Differentiating e-cigarette use and dual use: the role of impulsivity

Abstract Rationale Elevated impulsivity has been associated with vaping, but research has not explored potential differences between e-cigarette-only and dual users of cigarettes and e-cigarettes across multiple dimensions of trait and state impulsivity. Objective This study examined the differential role impulsivity may play when vaping and smoking occur in isolation, versus when in combination. Methods Trait impulsivity (UPPS-P) and behavioural impulsivity (monetary delay discounting, cigarette choice, vaping choice, and drug-cue Go/No-go tasks) were compared across non-users ( n = 27), cigarette-only ( n = 25), e-cigarette-only ( n = 26) and dual users ( n = 22) recruited online via Prolific. Results Vaping was associated with heightened sensation seeking, whereas smoking was characterised by elevated negative urgency. Disinhibition was uniquely related to vaping, with dual users demonstrating poorer inhibitory control to nicotine-cues, whilst impulsive choice for non-drug rewards was heightened as a function of smoking and vaping. Importantly, increased preference for immediate gratification within dual users extended to cigarette rewards. Conclusions Dimensions of impulsivity play distinct roles in vaping and smoking. Whilst heightened impulsive choice may play a critical role in both, preference for novel experiences and diminished inhibitory control may be unique to vaping. Critically, sensitivity to immediate cigarette and monetary rewards, as well as reduced inhibitory control in the presence of nicotine cues, may be associated with an increased risk of initiation and maintenance of dual use. These findings have implications for interventions, policies, and regulations which aim to increase the transition from smoking to vaping, reduce prevalence of dual-use, and support e-cigarette-only users to become nicotine-free.