E-cigarette dependence in former smoker: A Tunisian survey


Chirine Moussa
Nour Mahmoud
Houda Rouis
Amel Khattab
Ines Zendah
Sonia Maâlej


Introduction: Since its appearance, E-cigarette (EC) has experienced a strong craze among those seeking to reduce their conventional cigarette (CC) consumption.

Aim: This study aimed to compare EC to CC addictive power in actual users of EC and former smokers of CC.

Methods: We conducted a comparative cross-sectional study including 65 EC users and former smokers. They were collected on Facebook using a questionnaire including Fagrestrom score (FS).

Results: The average total of FS was estimated at 3.45 ± 2 with EC vs 3.89±2.45 with CC (p=0.04). The dependence on the EC was strong in 8%, average in 25%, and weak in 35% of cases. The predictive factors of a medium to high dependence on EC were the duration of its consumption (p=0.008) and the daily quantity of e-liquid (p=0.009). The presence of medical history was inversely correlated with EC addiction. The duration of EC use was the only independent factor of dependence with an OR of 4.25 IC95% [1.019-17.729]. EC users continued to smoke TC in 68% of cases.

Conclusion: Our study shows that even if it remains less important than that of CC, the dependence on EC is not negligible.


E-cigarette, Nicotine, Dependance



  1. Caponnetto P, Campagna D, Cibella F, Morjaria JB, Caruso M, Russo C, et al. EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as Tobacco Cigarettes Substitute: A Prospective 12-Month Randomized Control Design Study. Le Foll B, éditeur. PLoS ONE. 24 juin 2013;8(6):e66317.
  2. Bullen C, Howe C, Laugesen M, McRobbie H, Parag V, Williman J, et al. Electronic cigarettes for smoking cessation: a randomised controlled trial. The Lancet. nov 2013;382(9905):1629‑37.
  3. Javelle E. Electronic cigarette and vaping should be discouraged during the new coronavirus SARS-CoV-2 pandemic. Arch Toxicol. juin 2020;94(6):2261‑2.
  4. Rutten LJF, Blake KD, Agunwamba AA, Grana RA, Wilson PM, Ebbert JO, et al. Use of E-Cigarettes Among Current Smokers: Associations Among Reasons for Use, Quit Intentions, and Current Tobacco Use. Nicotine Tob Res Off J Soc Res Nicotine Tob. oct 2015;17(10):1228‑34.
  5. Hummel K, Hoving C, Nagelhout GE, de Vries H, van den Putte B, Candel MJJM, et al. Prevalence and reasons for use of electronic cigarettes among smokers: Findings from the International Tobacco Control (ITC) Netherlands Survey. Int J Drug Policy. juin 2015;26(6):601‑8.
  6. Balfour DJK, Benowitz NL, Colby SM, Hatsukami DK, Lando HA, Leischow SJ, et al. Balancing Consideration of the Risks and Benefits of E-Cigarettes. Am J Public Health. sept 2021;111(9):1661‑72.
  7. Serhier Z, Bendahhou K, Soulimane A, Othmani MB, Abdelaziz AB. Prévalence du tabagisme au Maghreb: Revue systématique de la littérature et méta analyse Prevalence of smoking in the Maghreb: a systematic review and meta-analysis. Tunis Med. 2018;96.
  8. Asma SB, Sana E, Iness B, Chahida H, Aroua BS, Kamel BS, et al. les attitudes envers l’arrêt du tabac chez les fumeurs adultes. Tunis Med. 2015;93.
  9. Cooper M, Harrell MB, Perry CL. Comparing young adults to older adults in e-cigarette perceptions and motivations for use: implications for health communication: Table I. Health Educ Res. août 2016;31(4):429‑38.
  10. Agence nationale de sécurité du médicament et des produits de santé. Informations réglementaires relatives à la cigarette électronique - Point d’Information. 2016.
  11. Auriacombe M, Dubernet J, Sarram S, Grelot B, Fatseas M, Dalouède J. Le craving : une nouvelle clinique diagnostique et thérapeutique pour l’addiction – Implications pour le trouble de l’usage des opioïdes. Le Courrier des Addictions. 2018;20(1 (Suppl)):S4-7.
  12. Hajek P, Phillips-Waller A, Przulj D, Pesola F, Myers Smith K, Bisal N, et al. A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy. N Engl J Med. 14 févr 2019;380(7):629‑37.
  13. Marques P, Piqueras L, Sanz MJ. An updated overview of e-cigarette impact on human health. Respir Res. déc 2021;22(1):151.
  14. Centers for Disease Control and Prevention (CDC). Fixed obstructive lung disease among workers in the flavor-manufacturing industry--California, 2004-2007. MMWR Morb Mortal Wkly Rep. 27 avr 2007;56(16):389‑93.
  15. Choi K, Bernat D. E-Cigarette Use Among Florida Youth With and Without Asthma. Am J Prev Med. oct 2016;51(4):446‑53.
  16. Honeycutt L, Huerne K, Miller A, Wennberg E, Filion KB, Grad R, et al. A systematic review of the effects of e-cigarette use on lung function. Npj Prim Care Respir Med. 22 oct 2022;32(1):45.
  17. Rahman A, Mohamed MN, Jamshed S, Mahmood S, Baig MI. The development and assessment of modified Fagerstrom test for nicotine dependence scale among Malaysian single electronic cigarette users. J Pharm Bioallied Sci. 2020;12(6):671.
  18. Johnson JM, Muilenburg JL, Rathbun SL, Yu X, Naeher LP, Wang JS. Elevated Nicotine Dependence Scores among Electronic Cigarette Users at an Electronic Cigarette Convention. J Community Health. févr 2018;43(1):164‑74.
  19. Browne M, Todd DG. Then and now: Consumption and dependence in e-cigarette users who formerly smoked cigarettes. Addict Behav. janv 2018;76:113‑21.
  20. Sahr M, Kelsh S, Blower N, Sohn M. Pilot Study of Electronic Nicotine Delivery Systems (ENDS) Cessation Methods. Pharmacy. 14 janv 2021;9(1):21.