A qualitative study of e-cigarette use among young people in Ireland: Incentives, disincentives, and putative cessation

Lived experiences of stigma and altered self-perceptions among young people who are addicted to ENDS: a qualitative study from Aotearoa New Zealand

INTRODUCTION

Rising use of electronic nicotine delivery system (ENDS) among young people, especially those who have never smoked, has received considerable attention from the health community. However, fewer studies have examined the mental health impacts of ENDS use. We addressed this gap by exploring the stigma, altered self-perceptions and negative affect experienced by adolescents who assessed themselves as addicted to using ENDS.

METHODS

We interviewed 20 adolescents aged 16-18 who lived in Aotearoa New Zealand and assessed themselves as moderately or highly addicted to ENDS use. Using in-depth, semistructured qualitative interviews, we explored participants' experiences of addiction and its effects on their well-being. We interpreted the data using an inductive reflexive thematic analysis approach.

RESULTS

We identified four key themes. First, addiction to ENDS use adversely affected participants' physical and mental health. Second, addiction greatly diminished the pleasurable effects ENDS use first provided and participants who initially enjoyed using ENDS now felt unable to stop. Third, participants felt judged, stigmatised and belittled by others who did not understand their struggle with addiction. Fourth, they experienced several negative emotions, including self-blame, regret, disappointment and embarrassment that diminished how they saw themselves.

CONCLUSIONS

We extend earlier studies by probing the mental health burden ENDS use imposes on young people, offer new insights into how they experience addiction and outline potential policy responses. Measures reducing young people's access to ENDS are urgently needed alongside empathetic, youth-oriented cessation support.

Young people's experiences of addiction to nicotine vaping products: A qualitative analysis from Aotearoa New Zealand

INTRODUCTION

Young people who use nicotine-containing electronic cigarettes, or 'vapes', risk becoming addicted to these products. While several studies document dependency symptoms, few report in-depth qualitative analyses of addiction.

METHODS

We explored experiences of self-reported vaping addiction using in-depth interviews with 22 young people aged 16-20 years who vaped and lived in Aotearoa New Zealand. Our semi-structured interview guide probed participants' early experiences and how they progressed from experimentation to addiction and explored how addiction affected their perceptions and daily routines. We used an inductive reflexive thematic analysis approach to interpret the data.

RESULTS

Vaping's pervasiveness piqued participants' curiosity and encouraged trial. Most transitioned from experimentation to addiction within a couple of months; while a minority described a slower progression, nearly all felt irritable, angry or uncomfortable if they had to delay vaping. Intense cravings disrupted school and work routines and dictated how they spent their time. Many deeply regretted vaping and some suffered shame and embarrassment. These participants saw vaping as a threat to the well-being of younger youth, which they tried to shield from addiction.

DISCUSSION AND CONCLUSIONS

We go beyond earlier studies by probing the burden vaping comes to represent, offering new insights into young people's everyday experiences of vaping addiction. In addition to informing health promotion campaigns, our findings could inform policy directions. Understanding the speed with which addiction can occur, its impact on daily life, and the considerable regret many felt could help inform a more strategic and sorely needed approach to reducing youth vaping.

"I knew the effects the whole time." Examination of facilitators and barriers to quit vaping among adolescents

Despite declines in adolescent nicotine vaping during the COVID-19 pandemic, vaping continues to be a public health issue for many adolescents. Most studies on teen reasons for vaping and on barriers and facilitators of vaping were conducted prior to the pandemic. Because teen culture changes so rapidly, and because the pandemic had wide-reaching effects on teens and mental health, it is critical to have a current understanding what helps adolescents to quit vaping (facilitators), as well as what prevents them from quitting (barriers) in order to design effective and engaging interventions. The objective of this qualitative study was to examine reasons for vaping, and barriers and facilitators to quitting vaping among high school age (14-18 years old) students. Students (n = 28; 60.7 % female; 50 % White, 10.7 % Black or African American, 25 % Asian or Asian American, 3.6 % other non-Hispanic; 7.2 % Hispanic; 21.4 % former vapers, 78.6 % current vapers) were recruited online from four regions in the US and participated in one of five online focus groups. We conducted a content analysis of the focus groups using a team-based coding approach. The most frequently cited reasons for vaping were mood, peer influence, and boredom. Results also showed that the stigma of seeking treatment acted as a barrier to quitting vaping, while self-reflection acted as a facilitator. In addition, two factors, peer influence and health effects, served as both barriers and facilitators, depending on the context. Program developers can use this information to design engaging vaping cessation programs intended for adolescents.

Smoking cessation program preferences of individuals with chronic obstructive pulmonary disease: a qualitative study

AIM

To explore the views of tobacco-smoking chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap (ACO) patients on telehealth-based cessation programs and the role of e-cigarettes as an aid to quit smoking.

BACKGROUND

Tobacco smoking accelerates the progression of COPD. Traditional smoking cessation programs often do not entirely address the unique needs of COPD patients, leading to suboptimal effectiveness for this population. This research is aimed at describing the attitudes and preferences of COPD and ACO patients toward innovative, telehealth-based smoking cessation strategies and the potential application of e-cigarettes as a quitting aid.

METHODS

A qualitative exploratory approach was adopted in this study, employing both focus groups and individual interviews with English-speaking adults with diagnosed COPD or ACO. Participants included both current smokers (≥ 5 cigarettes/day) and recent ex-smokers (who quit < 12 months ago). Data were systematically coded with iterative reliability checks and subjected to thematic analysis to extract key themes.

FINDINGS

A total of 24 individuals participated in this study. The emergent themes were the perceived structure and elements of a successful smoking cessation program, the possible integration of telehealth with digital technologies, and the strategic use of e-cigarettes for smoking reduction or cessation. The participants stressed the importance of both social and professional support in facilitating smoking cessation, expressing a high value for insights provided by ex-smokers serving as mentors. A preference was observed for group settings; however, the need for individualized plans was also highlighted, considering the diverse motivations individuals had to quit smoking. The participants perceived online program delivery as potentially beneficial as it could provide immediate access to support during cravings or withdrawals and was accessible to remote users. Opinions on e-cigarettes were mixed; some participants saw them as a less harmful alternative to conventional smoking, while others were skeptical of their efficacy and safety and called for further research.

Effectiveness of an intervention program to develop e-cigarette control leaders at the University in Lampang Province, Thailand

INTRODUCTION

The use of e-cigarettes is increasing worldwide, especially among young adults. Due to the health risks, this study aimed to assess undergraduate students' e-cigarette use and attitudes toward them, and evaluate the effectiveness of an intervention program to develop e-cigarette control leaders at the University in Lampang province, Thailand.

METHODS

Participatory action research (PAR) was conducted among 46 undergraduate students. To assess the situations of undergraduate students' e-cigarette use and attitudes toward them, in-depth interviews were conducted with 18 of those students - nine users and nine non-users. The remaining 28 were student leaders who were given questionnaires and took part in focus groups to evaluate the effectiveness of the intervention program in developing e-cigarette control leaders. Descriptive statistics and the Wilcoxon signed rank test were used to analyze quantitative data. The qualitative data were analyzed using a thematic analysis of the content. This study took place at the University in Lampang province, Thailand, in 2023.

RESULTS

Regarding the use of e-cigarettes on the part of undergraduate students and their attitudes about their use, the majority of users stated that e-cigarettes were accessible, appealing, and more socially acceptable than conventional cigarettes. However, most non-users cited vapor smell and health impacts as their main reason for not using e-cigarettes. The intervention program to develop leaders in e-cigarette control could significantly enhance the leaders' knowledge (p<0.001) and attitude regarding e-cigarettes (p=0.001). After their anti-e-cigarette campaign, the soft skills and managerial abilities of the leaders in e-cigarette control improved, and the knowledge and attitude regarding e-cigarettes of undergraduate students who attended the campaign also increased.

CONCLUSIONS

The intervention program to develop leaders in e-cigarette control resulted in positive outcomes. This program could enhance the leaders' knowledge and attitude regarding e-cigarettes. Their soft skills and managerial abilities in e-cigarette control also improved.

Regional French evolution of tobacco and e-cigarette experimentation and use among adolescents aged 15-16 years: A cross-sectional observational study conducted in the Loire department from 2018 to 2020

Background

We assessed/compared the evolution of tobacco and e-cigarette experimentation and use among French adolescents of the Loire department aged 15-16 years.

Methods

A descriptive, cross-sectional/observational study conducted in 2018-2020 among 7,950 Year 11 pupils attending 27 public secondary schools of the Loire department, France.

Results

From 2018 to 2020, 66.18% of adolescents were "non-vapers and non-smokers", 19.76% were "vapers and smokers", 7.90% were "non-vapers and smokers" and 6.15% were "vapers and non-smokers". E-cigarette experimentation was more prevalent than tobacco experimentation (44.92% vs 41.67%), and daily vaping was less prevalent than daily smoking (5.40% vs 10.24%). More boys than girls were daily vapers or daily smokers. A decrease was observed in tobacco experimentation (from 41.22% in 2018 to 39.73% in 2020) and e-cigarette experimentation (from 50.28% in 2018 to 41.25% in 2020). Current vaping remained stable, with an increase in daily vaping. French adolescent vapers frequently use e-liquids with little or no nicotine or with fruit or sweet flavours.

Conclusions

Adolescents used e-cigarettes mainly for experimental and/or recreational purposes, with no intention of progression to daily smoking. Although the design of this study is not longitudinal and caution must be exercised, from our cross-sectional observational study data, it appears that the proportion of "non-vapers and non-smokers" tended to increase. "Smokers" tended to progress to the dual use of vaping and smoked tobacco, with the likely intention to reduce or quit smoking.

Investigating #vapingcessation in Twitter

Evidence suggests that an increasing number of e-cigarette users report intentions and attempts to quit vaping. Since exposure to e-cigarette-related content on social media may influence e-cigarette and other tobacco product use, including potentially e-cigarette cessation, we aimed to explore vaping cessation-related posts on Twitter by utilizing a mixed-methods approach. We collected tweets pertaining to vaping cessation for the time period between January 2022 and December 2022 using snscrape. Tweets were scraped for the following hashtags: #vapingcessation, #quitvaping, and #stopJuuling. Data were analysed using Azure Machine Learning and Nvivo 12 software. Sentiment analysis revealed that vaping cessation-related tweets typically embody positive sentiment and are mostly produced in the U.S. and Australia. Our qualitative analysis identified six emerging themes: vaping cessation support, promotion of vaping cessation, barriers and benefits to vaping cessation, personal vaping cessation, and usefulness of peer support for vaping cessation. Our findings imply that improved dissemination of evidence-based vaping cessation strategies to a broad audience through Twitter may promote vaping cessation at the population level.

E-cigarette use and conventional cigarette smoking among European students: findings from the 2019 ESPAD survey

BACKGROUND AND AIMS

Representative data on e-cigarette use among European adolescents are scant. This study reports current vaping and tobacco smoking individual and country-specific correlates among European students.

DESIGN

Cross-sectional survey: 2019 European School Survey Project on Alcohol and Other Drugs (ESPAD) collecting data on risk behaviours on a representative sample of 16-year-old students.

SETTING

A total of 35 European countries, 25-30 with Tobacco Control Scale (TCS) and TCS components PARTICIPANTS: A total of 99 648 students (49.1% males) turning 16 years in the survey year.

MEASUREMENTS

Data on current cigarette and e-cigarette use were gathered through a self-administered questionnaire which also collected socio-demographics and individual and family characteristics. ESPAD data were integrated with country-level data on TCS and selected TCS parameters to assess their association with the prevalence of current cigarette and e-cigarette use.

FINDINGS

Of the 99 648 participating students, 12.4% were current e-cigarette users, from 5.5% in Serbia to 41.4% in Monaco; 19.3% current smokers, from 5.1% in Iceland to 32.4% in Italy. Compared with non-users, current e-cigarette users less frequently came from an average well-off family [odds ratio (OR) = 0.85, 95% confidence interval (CI) = 0.80-0.90] and lived in countries with higher cigarette prices (OR = 0.71, 95% CI = 0.50-0.99), restrictive measures on tobacco advertising and promotion (OR = 0.79, 95% CI = 0.63-0.99) and intermediate implementation of tobacco control measures (OR = 0.57, 95% CI = 0.38-0.85). Current vapers were more frequently life ever smokers (OR = 7.31, 95% CI = 6.47-8.25), were early smokers (OR = 4.35, 95% CI = 3.66-5.17), males (OR = 1.61, 95% CI = 1.55-1.67), from non-traditional families (OR = 1.43, 95% CI = 1.34-1.53), with relatively low parental education (OR = 1.15, 95% CI = 1.10-1.20). Compared with non-smokers, current smokers had similar family characteristics to vapers, and were less likely to live in countries with higher cigarette prices (OR = 0.70, 95% CI = 0.49-0.99) and higher spending on public anti-tobacco media campaigns (OR = 0.23, 95% CI = 0.10-0.50).

CONCLUSIONS

E-cigarette use among European adolescents is associated with weaker tobacco control measures, particularly on tobacco price, advertising and promotion. Besides preventing tobacco smoking, the adoption of governmental tobacco control policies in European countries also seems to contribute to the prevention of vaping among adolescents.

Intentions and Attempts to Quit JUUL E-Cigarette Use: The Role of Perceived Harm and Addiction

INTRODUCTION

Research on electronic cigarette (e-cigarette) quit intentions and attempts is limited despite the potential health benefits of quitting, especially for long-term users. The current study aimed to investigate perceptions of harm and addictiveness and tobacco use characteristics associated with quit variables among users of a popular e-cigarette brand, JUUL.

METHODS

We surveyed 301 US adult JUUL users on their tobacco use characteristics, perceptions of JUUL harm and addictiveness, and quit variables at 3 time points, from July 2019 to April 2020. We used logistic regression models to assess demographic characteristics, smoking characteristics, and perceptions of JUUL harm and addictiveness as correlates of e-cigarette quit intentions, attempts, importance, and confidence.

RESULTS

Twenty-three percent of the sample had intentions to quit using JUUL within the year, and 22.6% reported making a lifetime quit attempt. The average rating of quit importance was 4.1 and quit confidence was 5.8 on a Likert scale of 1 to 10. More than 90% of the sample indicated that JUUL was at least moderately addictive, whereas less than one-quarter indicated that JUUL was as harmful or more harmful than smoking. Higher levels of perceived JUUL addictiveness were associated with more quit intentions, attempts, and importance. Higher levels of perceived JUUL harm compared with smoking were associated with more quit importance.

CONCLUSION

Our findings suggest that a small proportion of adult JUUL users are interested in quitting. Self-reported perceptions of JUUL's addiction potential may be related to more quit attempts. Findings highlight the need for evidence-based information on e-cigarette addictiveness and effective strategies for cessation.

Friends and family matter Most: a trend analysis of increasing e-cigarette use among Irish teenagers and socio-demographic, personal, peer and familial associations

BACKGROUND

E-cigarette ever-use and current-use among teenagers has increased worldwide, including in Ireland.

METHODS

We use data from two Irish waves (2015, 2019) of the European School Survey Project on Alcohol and other Drugs (ESPAD) to investigate gender and teenage e-cigarette use (n = 3421 16-year-olds). Using chi-square analyses, we report changes in e-cigarette ever-use, current-use, and associated variables. Using multivariable logistic regression, we analyse the increase in e-cigarette use and socio-demographic, personal, peer and familial associations, focusing on gender differences.

RESULTS

E-cigarette ever-use increased from 23% in 2015 to 37% in 2019, and current-use from 10 to 18%. Compared with 2015, the odds in 2019, of becoming both an e-cigarette ever-user and current-user, were significantly higher for girls than boys (ever-use: AOR 2.67 vs 2.04; current-use: AOR 3.11 vs 1.96). Smoking and e-cigarette use are linked but never-smokers who try e-cigarettes rose significantly from 33 to 67% and those using e-cigarettes to quit smoking decreased significantly from 17 to 3%. Almost two-thirds of respondents (66%) in 2019 said that their reason for trying e-cigarettes was "out of curiosity". Peer smoking is significantly associated with likelihood of e-cigarette ever-use (AOR 6.52) and current-use (AOR 5.45). If "Most/All friends smoke", odds were significantly higher for boys than for girls (ever-use AOR 7.07 vs 6.23; current-use AOR 5.90 vs 5.31). Less parental monitoring is significantly associated with greater e-cigarette ever-use (AOR 3.96) and current-use (4.48), and having parents who usually don't know where their child is on Saturday nights was also associated with significantly higher odds for boys than for girls (ever-use AOR 5.42 vs 3.33; current-use AOR 5.50 vs 3.50).

CONCLUSION

Respondents had significantly higher odds of being e-cigarette ever- and current-users in 2019 compared with 2015. Use is higher among boys but girls are increasingly at risk. Two-thirds had never smoked cigarettes at first e-cigarette use; two-thirds used out of curiosity but few (3%) for smoking cessation. The most prominent risk factors for e-cigarette use were peer- and parent-related, especially so for boys. Interventions that take account of friend and family influences may provide mechanisms for preventing an increasing risk of nicotine addiction.

E-cigarettes and smoking in Irish teens: a logistic regression analysis of current (past 30-day) use of e-cigarettes

Aim

Electronic cigarette (e-cigarette) use among Irish teenagers has risen significantly. In 2019, prevalence of current use (last 30 days) among 15–17-year-olds was 17.3%. We examine social determinants of adolescent e-cigarette current use.

Subject and methods

A stratified random sample of 50 schools in Ireland was surveyed in 2019, part of the European School Survey Project on Alcohol and other Drugs (ESPAD), with 3495 students aged 15, 16, and 17. Bivariate and multivariable logistic regression [providing adjusted odds ratios (AORs)] analyses were performed using Stata version 16.

Results

Current e-cigarette users were more likely to be male (AOR = 0.55, 95% CI:0.32–0.96, p < .01), younger (AOR = 0.34, 95% CI: 0.17–0.67, p = < .05), to participate in sport (AOR = 2.21, 95% CI: 1.05–4.65, p < .05), to have higher-educated parents (maternal higher education: AOR = 27.54, 95% CI: 1.50–505.77, p = < .05, paternal higher education: AOR = 2.44, 95% CI: 1.00–5.91, p < .05), and less likely to consider their families better off (AOR = 0.29, 95% CI: 0.13–0.65, p < .01), or to report familial support (AOR = 0.78, 95% CI: 0.64–0.95, p < .05). They were more likely to be cigarette smokers (AOR = 7.22, 95% CI: 3.97–13.12, p < .001), to report problem cannabis use (AOR = 3.12, 95% CI: 1.40–6.93, p < .01), to be ‘binge’ drinkers (AOR = 1.81, 95% CI : 1.00–3.32, p = .054), and to have friends who get drunk (AOR = 5.30, 95% CI: 1.34–20.86, p < .05).

Conclusion

Boys, smokers, binge drinkers, problem cannabis users, and sport-playing teenagers from higher-educated families, are at particular risk. As the number of young people using e-cigarettes continues to rise, including teenagers who have never smoked, improved regulation of e-cigarettes, similar to other tobacco-related products, is needed urgently to prevent this worrying new trend of initiation into nicotine addiction.