigarettes or vaped, how many
cigarettes did you smoke per day?

I did not smoke cigarettes during the past 30 days

Less than 1 cigarette per day (a few puffs or so)

1 cigarette per day

2 to 5 cigarettes per day

6 to 10 cigarettes per day

11 to 20 cigarettes per day

More than 20 cigarettes per day

Refuse to answer

167. Among the following, what were the most significant elements that made you start
using e-cigarettes, vape mods, or vape pens?

Your friends use e-cigarettes or vape

You like the taste or smell of e-cigarettes or vape smoke

 136

E-cigarettes or vaping is more affordable

You liked the packaging of e-cigarettes, vape mods, or vape pens

Combustion reasons

Other (spontaneous)

Don't know

Refuse to answer

Below are a series of statements about e-cigarettes and vaping. Please rate your level of
agreement for each question.

* 168. For the most part, I enjoy the taste of e-cigarettes and vaping.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 169. When I am in a good mood, using e-cigarettes or vaping makes it even better.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral
 137

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 170. The activity of using e-cigarettes or vaping carries a considerable amount of

control over my life.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 171. To improve my mood, I will use an e-cigarette or vape.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 172. I get a feeling of contentment when I use e-cigarettes or vape.

 138

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 173. I find the taste from e-cigarettes or vaping, pleasurable.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 174. The most that I can go in between e-cigarettes and vaping is a couple of hours.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral
 139

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 175. Within seconds after using an e-cigarette or vaping, I start to feel better.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 176. There aren't many things that can take the place of e-cigarettes or vaping in my
life.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 177. When I have to deal with stressful situations, I will use an e-cigarette and/or vape.
 140

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 178. The majority of my daily e-cigarettes and vaping taste good.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 179. At times I feel that using e-cigarettes or vaping has too much control in my life.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me
 141

Mostly True of Me

Extremely True of Me

* 180. It is common for me to have cravings to use an e-cigarette or vape.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 181. After I use an e-cigarette or vape, I feel better.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 182. When I want to reward myself, the fastest way to do so is with an e-cigarette or
through vaping.

Not True of Me At All

 142

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 183. The urge to use e-cigarettes or vape grows increasingly stronger as time goes by.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 184. I will continue to use e-cigarettes or vape even at the expense of my other interests
and hobbies.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me
 143

Mostly True of Me

Extremely True of Me

* 185. I receive a great deal of pleasure from using e-cigarettes or vaping.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 186. When I need a lift, nothing can get it done like an e-cigarette or vaping can.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 187. Other e-cigarette users and "vapers" would consider me a heavy e-cigarette user or
"vaper".

Not True of Me At All

 144

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 188. It would take a pretty serious medical problem to make me quit using e-cigarettes
or stop vaping.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 189. When something prevents me from using e-cigarettes or vaping for hours, the
cravings I have for e-cigarettes or vaping becomes nearly intolerable.
Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral
 145

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 190. When I inhale e-cigarette vapor into my mouth, I enjoy the way it makes me feel.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 191. When I wake up in the morning, I will use an e-cigarette or vape within about 30
minutes.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 192. I reach for an e-cigarette, a vape mod, or a vape pen, when I feel irritable.
 146

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 193. When I use an e-cigarette or vape it makes me feel good.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 194. I have no control when it comes to my urge to use e-cigarettes or vape.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me
 147

Mostly True of Me

Extremely True of Me

* 195. I see myself as a heavy e-cigarette user or vaper.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 196. No matter what the mood, using e-cigarettes or vaping makes it that much better.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 197. Feelings of irritability can cause me to reach for an e-cigarette, vape mod, or vape
for relief.

Not True of Me At All

 148

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 198. There are few feelings that can compare to a long, slow exhalation from an e-
cigarette puff or from vaping.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 199. For a quick pick me up, using an e-cigarette or vaping does the job.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral
 149

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 200. Have you a smoked a cigarette, even one or two puffs, in the past 30 days?

Yes

No

* 201. How soon after waking up do you smoke your first cigarette?

Within 5 minutes

6-30 minutes

31-60 minutes

Refuse to answer

* 202. Do you find it difficult to refrain from smoking in places where it is forbidden?
(E.g., church, library, etc.)

Yes

No

Refuse to answer

* 203. Do you smoke more frequently in the morning, as opposed to the afternoon or
evening?

Yes

No

Refuse to answer

* 204. Do you smoke even if you are sick in bed sick most of the day?
 150

Yes

No

Refuse to answer

* 205. Do you currently smoke every day, some days, or not at all?

Every day

Some days

Not at all

No answer

Refuse to answer

* 206. How many cigarettes a day do you smoke?

10 cigarettes or less

11-20

21-30

More than 30

Refuse to answer

* 207. About how many cigarettes have you smoked in your entire life? (An approximate
guess)

10 cigarettes or less

11-100 (up to 5 packs)

More than 100 cigarettes (more than 5 packs)

Refuse to answer
 151

* 208. At any time in your life, have you smoked more than 1 cigarette per day for 30
days straight?

Yes

No

Refuse to answer

* 209. During the past 30 days, on how many days did you smoke?

Every day or almost every day

Some days

No days

Refuse to answer

* 210. When you first started smoking, did you believe that smoking cigarettes could be
harmful to your health?

Yes

No

Don't know/not sure

Refuse to answer

* 211. How would you decribe yourself?

I am a daily smoker

I am an infrequent smoker

I am an occasional smoker

I am a non-smoker, but smoke at special occasions (e.g., when I am at a party)

 152

Refuse to answer

* 212. If your partner/best friend is a smoker, how often does he or she smoke?

Never

Infrequently

Occasionally

Regularly

Refuse to answer

* 213. How old were you when you tried your first cigarette, even a single puff?

7 years old or younger

8 or 9 years old

10 or 11 years old

12 or 13 years old

14 or 15 years old

16 or 17 years old

18-21 years old

22 years old or older

Refuse to answer

* 214. When did you become a regular/daily smoker?

I have never been a regular/daily smoker

Before age 10

10-13 years old

 153

14-17 years old

18-21 years old

22 years old or older

Refuse to answer

* 215. Which cigarette would you hate to give up?

The first in the morning

Any other

Refuse to answer

* 216. Do you intend to use e-cigarettes or vape within the next 12 months?

Definitely not

Probably not

Unsure

Probably

Definitely

Refuse to answer

* 217. How many of your friends smoke?

None

A few

Most

All
 154

Refuse to answer

* 218. When you first started smoking, did you believe that you could become addicted to
cigarettes?

Yes

No

Don't know/not sure

Refuse to answer

* 219. While you were growing up, how many of your parents/guardians smoked?

None

One

More than one

Don't know/not sure

Refuse to answer

* 220. While you were growing up, what was your oldest age when at least one of your
parents/guardias smoked?

None of my parents/guardians smoked when I was growing up

6 years old or less

7-10 years old

11-13 years old

14-18 years old

Don't know/not sure

 155

Refuse to answer

* 221. While you were growing up, did any of your siblings who lived with you smoke?

Yes

No

I don't have any siblings who lived with me while I was growing up

Don't know/not sure

Refuse to answer

* 222. While you were growing up, did any of your parents/guardians smoke inside your
home?

Yes

No

Don't know/not sure

Refuse to answer

* 223. While you were growing up, did your parents/guardians allow visitors and guests
to smoke inside your home?

Yes

No

Don't know/not sure

Refuse to answer

* 224. While you were growing up, did your parents/guardians allow you to smoke inside
your home?

Yes
 156

No

Don't know/not sure

Refuse to answer

* 225. I plan to stop smoking within the next...

7 days

30 days

6 months

1 year

I do not plan to stop smoking within the next year

Refuse to answer
*
*
* 226. During the past 12 months, how many times have you stopped smoking for
one day or longer because you were trying to quit smoking for good?

I did not try to quit during the past 12 months

1 time

2 times

3 to 5 times

6 to 9 times

10 or more times

Refuse to answer
 157

* 227. When you last tried to quit, how long did you stay off cigarettes?

I have never tried to quit

Less than a day

1 to 7 days

More than 7 days but less than 30 days

More than 30 days but less than 6 months

More than 6 months but less than 1 year

1 year or more

Refuse to answer

* 228. Are you thinking about quitting for good?

Yes, within the next 30 days

Yes, within the next 6 months

Yes, within more than 6 months from now

I am not thinking about quitting

Refuse to answer
*
* 229. In the past 12 months, did you do any of the following to help you quit smoking?
(You can choose more than one response)

Attended a program at my school

Attended a program in my community

Called a telephone help line or telephone quit line

 158

Used nicotine gum

Used nicotine patch

Used any medicine to help quit

Visited an Internet site designed for quitting

Got help from family and/or friends

Used another method such as hypnosis and/or acupuncture

Tried to quit on my own or quit "cold turkey"

Did not try to quit

Refuse to answer

* 230. How old were you when you smoked your first cigarette?

* 231. During the past 30 days, on how many days did you smoke?

0 days

1 or 2 days

3 to 5 days

6 to 9 days

10 to 19 days

20 to 29 days

All 30 days

Refuse to answer

* 232. During the past 30 days, on the days you smoked, how many cigarettes did you
smoke per day?
 159

Less than 1 cigarette per day

1 cigarette per day

2 to 5 cigarettes per day

6 to 10 cigarettes per day

11 to 20 cigarettes per day

More than 20 cigarettes per day

Refuse to answer

Below are a series of statements about smoking. Please rate your level of agreement for
each question.

* 233. For the most part, I enjoy the taste of cigarettes.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 234. When I am in a good mood, smoking makes it even better.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

 160

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 235. The activity of smoking carries a considerable amount of control over my life.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 236. To improve my mood, I will smoke.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me
 161

* 237. I get a feeling of contentment when I smoke.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 238. When I wake up, most of the time, I want to smoke a cigarette.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 239. I can't think of many things that satisfy me the way that cigarettes do.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral
 162

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 240. It is difficult to disregard the urge to smoke.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 241. I find the taste of cigarettes, pleasurable.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 242. The most that I can go in-between cigarettes is a couple of hours.

 163

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 243. Within seconds after smoking a cigarette, I start to feel better.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 244. There aren't many things that can take the place of cigarettes in my life.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me
 164

Mostly True of Me

Extremely True of Me

* 245. Much of the time, I am around people who smoke.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 246. When I have to deal with stressful situations, I will smoke.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 247. The majority of my daily cigarettes taste good.

Not True of Me At All

 165

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 248. At times, I feel that smoking has too much control in my life.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 249. It is common for me to have cravings to smoke.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me
 166

Extremely True of Me

* 250. The people I spend most of my time with, smoke.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 251. After I smoke, I feel better.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 252. Some of the cigarettes I smoke taste better than others.

Not True of Me At All

Mostly Not True of Me

 167

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 253. I can't deny that I am hooked on cigarettes.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 254. When I want to reward myself, the fastest way to do so is by smoking.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me
 168

* 255. The urge to smoke grows increasingly stronger as time passes by.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 256. I will continue to smoke at the expense of my other interests and hobbies.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 257. Many of my friends and family, smoke.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

 169

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 258. I receive a great deal of pleasure from smoking.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 259. When I need a lift, nothing can get it done like smoking a cigarette can.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 260. Other smokers would consider me a heavy smoker.

 170

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 261. It would take a pretty serious medical problem to make me quit smoking.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 262. When something prevents me from smoking for hours, the cravings I have for
a cigarette becomes nearly intolerable.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

 171

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 263. The majority of the people I associate with are social smokers.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 264. When I inhale smoke into my mouth, I enjoy the way it makes me feel.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 265. When I wake up in the morning, I will smoke within about 30 minutes.
 172

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 266. I reach for a cigarette when I feel irritable.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 267. When I smoke, it makes me feel good.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral
 173

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 268. I have no control when it comes to my urge to smoke.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 269. I see myself as a heavy smoker.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 270. No matter what the mood, smoking makes it that much better.

Not True of Me At All

 174

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 271. Feelings of irritability can cause me to reach for a cigarette.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me

* 272. There are few feelings that can compare to a long, slow exhalation from a cigarette
puff.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me
 175

Mostly True of Me

Extremely True of Me

* 273. For a quick pick me up, smoking a cigarette does the job.

Not True of Me At All

Mostly Not True of Me

Slightly Not True of Me

Neutral

Slightly True of Me

Mostly True of Me

Extremely True of Me
 176

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California State University, Dominguez Hills. PLEASE PUT YOUR LAST NAME
and FIRST NAME in the boxes below. Please make sure to include your given name
and not nicknames.

NOTE: THIS INFORMATION WILL BE REMOVED BEFORE YOUR RESPONSES

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274. PLEASE PUT YOUR LAST NAME IN THE TOP BOX AND YOUR FIRST
NAME IN THE BOTTOM BOX SO THAT YOU CAN GET CREDIT FOR THIS
ASSIGNMENT. PLEASE PUT YOUR FULL NAME AND DON'T USE
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SHOULD GET THE EXTRA CREDIT.

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