User pathways of e-cigarette use to support long term tobacco smoking relapse prevention: A qualitative analysis

Background and aims

E‐cigarettes are the most popular consumer choice for support with smoking cessation in the United Kingdom. However, there are concerns that long‐term e‐cigarette use may sustain concurrent tobacco smoking or lead to relapse to smoking in ex‐smokers. We aimed to explore vaping trajectories, establishing e‐cigarette users' perspectives on continued e‐cigarette use in relation to smoking relapse or abstinence.

Design

Qualitative longitudinal study collecting detailed subjective data at baseline and ~12 months later.

Setting

United Kingdom.

Participants

E‐cigarette users (n = 37) who self‐reported that they had used e‐cigarettes to stop smoking at baseline.

Measurements

Semi‐structured qualitative interviews (face‐to‐face or telephone) collected self‐reported patterns of e‐cigarette use. Thematic analysis of transcripts and a mapping approach of individual pathways enabled exploration of self‐reported experiences, motives, resources, and environmental and social influences on vaping and any concurrent tobacco smoking.

Findings

Three broad participant pathways were identified: ‘maintainer’ (e‐cigarette use and not smoking), ‘abstainer’ (neither smoking nor using e‐cigarettes), and ‘relapser’ (dual‐using, or relapsed back to tobacco smoking only). In each pathway, individual experiences with vaping nicotine appeared to play an important role and appeared to be related to psychological and social factors. A social context supportive of vaping was important for the maintainers, as was a belief in the need to overcome nicotine addiction for the abstainers, and dislike of the ‘vaping culture’ expressed by some in the relapser group. Dual‐users held beliefs such as a need for cigarettes at time of acute stress that affirmed dependence on tobacco.

Conclusions

In a sample of UK e‐cigarette users who report having used e‐cigarettes to quit smoking, a social context that supports continued vaping was perceived to be helpful in preventing relapse to smoking.