Using cognitive interviewing to better understand young adult e-cigarette use

Abstract

Questionnaires that assess emerging electronic nicotine delivery systems, or ENDS, are often based on traditional tobacco product surveys. Unique attributes of ENDS makes accurate assessment of their use a challenge for researchers. Cognitive interviews are a way of gaining insight into participants’ interpretations of survey questions and the methods they use in answering survey questions. As part of a larger study, cognitive interviews were used to test a tobacco use survey that included ENDS questions with 25 young adults in Texas. By mapping results from cognitive interviews onto Tourangeau’s four stage model of the survey response process, problems associated with survey questions were revised and then re-tested in multiple rounds of cognitive interviews. The four main areas of identified problems and attempts at question revision lay in improving the participant comprehension of the questions, the answer estimation processes, answer retrieval, and the answer response process. Comprehension issues regarding discernment between ENDS device types appeared to improve when representative pictures were added to the survey showing the vii type of device in question. Question comprehension and answer estimation processes both improved regarding using ENDS only as nicotine delivery systems when specific language that named nicotine cartridges and e-liquid as the content of devices was included in the question text. Regarding the answer retrieval process, results of this study showed that this sample of users had problems quantifying the amount of ENDS products consumed, as well as difficulty reporting the frequency of ENDS product use. The answer response improvement process allowed cognitive interview participants to add their own reasons for trying and using ENDS products to the list of available answer choices in multiple response questions. Cognitive interviews offered insight into the new and rapidly changing landscape of ENDS products through in-depth conversations with users. Future research is needed that allows both users and researchers to quantify ENDS product use. Exploration into the wide array of ENDS devices as well as possible population differences among specific device-type users would be valuable to public health professionals. As a survey-improvement tool, cognitive interviewing provided valuable insight into survey interpretation that was otherwise inaccessible to researchers.