Fagerström Test: which e-cigarette and nicotine should you choose?

Fagerström Test: what nicotine level and which e-cigarette should you choose?

Choosing your first e-cigarette is not always straightforward. Between the nicotine level, the device format, battery life, the type of draw or the various e-liquids available, many smokers do not really know where to start when it comes to smoking cessation. Yet a suitable device and a coherent nicotine dosage are often the key elements of a successful quit.

A poor choice of e-cigarette can quickly create frustration: lack of nicotine, flat battery at the wrong moment, unpleasant throat sensation, cravings for cigarettes that persist despite vaping… Conversely, a correctly chosen device helps to limit strong cigarette cravings, reduce the frustration associated with cessation and progressively support the treatment of nicotine dependence.

It is precisely to guide smokers through this step that the Fagerström test exists. This simple and quick questionnaire has been used for years in numerous medical consultations, at pharmacies or with smoking cessation specialists. Through a few targeted questions, this test measures your level of nicotine dependence and provides a score that serves as a basis for a more precise assessment of your nicotine needs.

The Fagerström test is today used by doctors, tobacco specialists and pharmacists to determine:

• the correct dosage of nicotine replacement products;
• the type of treatment to prioritise;
• the appropriate nicotine dose;
• the average duration of cessation;
• the smoker's tolerance to the gradual reduction of nicotine.

In general, tobacco professionals recommend a gradual cessation over approximately six months:

• 2 months at a high dose;
• 2 months at a medium dose;
• 2 months at a lighter dose before stopping nicotine altogether.

Even if the Fagerström test was initially designed for nicotine replacement products such as patches, sprays, gums or lozenges, it proves useful for choosing a vaping device and a nicotine level genuinely suited to the smoker's profile.

In this comprehensive guide, we will:

• have you complete the Fagerström questionnaire;
• analyse your score;
• determine your nicotine needs;
• guide you towards the vaping device most consistent with your tobacco dependence.

Step 1: take the Fagerström test

The Fagerström questionnaire is based on 6 simple questions allowing a quick assessment of your tobacco and nicotine dependence.

1. In the morning, how long after waking do you smoke your first cigarette?

• Within the first 5 minutes (3)
• Between 6 and 30 minutes (2)
• Between 31 and 60 minutes (1)
• More than 60 minutes after waking (0)

This first question of the Fagerström test is often considered the most revealing. The sooner a smoker feels the need to smoke their first cigarette after waking, the greater the nicotine dependence.

2. Do you find it difficult not to smoke in forbidden places?

• Yes (1)
• No (0)

This question in the questionnaire allows the behavioural and addictive weight of tobacco in your daily life to be assessed.

3. Which cigarette would be the most difficult to give up?

• The first cigarette of the day (1)
• Another cigarette (0)

Once again, the first cigarette of the morning plays a primary role in assessing the smoker's dependence.

4. How many cigarettes do you smoke each day?

• 10 cigarettes or fewer (0)
• 11 to 20 cigarettes (1)
• 21 to 30 cigarettes (2)
• 31 cigarettes or more (3)

The number of cigarettes smoked daily remains an important indicator of the level of tobacco dependence and future nicotine needs.

5. Do you smoke more during the first hours of the day?

• Yes (1)
• No (0)

This question in the Fagerström test measures the level of nicotine withdrawal felt by the smoker upon waking.

6. Do you smoke even when you are ill?

• Yes (1)
• No (0)

When a smoker continues to smoke despite illness or a physical impossibility, this often indicates a nicotine dependence that is already well established.

How do you calculate your Fagerström score?

Simply add up the numbers in brackets associated with your answers.

Your final score will then allow you to determine your level of nicotine dependence:

• 0 to 2: non-existent or very low dependence;
• 3 to 4: low dependence;
• 5 to 6: moderate dependence;
• 7 to 8: strong dependence;
• 9 to 10: very strong dependence.

The score obtained from the Fagerström test obviously does not replace a medical consultation, but it remains an excellent tool to guide a smoker towards a treatment or a device consistent with their needs.

Fagerström test result: score of 0 to 2 points

Non-existent or very low dependence

With a Fagerström score between 0 and 2, nicotine dependence is generally considered to be low or non-existent. This does not mean, however, that there is no behavioural or gestural dependence.

If you are completing this questionnaire today, it is probably because you smoke a few occasional cigarettes:

• in the evening;
• with friends;
• during moments of stress;
• or in specific social contexts.

Many smokers who have developed a strong tobacco dependence started this way. A "social" cigarette can gradually become a daily habit and then a real nicotine dependence.

Even with low exposure to tobacco, a smoker still faces the risks associated with cigarettes. The daily dose of tobacco, even if small, ends up having an impact on health when it becomes regular over several years.

Your nicotine needs

Good news: your nicotine needs are low.

You can generally use:

• an e-liquid at 0 mg of nicotine;
• or possibly 3 mg/ml to retain a slight throat hit.

Large 50 ml formats are particularly interesting for your profile. These nicotine-free e-liquids allow:

• a lower cost;
• a wide variety of flavours;
• the addition of a nicotine booster if necessary.

For a smoker with low dependence, nicotine is not necessarily the primary element of cessation. Gestures, rituals and habits often play a more important role.

Which e-cigarette should you choose?

With such a low score on the Fagerström test, almost any device can be suitable:

• compact pod;
• discreet e-cigarette;
• tubular model;
• powerful mod;
• airy shisha-type e-cigarette.

Your battery and e-liquid consumption needs remain limited. You can therefore primarily choose a device that appeals to you aesthetically and that makes you want to permanently replace cigarettes.

Our selection for you

Suitable e-liquids

You can easily move towards:

• classic blond flavours;
• menthols;
• red berries;
• exotic fruity flavours.

50/50 PG/VG e-liquids remain the most versatile and compatible with the majority of e-cigarettes.

Small discreet pod or large e-cigarette?

A small discreet pod may be perfectly suitable if you are looking for:

• simplicity;
• discretion;
• a pocket-sized format;
• occasional use.

Conversely, some smokers prefer to go straight to a larger e-cigarette with more vapour and battery life.

The important thing above all is to avoid a frustrating device that could lead you back to tobacco.

To avoid at all costs: heavily nicotined disposable vapes

Many disposable vapes use nicotine salts dosed at 20 mg/ml. For a smoker with low dependence, this dose is often unnecessarily high.

An excessively high nicotine intake can:

• increase tolerance;
• reinforce addictive dependence;
• create unpleasant sensations.

If you still wish to use a disposable vape, prefer instead:

• a nicotine-free disposable vape;
• or a low nicotine dosage.

Fagerström test result: score of 3 to 4 points

Low dependence

With a score between 3 and 4, a nicotine dependence is truly beginning to take hold. Even if it remains considered low, this tobacco dependence should not be minimised.

The smoker already feels:

• certain automatic habits;
• more regular consumption;
• a moderate difficulty in stopping smoking altogether.

This stage often represents the best moment to commit to a genuine smoking cessation before dependence becomes more significant.

Your nicotine needs

For low dependence, nicotine needs remain moderate.

It is generally recommended:

• 3 mg/ml;
• or 6 mg/ml if you vape regularly.

If you smoke mainly in the evening or at certain specific moments, nicotine salts at 10 mg/ml can also be considered.

The main objective remains to avoid withdrawal without unnecessarily overdosing on nicotine.

Which device should you choose?

Your Fagerström score still allows you considerable freedom in your choice of device:

• compact pod;
• versatile e-cigarette;
• small MTL model;
• slightly airy device.

If you are using 3 mg/ml or 6 mg/ml, you can even enjoy a more airy vape without major discomfort.

Devices consistent with your profile

Simple-to-use pods often remain the best allies for smokers with low dependence:

• low maintenance;
• lightweight format;
• easy filling;
• reasonable consumption.

But some profiles prefer to go straight to a more versatile device so as not to have to change equipment a few weeks later.

Always avoid overly dosed disposable vapes

The same remark as for smokers with low dependence: heavily dosed nicotine salt disposable vapes are not always suitable.

A smoker with a mild dependence generally does not need 20 mg/ml to successfully quit.

Fagerström test result: score of 5 to 6 points

Moderate dependence

With a score of 5 to 6 on the Fagerström test, we are talking about a moderate dependence on nicotine and tobacco.

At this stage, the smoker generally already feels:

• the effects of withdrawal;
• a true daily habit;
• consumption that has become automatic;
• a difficulty in stopping smoking durably.

Smoking cessation must then be prepared more seriously. Nicotine dependence becomes a primary factor in the smoker's behaviour.

Your nicotine needs

Your nicotine needs are now very real.

Two main options exist:

• nicotine salts at 10 mg/ml;
• or nicotine salts at 20 mg/ml if you vape occasionally.

If you prefer classic nicotine, a dosage of around 12 mg/ml often remains coherent.

Choosing the right dosage remains essential:

• too low → frustration and craving for cigarettes;
• too strong → discomfort and irritation.

Which device should you choose?

With moderate dependence, battery life becomes important.

It is generally recommended:

• at least 1200 mAh battery;
• a sufficient tank;
• a reliable device to last the whole day.

The tight MTL draw remains the most effective for optimising nicotine absorption.

An e-cigarette with too much airflow could:

• cause coughing;
• make the hit harsh;
• reduce nicotine effectiveness;
• increase the desire to smoke.

Why does MTL draw work better?

MTL ("mouth to lung") draw more closely resembles the sensation of a traditional cigarette:

• indirect inhalation;
• more discreet vapour;
• better nicotine efficiency;
• reduced e-liquid consumption.

For a moderately dependent smoker, this type of device often makes treating nicotine withdrawal easier.

To avoid: large airy e-cigarettes

DTL very airy e-cigarettes are rarely suitable for high nicotine dosages.

The greater the vapour:

• the more irritating nicotine becomes;
• the more e-liquid consumption increases;
• the more comfort decreases.

Fagerström test result: score of 7 to 10 points

Strong or very strong dependence

With a score of 7 to 8, tobacco dependence is strong.

Contrary to popular belief, heavy smokers are sometimes the most motivated profiles to stop smoking. After several years of tobacco consumption, many feel:

• significant fatigue;
• shortness of breath;
• reduced cardio fitness;
• psychological fatigue;
• a financial cost that has become heavy.

Cessation generally requires several attempts, but the motivation of the heavily dependent smoker can also become an extremely powerful driver.

Your nicotine needs

For strong dependence, it is often preferable to use:

• nicotine salts;
• at the maximum permitted dosage of 20 mg/ml.

This formulation allows:

• rapid absorption;
• better management of withdrawal;
• fewer strong cravings for cigarettes.

In this type of profile, under-dosing nicotine is often the main cause of failed cessation.

Which device should you choose?

The device must meet several key needs:

• significant battery life;
• reliability;
• tight draw;
• good nicotine delivery.

A minimum of 2000 mAh is generally recommended to avoid running out of battery during the day.

Some smokers also prefer to own two e-cigarettes:

• a primary one;
• a backup one.

This strategy greatly limits the risks of returning to tobacco in the event of a flat battery or a worn-out coil.

The best device profiles for strong dependence

MTL e-cigarettes remain the most effective:

• high-performance pods;
• cessation-oriented kits;
• tight draw;
• low consumption.

This type of device allows the smoker to rediscover a sensation close to that of a cigarette without generating an excess of vapour.

To avoid: shisha-type e-cigarettes

Very airy models are generally not suitable for high nicotine dosages.

The mixture:

• heavy vapour;
• high nicotine dose;
• direct inhalation

can quickly become uncomfortable and ineffective in the context of a serious smoking cessation programme.

Why is the Fagerström test still so useful today?

Even several decades after its creation, the Fagerström test remains a reference in the assessment of tobacco dependence.

This questionnaire allows:

• to obtain a quick score;
• to adapt the treatment;
• to guide smokers;
• to avoid dosage errors;
• to better understand one's cigarette consumption.

It remains used:

• during a medical consultation;
• at tobacco specialists;
• at a pharmacy;
• in specialist smoking cessation centres.

For vaping too, this test provides an excellent basis for adapting:

• the device;
• the nicotine dosage;
• the type of e-liquid;
• the rate of nicotine reduction.

How to gradually reduce nicotine?

Cessation does not necessarily mean an immediate stop of all nicotine.

Many smokers do better with a gradual reduction:

1. stabilisation with an appropriate dose;
2. moderate reduction after a few weeks;
3. gradual reduction down to 0 mg.

This strategy limits:

• frustration;
• stress;
• the risks of relapse;
• the feeling of withdrawal.

Tolerance to nicotine gradually decreases throughout cessation.

The most important thing: avoid under-dosing

Many smokers choose a nicotine level that is too low for fear of becoming "too dependent".

Yet under-dosing often leads to:

• significant frustration;
• permanent cravings to smoke;
• dual cigarette/vape use;
• a failed smoking cessation.

Nicotine used in an e-cigarette remains first and foremost a tool for treating tobacco dependence.

The real problem remains the combustion of cigarettes and the thousands of toxic substances produced by burning tobacco.

Knowing yourself better to quit smoking more effectively

The Fagerström test remains an extremely useful tool today for any smoker wishing to undertake a serious smoking cessation programme. Thanks to this simple questionnaire, it becomes easier to assess one's dependence, determine nicotine needs and choose an e-cigarette genuinely suited to one's profile.

Whether it is a low, moderate or strong dependence, there are today effective solutions to guide every smoker towards a lasting reduction in tobacco use. A good device, a coherent dosage and a progressive strategy remain the key elements of a successful quit.

The most important thing is not to stop perfectly on the first attempt, but to build a stable and realistic cessation. Every cigarette not smoked already represents significant progress.

Finally, do not hesitate to complement your approach with a consultation with a healthcare professional specialising in the treatment of smoking. Doctors, pharmacists and tobacco specialists can effectively support you in adapting your cessation and increasing your chances of success.