Metacognition can be understood as ‘cognition of cognition’ or ‘thinking about thinking’. It refers to the awareness, knowledge, and ability to regulate cognition. The Self-Regulatory Executive (S-REF) model was the first to present the role of metacognitive factors such as attentional processes and coping styles in activating and maintaining psychological distress. (Wells and Matthews, 1996) Several studies have documented associations between metacognitive factors and psychological disorders such as depression, anxiety, and personality disorders. (Sun et al., 2017, Leahy et al., 2019, Carcione et al., 2019) Spada et al have applied S-REF model to addictive behaviors and examined the role of metacognitions in addictive behaviors, (Spada et al., 2015) such as alcohol, (Spada and Wells, 2006) gambling, (Spada et al., 2015) and tobacco use. (Nikčević and Spada, 2008, Spada et al., 2007).

It was originally identified that three dimensions of general metacognitions were implicated to play a role in smoking behaviour, namely ‘positive beliefs about worry’, ‘cognitive confidence’, and ‘beliefs about the need to control thoughts’. (Spada et al., 2007) Nikčević et al. hypothesized that smoking behavior was a strategy to control negative affect, which was supported by the findings in another study where ‘beliefs about the need to control thoughts’ were found to be the only significant predictor of nicotine dependence, independent of negative emotions of anxiety and depression. (Nikčević and Spada, 2008).

The Metacognitions Questionnaire has been the most widely used instrument to measure metacognitive beliefs. (Cartwright-Hatton and Wells, 1997, Wells and Cartwright-Hatton, 2004) The measure uses a five-factor structure based on the S-REF model, with four factors regarding beliefs (positive beliefs about worry, negative beliefs about the controllability of thoughts and corresponding danger, cognitive confidence, negative beliefs about thoughts in general), and a fifth factor regarding cognitive self-consciousness. The Metacognitions about Smoking Questionnaire (MSQ) was developed through conducting interviews with smokers with nicotine dependence, using data from a British sample aged 18 years and older who defined themselves as ‘smokers.’ (Nikčević et al., 2015, Nikčević and Spada, 2010) A four-factor structure was extracted: two factors for positive metacognitions (‘cognitive regulation’ and ‘emotional regulation’) and two for negative metacognitions (‘uncontrollability of smoking’ and ‘interference of smoking related thoughts’). Each factor predicted daily cigarette use and nicotine dependence (measured by Fagerström Test of Nicotine Dependence) better than smoking outcome expectancies. Moreover, negative metacognition factors were found to be the independent predictors of nicotine dependence.

With respect to nicotine, metacognition research has primarily focused on cigarette smoking among adults, while e-cigarette use and metacognition among young people has been relatively unexplored. Cigarette use among youth declined over the last decade, (Cornelius et al., 2020) while e-cigarettes became the most used tobacco product among US youth. As per Monitoring The Future study, past 30-day e-cigarette use (measured as vaping nicotine) among 19–30-year-old consistently increased from 6.2% in 2017 to 14% in 2019, and slightly declined in 2020 to 13.7%. (Schulenberg et al., 2021) Although e-cigarette use among youth has been on a decline since 2019, it has remained a major public health challenge during EVALI and the COVID-19 pandemic. (Choi and Abraham, 2021) E-cigarette use has been associated with several physiological health effects, including the EVALI outbreak, and other health issues like respiratory issues and gastrointestinal issues. (Adkins et al., 2020, King et al., 2020, Case et al., 2022).

E-cigarette use has been extensively related to expectations of positive and negative outcomes (i.e., expectancies). Qualitative research has found relevant outcome expectancies such as social benefits, positive reinforcement, reduction of negative affect, stress relief and health related outcomes. (Harrell et al., 2019, Fairman et al., 2021) Quantitative studies have found positive expectancies (social enhancement, affect regulation, positive sensory experience, enjoyment, social influences, advantage over cigarettes) and negative expectancies (negative health consequences, addiction concern, negative appearance, negative sensory experience) to have significant associations with e-cigarette use and susceptibility among adolescents and young adults. (Pokhrel et al., 2014, Barker et al., 2019).

To effectively guide vaping cessation and prevention efforts, it is important to better understand cognitive processes underlying these smoking behaviors. Previously, the Metacognitions about Smoking Questionnaire (MSQ) was administered to adult cigarette smokers in the UK, with sound psychometric properties with high internal reliability. (Nikčević et al., 2015, Nikčević and Spada, 2010) This study examined the psychometric properties of MSQ for e-cigarette use in a US sample of young adults with substantial racial and ethnic diversity.

The objective of the study was to examine metacognitive factors associated with past 30-day e-cigarette use. Specifically, the aims of the first study were to:

Examine the factor structure of the Metacognitions about Smoking Questionnaire among adolescent and young adult e-cigarette users.

Examine the relationship between metacognitive factors and past 30-day e-cigarette use frequency.