Table 3.

Key Research Gaps: Behavior, Cessation, and Harm Reduction

Behaviors of use

• How are e-cigarettes used by current, former, and never-smokers? Is conventional cigarette use affected (measured using cohort studies, analyses of pattern of use, and retail outlet geocoding)? Are the social patterns of use different between e-cigarette and conventional cigarette users?

• How can modeling and population surveillance techniques be used to estimate and understand trends in use (e-cigarette uptake, complete or partial substitution for cigarettes, and as gateway to smoking cigarettes) and factors moderating these trends?

• Do e-cigarettes delay or facilitate cessation? What characteristics influence cessation?

• How is dual use defined? What are the patterns of and reasons for dual use? Does dual use lead to conventional cigarette or nicotine cessation? Does dual use lead to altered addiction levels or changes in health risk? What factors can decrease the likelihood of sustained dual use?

• How will use of e-cigarettes affect smoking prevalence and morbidity and mortality outcomes?

• Does e-cigarette availability affect uptake by former users? Can this lead to smoking relapse?

• Does e-cigarette availability lead to uptake in never-smokers? Does this substitute or complement uptake of conventional cigarettes?

• How should relative risk information be communicated to consumers, health professionals, and adolescents? How do clinicians view e-cigarettes?

• What guidance are clinicians providing to patients on e-cigarettes? Are they providing guidance on e-liquid toxicity and unintentional exposures, especially for infants and young children?

• What are the attitudes, knowledge, and beliefs about e-cigarettes? How do they affect behavior? How do various advertisement channels and messages affect attitudes, knowledge, belief, and behavior? How do messages about e-cigarettes conveyed by family and peers affect use?

• Is it possible to encourage users of conventional cigarettes to transition to e-cigarettes, while continuing to discourage e-cigarette use among youth and former cigarette smokers?

• How do changes in product types, cost, and availability affect uptake and continued use?

Cessation and harm reduction

• What is the efficacy of e-cigarettes in cessation of conventional cigarettes or nicotine, either alone (placebo or nicotine e-cigarettes) or with approved therapies? How will e-cigarette use affect exposure biomarkers and toxicants? Will nicotine fading be an effective treatment?

• What roles do nicotine delivery and behavioral aspects of e-cigarettes have in cessation of combustible tobacco or nicotine?

• Are there acceptable outcome measures unique to e-cigarettes short of cessation, such as level of combustible use, toxicant exposure, degree of dependence?

• Who are the best candidates for cessation or conventional cigarette reduction intervention with e-cigarettes? What are the unique considerations for special populations, individuals with comorbidities, or institutionalized populations?

• What is the optimal instructional set in a clinical study for using e-cigarettes to replace conventional cigarettes or for nicotine cessation? Are there complexities unique to e-cigarettes due to the variability of nicotine puff yield between naïve and experienced users?

• How can cessation opportunities with e-cigarettes be maximized?

• What is the population reach of e-cigarettes; is it different from approved cessation products?