“I’m both smoking and vaping”: a longitudinal qualitative study of US young adults who tried to quit smoking cigarettes by using electronic cigarettes

Abstract

ObjectiveTo describe how young adults use electronic cigarettes (electronic nicotine delivery systems (ENDS)) for smoking cessation and reasons why they may or may not successfully quit smoking.MethodsLongitudinal qualitative data were collected annually from 2017 to 2019 for 25 young adult tobacco users (aged 18–29 years) in California (USA) who used ENDS to quit/reduce smoking. Thematic and trajectory analyses were used to identify key within-person and between-person changes in tobacco/nicotine use over time.ResultsFive types of tobacco use transition were identified among baseline dual users of cigarettes and ENDS:sustained dual use without reduced smoking(n=8),transition to exclusive daily ENDS use(n=6),sustained dual use with reduced smoking(n=5),transition back to exclusive smoking(n=4) andtransition to neither smoking nor vaping(n=2). Participants’ ENDS use behaviour varied over time in terms of vaping quantity and device characteristics (eg, changing nicotine concentrations/flavours, switching between multiple devices). Three themes that related to successfully replacing cigarettes with ENDS wereperceived positive physical effects, perceived satisfaction and enjoymentandcontext changes. Four themes for unsuccessful replacement wereperceived negative physical discomforts, perceived addictiveness and harm,unsatisfactory substitution for cigarettesanddevice malfunction.ConclusionsYoung adults’ experiences with using ENDS as a smoking cessation aid were highly variable. Adequate nicotine delivery and perceived safety and benefits contributed to successfully reducing or quitting cigarettes. Providing behavioural counselling and standardising ENDS products may enhance cessation for young adults.