Smoke and Vapor: Exploring the Terminology Landscape among Electronic Cigarette Users.

Electronic cigarettes, also known as e-cigarettes, are electronic nicotine delivery systems that rely on battery power and use a heating element to atomize liquid containing nicotine to produce an aerosol. Consumers often view these products as a less harmful alternative to traditional combustible cigarettes1 and an effective method to reduce or quit smoking.2 Although these devices constitute only a small proportion of the overall tobacco market in the United States (US), sales doubled every year between 2008 and 2014. In 2014, sales reached $2.5 billion.3,4 The growth in the number and variety of e-cigarette products has had a parallel surge. Between August 2012 and January 2014 more than 460 different brands of e-cigarettes and almost 7800 different flavored e-cigarette liquids were available for sale online; an average of 10.5 brands and 242 flavors were introduced each month.5 As demand for these products increases, the varieties have expanded from the first generation of products that look like traditional cigarettes (ie, cigalikes) to later generation products that include vape pens, e-hookahs, hookah pens, vape pipes, personal vaporizers, mods, e-cigars, and e-gos.6–8 This increase in new varieties coincides with a surge in awareness and ever-use of e-cigarette products. 9 From 2010 to 2013, awareness of e-cigarettes increased from 40.9% to 79.7%, and ever-use of e-cigarettes increased from 3.3% to 8.5% among US adults.9 In 2014, 12.6% of adults reported ever having used an e-cigarette.10 The increased use and proliferation of these novel products requires understanding how consumers discuss and differentiate these products and the language and culture surrounding them. Surveillance efforts, policy development, health communication messaging, and future research will need to keep pace with a changing landscape of terminology, and reflect the appropriate use of language as understood by consumers. A number of studies have examined e-cigarettes using qualitative methods; however, the majority of these have examined consumers’ attitudes and beliefs about the products.11–13 In contrast, limited qualitative research exists on the terminology used by consumers to discuss these products and their use.14 This study explores the terminology that adult e-cigarette users employ. The study was guided by 2 main research questions: (1) How do adult e-cigarette users identify various types of e-cigarette products? and (2) How do e-cigarette users understand and describe terminology and language specific to e-cigarettes?