How and Why Do Smokers Start Using E-Cigarettes? Qualitative Study of Vapers in London, UK

Abstract

The aims of the study were to (1) describe how and why smokers start to vape and what products they use; (2) relate findings to the COM-B theory of behaviour change (three conditions are necessary for behaviour change (B): capability (C), opportunity (O), and motivation (M)); and (3) to consider implications for e-cigarette policy research. Semi-structured interviews (n = 30) were conducted in London, UK, with smokers or ex-smokers who were currently using or had used e-cigarettes. E-cigarette initiation (behaviour) was facilitated by: capability (physical capability to use an e-cigarette and psychological capability to understand that using e-cigarettes was less harmful than smoking); opportunity (physical opportunity to access e-cigarettes in shops, at a lower cost than cigarettes, and to vape in “smoke-free” environments, as well as social opportunity to vape with friends and family); and motivation (automatic motivation including curiosity, and reflective motivation, including self-conscious decision-making processes related to perceived health benefits). The application of the COM-B model identified multiple factors that may lead to e-cigarette initiation, including those that could be influenced by policy, such as price relative to cigarettes and use in smoke-free environments. The effects of these policies on initiation should be further investigated along with the possible moderating/mediating effects of social support.

Electronic Cigarette Use among Current Smokers: A Pilot Qualitative Study

“…All accounts in these focus groups of first-time use of e-cigarettes included specific individuals, friends or family who influenced the initial trial. Consistent with previous research, 5,21 this study underscores the rule of social acceptability, “social opportunity,” and perceived improved social image in e-cigarette use. Given the importance of social influence on e-cigarette initiation, 14 continuous monitoring of social climate surrounding e-cigarette use and marketing will inform regulation policy, enforcement, and health communication.…”

“…4 A study of British smokers who had used e-cigarettes showed that initiation of e-cigarette use was influenced by social and psychological factors, such as using e-cigarettes with friends and family and the belief that e-cigarettes were less harmful than combustible cigarettes. 5 …”

Perceptions of harm from electronic-cigarette use among a sample of US Navy personnel

“…Studies have revealed that most believe that ECs are less harmful than cigarettes and even some believe that they are harmless [11][12][13][14] . Even when EC users have concerns about safety, there is a pervasive belief that ECs are a healthier alternative to cigarettes and that the harmful effects of cigarettes outweigh the consequences of EC use 12,15 . A study of health-care professionals and cessation counselors found that 83% believed ECs were healthier than cigarettes but still did not recommend them as a cessation technique; however recent evidence suggests that this positive belief is waning 16,17 .…”

“…Evidence indicates that healthcare providers are divided on EC-use-area prohibition with wide ranges of 16% to 62% favoring use in cigaretteprohibited areas 16,22 . The belief that ECs can be used indoors or where cigarettes are prohibited, such as in schools or at work, is appealing to smokers 8,11,13,15 . One study found that EC experimentation was 4 times higher in groups that believed ECs could be used anywhere 8 .…”

“…One study found that EC experimentation was 4 times higher in groups that believed ECs could be used anywhere 8 . Increased restrictions on cigarette use, especially in the context of unclear and variable EC regulations, may provide a motivation for individuals to try ECs and become regular EC users 15,18 . The role of perceptions and beliefs in behavior adoption is critical to understanding modes of intervention and cessation.…”