Pleasure and Satisfaction as Predictors of Future Cigarette and E-Cigarette Use: A Novel Two-Stage Modeling Approach.

INTRODUCTION:Subjective experience of e-cigarettes may be an important factor in helping people who use combustible cigarettes switch completely to e-cigarettes to reduce harms from smoking. This paper describes a novel two-stage analysis using pleasure and satisfaction responses from Ecological Momentary Assessments (EMA) of both cigarette and e-cigarette use to predict future cigarette and e-cigarette tobacco use. METHODS:This observational study included adult users of cigarettes and e-cigarettes who provided 7-days of EMA, capturing cigarette and e-cigarette use, followed by biweekly reports of cigarette and e-cigarette use over one year. Participants were 279 adults who provided both cigarette and e-cigarette responses during the EMA. We employed a two-stage analytic approach in which EMA data were used to predict subsequent levels of cigarette and e-cigarette use. In the first stage, EMA responses of cigarette and e-cigarette events were modeled via a mixed-effects location scale (MELS) model to yield summaries of participants' means and variability on event-related ratings of pleasure and satisfaction. These EMA summaries served as predictors in the second stage analysis of the biweekly post-EMA longitudinal cigarette and e-cigarette use data. RESULTS:EMA pleasure and satisfaction ratings were similar for both products and predicted both longitudinal cigarette and e-cigarette use, even after controlling for baseline cigarette and e-cigarette dependence. Relatively higher levels of satisfaction with e-cigarettes were associated with greater decreases in cigarette use over time. CONCLUSIONS:Pleasure and satisfaction are important predictors of subsequent cigarette and e-cigarette use. IMPLICATIONS:Experienced subjective pleasure and satisfaction from e-cigarettes relative to cigarettes may be an important factor in helping individuals who smoke to switch completely to e-cigarettes as a harm reduction approach. In order to help sustain complete product switching and reduce dual use or relapse to smoking, e-cigarettes may need to deliver more satisfaction to the user compared to that experienced from cigarettes.