We read with interest the article by Wagener et al. 2), which calls for a balanced analysis of the risks and benefits of e-cigarettes (EC). There currently exist very few data on smokers’ reactions to EC to help guide relevant policy. Three internet surveys reported that many users consider the product a satisfactory replacement for cigarettes [2–4]. In all surveys, most EC users either stopped smoking conventional cigarettes completely or reduced their consumption substantially. However, user surveys are much more likely to attract EC enthusiasts than smokers who found the product disappointing, and so they do not provide an indication of a typical user reaction and the potential EC uptake by smokers.
We conducted a survey that may add to the available information by establishing the proportion of first-time users who find the product acceptable and satisfying, and continue to use it.
We approached people who bought cigarettes at five locations across Prague between 10 and 19 October 2011 and conducted brief structured interviews to establish whether the respondents had ever heard about electronic cigarettes; whether they had ever tried one; if so, what was their reaction to it; and what was their subsequent EC use. A total of 973 smokers (average age = 32, 54% men) were interviewed.
A total of 86% (n = 837) of respondents had heard about EC, 26% (n = 253) had tried them at least once, and 7% (n = 69), i.e. 27% of those who had ever tried them, were using them regularly.
Of the 253 respondents who had tried EC at least once, 245 provided information about their reaction, with 43% disappointed with the experience, 33% finding it as expected, and 24% finding EC better than expected.
The respondents who tried EC but did not continue using them were asked for the reasons for their decision (multiple reasons were allowed). Of the 262 responses, 33% reported lack of satisfaction, 32% did not like the taste, 13% did not continue to use EC because of the cost, 9% found it embarrassing to use and 4% gave other reasons, such as technical difficulties with the product and missing the natural timing of finishing a cigarette.
EC start to deliver nicotine only after a number of puffs and it is possible that some of the disappointed smokers did not puff on their first EC long enough, but this is only conjecture. The fact that more than 50% had a positive first response suggests that, overall, EC are sufficiently easy to use.
Our study has limitations due to the simplicity of the project (e.g. no data were collected on smoke intake), but it provides the first information on the proportion of smokers who have tried EC and found them satisfactory enough to use them regularly. The key result suggests an unexpectedly high rate of adoption of the product, with about a quarter of smokers who tried EC once progressing to regular use. Further surveys are needed to confirm our findings.