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

Background and aims: Vapes (E-cigarettes) are the most popular consumer choice for support with smoking cessation in countries where use is permitted. However, there are concerns that long-term nicotine vaping may sustain concurrent tobacco smoking or ultimately lead to smoking relapse. In this article we explore longitudinal vaping trajectories, establishing user perspectives on continued vaping in relation to smoking relapse or abstinence. Design: Qualitative longitudinal study collecting detailed subjective data at baseline and approximately 12 months. Participants (n=37) self-reported that they had used vaping to stop smoking at baseline. 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: The data show three key pathways: ‘maintainer’ (vaping and not smoking), ‘abstainer’ (neither smoking nor vaping), and ‘relapser’ (dual-using, or relapsed back to tobacco smoking only). In each pathway, individual experiences with vaping nicotine are critical, being heavily influenced by social and cultural factors. A context supportive of vaping was important, for the maintainers, as was 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 about dependence on tobacco. There is a need to offer alternative strategies for triggers such as stress. Information about changing nicotine strengths in order to prevent cravings and cope with stressors would be beneficial. Conclusions: Supporting continued vaping may decrease vulnerability to tobacco smoking relapse, through maintaining use of nicotine. Vapers require frequently updated evidence-based advice on safety to support harm reduction beliefs. Those who struggle to find a satisfying and effective vaping set-up need greater support. Those who wish to quit vaping need evidence-based information about effective ways to do this, without increasing vulnerability to tobacco relapse.