The 2019 outbreak of E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) increased awareness of potential health risks associated with vaping among the general public. Little is known, however, about how unfolding information regarding EVALI affected knowledge, attitudes, and behaviors among e-cigarette users, particularly among young adults. This study describes attitudinal and behavioral responses to EVALI among young adult e-cigarette users. In October and November 2019, seven focus groups were held with college-going young adult tobacco users from two four-year public universities in California. Focus groups included questions regarding knowledge of and reaction to EVALI news, and how the news affected product use. Text from current e-cigarette users was extracted to develop individual phenomenological textural-structural descriptions of e-cigarette use for 38 individuals which were used to create a composite experience of e-cigarette use in light of EVALI. Experiences indicated that e-cigarette users were aware of information regarding EVALI and received information from numerous sources. Information was filtered for legitimacy of EVALI claims and causes of EVALI. Risk rationalizations were developed to assess potential harm of continued e-cigarette use and provided reasoning for behavioral responses to EVALI. The emerging harm associated with EVALI prompted e-cigarette users to engage in a cognitive process resulting in employment of a range of rationalities to justify continued use. These results suggest how environmental, cognitive, and behavioral factors may interact as young adults negotiate e-cigarette-related harms.

INTRODUCTION Though university smoke-free and tobacco-free campus policies have been proliferating across the US, compliance and enforcement remain challenges. This study examined perceptions and behaviors of employees and students who used tobacco products on tobacco-free campuses, to better understand policy noncompliance. METHODS Students (n=56) and employees (n=20) from two tobacco-free 4-year public universities in Southern California who self-reported using tobacco products on campus participated in focus groups, stratified by university and student or employee (faculty and staff) status, to discuss attitudes toward campus tobacco policies and on-campus smoking. Focus group discussions were transcribed and analyzed after structured coding and subcoding. RESULTS Participants were generally aware that smoking and vaping were not allowed on campus, though few could correctly identify their campus as tobacco-free. Attitudes toward the policy varied by subgroup and by campus, with students and employees at different universities expressing varying levels of support. Noncompliance was a unique interaction of individual, institutional, and interpersonal factors including a desire to smoke or vape to reduce stress, lack of formal enforcement or penalty for violating the policy, and efforts to smoke or vape in ways that reduce harm to others as a way of rationalizing non-compliance. CONCLUSIONS Attitudes toward university tobacco-free policies are campus-and constituency-specific, with similarities in individual, institutional, and interpersonal factors underlying non-compliance. Interventions to increase compliance should address individual, institutional, and interpersonal influences on non-compliance through efforts tailored to specific campus constituencies based on their particular knowledge and attitudes towards tobacco-free policies.