A qualitative examination of e-cigarette use among California young adults during the EVALI outbreak

Abstract

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.

Cannabis Vape Product Sales in California Following CDC's Initial Advisory About Lung Injuries

“…A recent qualitative study on why younger adults continued to use ENDS throughout the EVALI outbreak (24) may shed light on our findings of the group's persistent use. Yang et al (25), which remained high and even exceeded negative sentiment in the summer of 2019.…”

Non-compliance with university tobacco-free policies: A qualitative exploration

“…Studies have shown that colleges rarely communicate e-cigarette risk information or distinguish them in information about university tobacco-free campus policies 33 , yet appropriately tailored messaging about e-cigarette risk may increase perceived harm from e-cigarette use and emissions 34 . For example, in relation to user perceptions in response to the 2019 outbreak of lung injury associated with the use of e-cigarette, or vaping, products (EVALI), which coincided with this period of data collection, a separate study published by the authors found that college respondents using e-cigarettes engaged in various cognitive processes and a range of risk rationalizations in order to justify continued use 35 . Hence, tailored policy rationale, outreach materials, and communication campaigns should be developed for each product type covered under a smoking policy to account for difference in risk perception and use patterns.…”