Playful consumption, serious concerns: navigating risks and normalization in Chile’s e-cigarette unregulated market

Background

Despite legal restrictions, e-cigarette use is rapidly expanding in Chile, driven by informal sales and weak enforcement. Classified as pharmaceutical products, e-cigarettes are technically prohibited for commercial sale without health authority approval. However, widespread access and appealing product features have contributed to their social normalization (e.g., perceived as a common or an acceptable practice). This study aims to explore e-cigarette related behaviors and perceptions in the absence of clear institutional guidelines and oversight.

Methods

This qualitative study draws on 18 in-depth, semi-structured interviews conducted between May 2024 and May 2025 with adult users and adult informal sellers of e-cigarettes in the Metropolitan Region of Chile. Participants were recruited through snowball sampling. Data were transcribed, anonymized, and analyzed thematically using an inductive approach to capture participants’ motivations, perceptions of harm, and experiences navigating a largely unregulated vaping landscape.

Results

Three major themes emerged among adult users: (1) E-cigarettes were often introduced through peer influence and framed as a playful, socially embedded practice rather than a cessation tool; (2) Participants described high levels of normalization and visibility of e-cigarettes across public and private settings, even as they expressed ambivalence about health risks; (3) Most participants reported navigating a state of uncertainty fueled by inconsistent e-cigarette regulations, limited product labeling, and reliance on informal sources such as social media. The lack of clear legal guidance or public health communication contributed to both confusion and normalization of use in our sample.

Conclusions

Participants described a legal and informational ambiguity that enables normalization and downplays perceived harms. As the first qualitative study on adult e-cigarette–related behaviors in Chile, these findings provide timely insights that may be valuable for other Latin American contexts facing similar regulatory gaps.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-025-24936-x.

Highlights

• Vaping is framed as playful and normalized among adults in Chile.

• Users report uncertainty about product safety and legal status.

• Lack of regulation fuels normalization and risky consumption patterns.

• Stronger policies are needed to align vaping with public health goals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-025-24936-x.

Introduction

The rapid increase in the use of electronic cigarettes (e-cigarettes or ENDS) among young people has raised global concern among health professionals, policymakers, and educators. Promoted as a less harmful alternative to combustible tobacco and a potential smoking cessation tool [12, 19], e-cigarettes have gained popularity worldwide, particularly among adolescents and young adults. While some studies suggest e-cigarettes may pose fewer health risks than traditional cigarettes [19], the long-term effects of nicotine vaping (action of using an e-cigarette) remain uncertain, and growing usage among non-smokers has intensified debates about their safety, addictive potential, and regulatory implications [5, 11].

Globally, regulatory approaches to e-cigarettes vary significantly, ranging from liberal frameworks promoting harm reduction to total bans [23, 29]. In Latin America, this variability is especially pronounced. Countries such as Brazil, Mexico, and Uruguay have imposed bans on the import and sale of e-cigarette products, while others, like Chile, have adopted pharmaceutical classifications that prohibit their commercialization unless approved by national health authorities [9, 24]. The lack of harmonized policy in the region, has been exploited by the e-cigarette industry to market these products as “safer alternatives” and as tools for harm reduction, often using selective or distorted interpretations of international regulatory decisions [10].

Existing research in Latin America has primarily focused on prevalence data and regulatory reviews [10, 23], with limited qualitative insight into users’ experiences and motivations. Thus, there is a need to understand how e-cigarettes become embedded in everyday life, how users perceive risk, and how regulatory ambiguity influences behavior. Moreover, while studies in high-income countries have examined the role of e-cigarettes in harm reduction or youth initiation, far less is known about how these dynamics play out in contexts of weak enforcement and informal markets.

Chile offers a particularly illustrative case. Current legislation classifies e-cigarettes as pharmaceutical products [9] and restricts their sale and use in public spaces [6]; the law is poorly enforced. Vaping products, including e-cigarettes, cannabis vaping devices, and THC pens or “dabs”, are widely available through online marketplaces, physical stores, or informal channels. Law 21.642, passed in October 2023, and its transitional provisions introduced in 2025 represent an effort to bridge the regulatory gap for e-cigarettes [6]. This law, which came into effect in May 2025, prohibits the sale, distribution, or free delivery of tobacco and e-cigarettes to individuals under 18 years of age; restricts sales within 100 m from educational and healthcare institutions; mandates the inclusion of health warnings on the packaging and labeling of e-cigarettes (with or without nicotine) and vaping liquids; prohibits misleading advertising or messages suggesting health benefits; extends the ban on use in enclosed public spaces, public transportation, and beaches; and strengthens enforcement by the health authorities and other competent institutions [20]. However, additional significant gaps persist, including the lack of comprehensive standards for product quality, prohibited substances (such as caffeine or colorants), taxation schemes, a cap on the maximum nicotine concentration of e-liquids (short for electronic cigarette liquid composed by glycerin, flavorings, and usually nicotine) in the market, and consistent public education. Consequently, consumers navigate an ambiguous and under-regulated market in which e-cigarette is normalized as part of culture, yet remains surrounded by confusion, misinformation, and inconsistent institutional messaging, marked by a disconnect between public health communications and the wide body of scientific research.

Within this context, there is a pressing need for localized research that goes beyond prevalence estimates and investigates the broader social, behavioral, and perceptual dimensions of e-cigarette use. Despite the rapid growth of nicotine vaping across Latin America, most existing evidence comes from high-income countries, leaving a significant knowledge gap in how these dynamics unfold in low- and middle-income settings like Chile. The aim of this study is to explore how social, regulatory, and informational dynamics shape the use, perception, and normalization of e-cigarette use among adults in Chile, within the context of an unregulated and legally ambiguous market. To our knowledge, this is the first qualitative study to examine these dynamics in the country. We employ qualitative methods, particularly in-depth interviews, to uncover user’s perspectives often overlooked by survey-based approaches. By documenting users’ motivations, market accessibility, and perceived risks and benefits, this study contributes essential insights for the development of effective, context-sensitive policies. Such evidence is critical to help policymakers craft regulations that reflect lived experiences, address misinformation, and balance harm reduction goals with consumer protection. Without such evidence, Chile may face challenges in developing targeted measures that adequately reflect the realities of e-cigarette use in the country and across the region.

Methods

Overview

This qualitative study aimed to explore how social, regulatory, and informational dynamics shape the use, perception, and normalization of e-cigarette use among adults in Chile, particularly in the context of an unregulated and legally ambiguous market. To achieve this, we conducted an exploratory, interview-based study designed to capture the lived experiences and perspectives of adult e-cigarette users and informal sellers in Chile. Results are presented following the COREQ (COnsolidated criteria for REporting Qualitative research) guidelines (See Supplementary Material) [26]. This is the first qualitative study to explore the cultural and behavioral dimensions of e-cigarette use in Chile, where the Public Health Institute discourages their purchase, Congress is actively legislating their regulation, and yet e-cigarettes remain widely available and socially embedded.

The study was conducted in urban areas of the Metropolitan Region of Santiago, Chile, between May 2024 and May 2025, when data collection was completed. The setting reflects a relevant location for this research, as it concentrates much of the country’s informal e-cigarette market and includes diverse age and socioeconomic groups. The research team was composed of two female academic researchers (CSG, Ph.D., Universidad San Sebastián; TRJ, Ph.D., Universidad Mayor) and a male undergraduate research assistant (GA, B.S.), all with prior training in qualitative data collection and analysis within public health and social science research. The team maintained a reflexive approach throughout the study, acknowledging their academic interest in harm reduction, nicotine regulation, and social perceptions of substance use. To minimize bias, interviewers used open-ended, non-leading questions and engaged in regular debriefings to reflect on positionality, assumptions, and potential influence on the data collection process. Ethical approval was granted by the Ethics Committee at Universidad Mayor (N° 0447), which approved the protocol, and all participants provided written informed consent before taking part in the study.

Participants and procedure

Researchers CSG, GA, and TRJ conducted 18 in-depth individual semi-structured interviews between May 2024 and May 2025. We developed a semi-structured interview guide specifically for this study. The guide was informed by existing literature on vaping behaviors and harm reduction and was pilot tested with two participants to ensure clarity, relevance, and cultural appropriateness. Minor adjustments were made based on this feedback before proceeding with the full set of interviews. While the interview guide included questions about both nicotine and THC vaping, the present analysis focused exclusively on narratives related to e-cigarette use. During transcription and coding, any references to THC or cannabis use were excluded from this analysis, except where participants made explicit comparisons between the two substances.

Eligibility criteria for this study included adults aged 18 or older who (1) reported using e-cigarettes (both disposable and rechargeable) within the past 30 days and (2) resided in the Metropolitan Region (capital city) of Chile. Participants were contacted and recruited using snowball sampling, a non-probabilistic method in which initial contacts refer additional potential participants (C. [21]). Contact and recruitment were conducted through various channels, including social media platforms (Instagram, X, LinkedIn), word of mouth, WhatsApp (via shared contacts), and a university-wide email listservs. Posters were also placed in different universities across the city. Additionally, individuals seen using e-cigarettes in public spaces were approached and invited to participate in the study. Interested individuals first completed a screening form via Google Forms, which explained the goals of the study and participants inclusion criteria, it also included the laboratory website and the P.I.’s contact. Eligible participants were contacted directly via email. Of 38 people contacted, 21 interviews were conducted, with no repeat interviews. The other 17 contacted prospective participants either did not respond or did not have available time for the duration of our interview. Among the 21 interviewed participants, three were excluded: two for exclusively vaping THC and one for residing abroad and self-identifying as a pro-vaping activist.

Eighteen participants (49%) completed semi-structured interviews (seventeen were only users while one participant was a user and a seller). Six interviews were conducted in person at convenient, quiet, and private spaces for the participants, while twelve via Zoom. Written informed consent was obtained from participants before each interview. This institutional approved document detailed the project’s ID, goals, data obtention steps, including approval sections for taking notes and audio recording, data security measures, and ethics committee and PI contact. Each in-depth interview was conducted with CSG present and at least two of the other interviewers were present (TRJ or GA), lasted approximately 60 min and was recorded for transcription. Thematic saturation was reached after 18 interviews and was discussed between the three interviewers, as no new content or patterns emerged from additional data [2]. Interviewers’ backgrounds were taken into consideration as they might influenced data collection, therefore, to reduce bias, all interviews were conducted in pairs and followed a structured guide (See Supplementary Materials). All interviewers engaged in regular debriefings to reflect on their influence and ensure consistency. Participant’s transcripts were not returned to them for comments. As part of our protocol, participants were compensated with a gift card worth 5,000 Chilean pesos (approximately 5 USD) for each interview.

Our semi-structured interview guide focused on content/thematic analysis and explored various dimensions of e-cigarette use. Key topics included contextual factors such as motivations for initiation, first encounters with e-cigarettes, and peer influence. Participants were also asked about their usage patterns, including e-cigarettes and e-liquids preferred brands and flavors, use duration, concerns, as well as their purchasing habits and views on the sale and regulation of e-cigarettes in Chile. Additional questions addressed perceived health concerns, access to trustworthy information, and awareness on e-cigarette regulations.

Data analysis

All interviews were transcribed verbatim using a denaturalized approach that prioritized informational content over speech naturalism, checked for accuracy and anonymized by assigning unique participant codes to ensure confidentiality through the analysis process [1]. Transcripts were uploaded and analyzed using Dedoose software (version 9.2.22). To build familiarity with the dataset, members of the research team (CSG, FC, GA) read the transcripts in full, discussed preliminary impressions, and collaboratively developed a thematic coding strategy based on themes, subthemes, and ethical principles codes to provide more details of the diverse experiences reported. Each transcript was coded independently by three researchers (CSG, FC, GA) using a systematic case-by-case approach. Regular team meetings were held to compare coding decisions, discuss and resolve disagreements, and refine the codebook to ensure consistency and reliability across the dataset [7]. Discrepancies in coding were discussed in depth until consensus was reached. While we did not calculate a formal statistical measure of inter-coder reliability (e.g., Cohen’s kappa), agreement was achieved through iterative dialogue and constant comparison, guided by the shared codebook. Revisions were made to the codebook accordingly to improve consistency before applying it to the remaining transcripts.

We used an inductive thematic analysis approach, allowing for both anticipated and emergent themes to surface through close engagement with participant narratives [16, 18]. We employed thematic analysis to identify patterns across interviews, using both inductive and deductive coding strategies. The initial coding tree was developed based on recurring themes in participants’ narratives. As coding progressed, these categories were refined into three major thematic domains: (1) contextual and social drivers of e-cigarette initiation (e.g., peer influence, accessibility, curiosity); (2) perceptions of health risks and benefits associated with e-cigarette; and (3) concerns about e-cigarette product regulation, regulatory awareness and access to scientific information. Participants did not provide formal feedback on the findings; however, emerging themes were discussed iteratively among the research team to ensure interpretive coherence and alignment with participants’ narratives. Each thematic category comprised codes and subcodes that captured specific dimensions of e-cigarette use behaviors, motivations, risk perceptions, concerns and regulatory awareness. The coding tree, its sub-categories and relationship with quotes are available in Supplementary Table 1. The percentages reported in our results are intended to indicate how frequently certain themes and subthemes appeared across participant accounts, without implying statistical generalizability. Quotes presented in the results were translated from Spanish into English as literally as possible to preserve meaning and tone. The word “vape” or “vaping” was used by the participants to refer to the action of inhaling from e-cigarettes, while “vaper” was used to refer to the e-cigarette device.

Results

Our main findings were that for 66.6% of participants, e-cigarette initiation was framed as a playful experience, while 72% described nicotine vaping as a highly normalized and visible practice. However, 77.7% of participants reported uncertainty and mistrust, shaped by conflicting information and informal sources, which influenced how they perceived harm and contributed to the normalization of e-cigarette use in Chile. Participants ranged in age from 19 to 45 and included 14 women and 4 men. Their e-cigarette use experience spanned from a few months to several years, with varying use intensities, device preferences, and motivations. While some participants reported using e-cigarettes as a continuation of past tobacco use, others described e-cigarettes as a socially motivated or recreational behavior unrelated to smoking cessation. Table 1 presents the demographic characteristics of the interview sample (n = 18).

Table 1.

Demographics of the interview sample (n = 18)

	Participants
Demographics	% (N)
Gender
Females	77.8% (14)
Male	22.2% (4)
Age
18–24	27.8% (5)
25–34	50.0% (9)
35–45	22.2% (4)
Occupation
Student	11.1% (2)
Worker-student	16.7% (3)
Public area professional	11.1% (2)
Private area professional	38.9% (7)
Independent/Entrepeneur	22.2% (4)
Religion
Without religion	61.1% (11)
Christian-Catholic	22.2% (4)
Jew	16.7% (3)
District
High	55.6% (10)
Medium	44.4% (8)
Low	0 (0)

Thematic analysis of the interviews revealed a complex landscape of behaviors, perceptions, and tensions surrounding e-cigarette use within Chile’s unregulated market. Findings are organized into three major thematic categories that emerged from the data. Selected quotes, attributed by participant gender and age, illustrate key themes (see Supplementary Table 1). Overall, the results expose a core contradiction: while e-cigarette use is often framed as a harmless, modern practice, it coexists with underlying concerns about lack of regulation, and uncertainty regarding health risks; factors that complicate its growing normalization.

Playful e-cigarette use: appealing devices and the role of social influence in first use

E-cigarette initiation was commonly shaped by social influence, gift-giving, and a perception of the devices as harmless, playful, and non-serious. Many participants described their introduction to e-cigarette use devices as a light-hearted, social experience. Most reported encountering e-cigarettes in recreational or informal settings, such as parties or gatherings, where these devices were seen as visually appealing, novel, and non-serious (something perceived as harmless, casual, playful, or without real consequences). Among participants (66.6%, aged 19 to 45), e-cigarette initiation was framed more as playful experimentation than as a deliberate decision to replace cigarette smoking.

“The vape was like a phase, like a toy.” (29 years-old)

This participant refers e-cigarette use as a “phase” might be implying that this behavior was transitory or that it wasn’t meant to be permanent. Moreover, the participant adds by calling the e-cigarette device a “toy,” diminishing its perceived risk or substance, and it is associated with a fun experimentation phase.

“Sure, at first, I had that fake cigarette, which was basically nothing”. (45 years-old)

In this quote, the participant describes her first e-cigarette use experience as “basically nothing” and refers to the device as a “fake cigarette.” Her choice of words emphasizes how minimal or insignificant the experience felt at the time. The term “nothing” suggests that the device did not produce intense sensations or noticeable effects. By calling it a “fake cigarette,” she highlights that it lacked the qualities she associated with traditional smoking, perhaps in taste, strength, impact, social or moral weight. The description conveys a sense that e-cigarette use, in that initial encounter, did not leave a lasting impression and did not resemble what she understood as “real” smoking (i.e., tobacco cigarette smoking).

The two previous quotes reveal how e-cigarette use is initially framed as harmless, unserious, and even trivial, especially in contrast to traditional smoking. This perception may lower users' risk awareness and facilitate more frequent or habitual use over time, particularly in environments where e-cigarette use is normalized or encouraged.

In terms of the context in which e-cigarette initiation occurs, many participants described their first experience not as a deliberate decision, but as a moment shaped by curiosity and social influence. Friends and family members played a central role in this process, often being the first to introduce or demonstrate the e-cigarette device to others. In several cases (77.7%), initiation was facilitated through the act of gifting an e-cigarette vaping device, suggesting that participants' social networks viewed these devices as meaningful, thoughtful, or practical gifts, particularly for individuals who had previously smoked cigarettes or were trying to quit. This gesture implies that the giver believed the device was something the recipient would enjoy, appreciate, or benefit from; that it was less harmful than traditional cigarettes, and that it was socially acceptable, even fashionable. When given for occasions such as birthdays, e-cigarettes were framed not as risky substances but as normalized consumer products, aligned with modern trends and everyday use.

“My partner had a connection to it, because he gave me my first vape as a gift.” (41 years-old)

“I’ve bought it twice, and the first time it was given to me as a gift.” (27 years-old)

“Around 2017, more or less, my sister gifted me a device, a Vaporesso, for my birthday.” (39 years-old)

In our sample, a significant number of participants (83.3%) reported that their first contact with an e-cigarette came through someone they knew. One participant recalled the joyful and entertaining atmosphere of that moment:

"It was the best thing in the world because [a friend] was there having fun blowing little puffs of smoke.” (21 years-old)

Another participant described how exposure through a friend shifted her interest from traditional cigarettes to e-cigarettes:

"(…) And they kind of brought the vape, and I was like, 'oh, okay,' since I always smoked cigarettes. And that’s when I started trying it, and then I started liking it” (22 years-old)

Even there is one participant that reported some peer pressure to try for the first time e-cigarettes.

“And look, I have my cousin, he told me, and my best friend, who also tried to get me into vaping like to infinity and beyond. I was like, “No, how annoying, I don’t like it, no, I don’t know.” And until, like I told you, a bit forcibly, in those two weeks I was with my cousin it was like, “Alright, fine.” (31 years-old)

This quote suggest how social networks, particularly close friends and family, can strongly influence e-cigarette initiation. The participant recalls persistent encouragement from her cousin and best friend, humorously described as “to infinity and beyond,” despite her initial reluctance and annoyance. Eventually, she gave in “a bit forcibly,” highlighting how repeated exposure and social pressure led to her first use. This example shows how e-cigarette can begin passively, shaped more by social dynamics than by individual motivation or intent.

Making e-cigarette use normal: the role of visibility, popularity, and ambivalence about health risks

E-cigarette use was widely described as visible, socially accepted, and normalized, despite persistent ambivalence about its health risks. Many participants (72%) described e-cigarette use as a highly visible and socially embedded practice. Perceptions of ubiquity were common, with several interviewees asserting that “everyone vapes,” whether during work breaks, social gatherings, or daily commutes. Participants mentioned that e-cigarette use was common across a range of environments, reinforcing the idea that it had become normalized among both peers and strangers.

“Everyone vapes, they leave work, hit their vapes and all that.” (38 years-old)

“Man, at work almost everyone, and there are like 10 executives more than me.” (27 years-old)

This visibility contributed to a widespread perception that e-cigarette use is not only common but culturally accepted, particularly among younger generations. As one participant remarked:

“I mean, the 12-year-old kid, you know? they vape, so it’s like a millennial cigarette, it’s like a Gen Z cigarette.” (29 years-old)

The visibility and accessibility of e-cigarette use in public spaces, such as nightclubs, where devices are even sold onsite, extended to commercial spaces and further reinforced its perceived legitimacy and prevalence. In these spaces e-cigarette use was visible and even integrated into the venues themselves.

“There are more clubs where there are people smoking vapes and also where they sell vapes.” (21 years-old)

Participants also noted the popularity of specific e-cigarette products and brands as a reflection of how trendy and widespread the practice had become.

“No, honestly I don’t remember, but I know it was one of those vapes that were like really trendy, like the kind that everyone sold” (21 years-old)

For many, the decision of using e-cigarettes was influenced by peer behavior and a broader perception of social acceptance. One participant, who smoked cigarettes only occasionally, noted that e-cigarettes felt like a natural extension of a widespread trend:

“There was a time when vaping was super trendy, so to speak, like the whole vape thing, and I smoke cigarettes but very little, like socially, so I thought, well, since everyone is vaping, we might as well try it, and that’s how I started vaping.” (22 years-old)

Others observed how the high visibility of e-cigarette use in daily life, such as seeing people vape on the street or in stores, contributed to its normalization and made initiation seem like a common, low-barrier choice.

“Every time I go out, I see more people with a vape.” (19 years-old)

“I noticed how many people were using vapes, I’ve been noticing now because every time I go to buy a refill, like, they’re out of stock.” (31 years-old)

Some participants expressed concern about how this normalization affected younger users, pointing to both the intensity and early age of initiation.

“I think these elements are dangerous too because consumption among minors is really intensive and also starts very early.” (30 years-old)

The same participant adds:

“The immediate access it implies, and the access everywhere is very early. So, it also makes you a more eager consumer.” (30 years-old)

Although participants did not consistently perceive e-cigarette use as a healthier alternative to cigarettes, their accounts revealed a state of ambivalence, uncertainty, and comparison, in which risk was not dismissed but often described as unclear or relative. Rather than framing e-cigarette use as entirely safe, many participants occupied a liminal space where harm was assumed but not well defined, an ambiguity that may contribute to its normalization. However, some users expressed outright concern:

“I think they’re worse than regular cigarettes (...) "Because it’s vapor. I feel like you’re putting moisture into your lungs.” (31 years-old)

“What I hear most, all this word-of-mouth stuff, is that vaporizers are worse than smoking tobacco (...) because of the humidity and for the liquid (...) but it is something I heard, not something that I have investigated.” (27 years-old)

Others highlighted the lack of scientific consensus, in comparison with combustible cigarettes, as a reason for doubt or cautious acceptance:

“I think it’s similar, no? Like, this is still new, and it hasn’t really been studied yet.” (19 years-old)

“Speaking of health, I think it’s much better than cigarettes.” (27 years-old)

For several participants (50%), the absence of immediate or visible harm led to more favorable personal assessments:

“In terms of my body and perception, the electronic cigarette is infinitely less harmful... individually speaking.” (39 years-old)

“Yeah, because cigarettes maybe won’t give you fungus, but they can give you lung cancer.” (21 years-old)

These two quotes illustrate how participants’ personal perceptions of harm contribute to the ambivalence surrounding health risks, which plays a key role in e-cigarette use social normalization. Rather than relying on scientific evidence, both participants assess harm based on subjective experience and relative comparison to cigarettes.

Others simply felt unsure, framing the risks as equal or hard to differentiate:

“[Do you think they’re more or less harmful than cigarettes… or just as harmful?] “I think it’s the same.” (22 years-old)

Participants described e-cigarette use as a highly visible and socially embedded practice, perceived as increasingly common and widely accepted across various settings and age groups. This everyday exposure, at work, in public, and in nightlife venues, reinforced the idea that e-cigarette use was a normal, even expected, behavior. For many, initiation was driven less by deliberate intent than by the sense that “everyone is doing it.” While some participants viewed e-cigarettes as trendy and socially convenient, perceptions of health risk were more ambivalent. Rather than consistently seeing e-cigarette use safer than smoking, participants expressed uncertainty, made relative comparisons to traditional cigarettes, or relied on personal experience to assess harm. Some believed e-cigarette use was equally or more harmful, while others perceived it as less damaging due to the lack of immediate effects. This state of ambiguity, where risk is neither entirely denied nor clearly understood, appears to facilitate social normalization, as users feel comfortable adopting a practice perceived as commonplace, culturally accepted, and not urgently dangerous.

Concerns in an unregulated e-cigarette market: how regulatory voids shape perceptions of harm

In the absence of clear regulation, labeling, or public health messaging, a 77.7% of the participants described navigating a landscape of uncertainty, marked by mistrust, conflicting information, and reliance on informal sources, that shaped both their perceptions of harm, and the normalization of e-cigarette use in Chile. Participants consistently voiced concerns about the absence of clear regulations surrounding nicotine vaping in Chile. While the products are widely available and openly sold, most users were unsure of their legal status or the responsibilities of health authorities in monitoring their sale and composition. This regulatory vacuum created a backdrop of confusion, prompting participants to question both the safety of the devices and the legitimacy of the market itself.

“I don’t really know if they’re legal or illegal. I imagine they are [legal] because there exist cigarettes [in the market] too.” (21 years-old)

“They lump it all in with tobacco regulation... There’s no differentiation. They want to regulate everything the same even though this could be a device to help people quit smoking.” (27 years-old)

This sense of institutional absence extended into concerns about e-liquids' quality and unknown content. Participants repeatedly expressed frustration about product transparency, particularly regarding ingredients and nicotine concentration.

“What does it have? What is it really? What’s in the liquid? What is it made of? What effects will it have? [we need] Real studies.” (39 years-old)

“Here, it’s like more generalized information, it’s not distinguished by device or liquid type.” (27 years-old)

In the absence of clear, product-specific guidance, users often found themselves in what one participant described as a kind of limbo, unsure of how to interpret or act on the limited and inconsistent information available to them.

“(…) So you’re like in that limbo.” (19 years-old)

While some users acknowledged that scientific studies exist, many noted that the findings are contradictory and difficult to interpret. Combined with the lack of public messaging, this led to widespread confusion over the potential risks and benefits of e-cigarette use.

“I’ve read papers saying it’s bad, that it’s less bad than cigarettes, others that say it’s worse” (38 years-old)

“It should be more visible, like what it can cause, because people consume it without knowing the risks they’re taking.” (21 years-old)

In the absence of trusted or centralized sources, social media and word-of-mouth became the primary channels through which users encountered information, though often in fragmentary or contradictory ways. Participants cited platforms like TikTok and Instagram as common sources of health warnings or anecdotal cases.

“I’ve seen TikToks of people whose lungs collapse and things like that from vaping, but personally I still breathe fine and everything.” (19 years-old)

“Actually, I’ve heard very little, or seen little about it in the media, maybe on TikTok or Instagram.” (21 years-old)

Some participants described how this environment of uncertainty and limited institutional presence contributed to the normalization of e-cigarette use through social exposure rather than evidence-based information.

“I think there’s very little information, or I haven’t seen people talking about it. People just normalize vaping.” (21 years-old)

Participants also reflected on secondhand exposure and health risks to others, particularly children. One user described searching online for guidance about passive e-cigarette vapor exposure and its effects on her younger sibling, only to find ambiguous or unclear results.

“I researched it because I have a four-year-old brother, so I Googled whether the vape did the same as cigarettes for passive smokers… and no, it said it didn’t. Or did it?” (19 years-old)

Another participant, a father of young children, expressed concern over residual nicotine in his clothing, noting that while such effects are well-documented for tobacco, they remain poorly understood for e-cigarette use.

“There was a fear because I hadn’t seen literature on nicotine fixation in clothes from vapes, but with tobacco it’s ultra studied.” (39 years-old)

This informational gap extended to perceptions of long-term health risks. Some participants described their own use as a personal experiment, voicing unease about consuming something whose effects remain largely unknown.

“It’s something like so, in quotes, “new,” that at least I consider myself like a vape experiment, if I keep vaping for another 5 years, I’ll see the effects.” (29 years-old)

“Honestly, I think they’re dangerous mostly because there’s not enough data to really understand what harm these devices can cause in the long run” (30 years-old)

Several participants also raised questions about e-liquid content and the possibility of contamination, often based on second-hand information or social media accounts.

“I’ve also noticed that there have been cases of people who have died from vaping, I think they are very particular cases, but I don’t know if they already had some kind of issue before, like a respiratory one, but yes, I did see that there are people who have died because of this vaping thing.” (21 years-old)

Although some participants saw e-cigarette use as a harm reduction tool, this belief was often overshadowed by the broader absence of information and institutional clarity.

“I feel like it’s a dangerous product as long as we don’t know. In the face of uncertainty, I think it’s dangerous.” (30 years-old)

This confusion also prompted more introspective concerns about health and consumption, particularly in the absence of standardized information or public health warnings.

“(…) what am I putting into my body?” (19 years-old)

Together, these accounts reflect how Chile’s unregulated e-cigarette market generates more than product availability, it generates uncertainty. Participants navigated what could be described as a “zone of epistemic uncertainty,” where personal interpretation, social influence, and scattered digital content replaced authoritative information. This highlights a pressing need for clear regulation and public messaging that addresses not only the legality and content of e-cigarette products but also their perceived and actual health risks.

Discussion

This study sheds light on how adults in Chile navigate the use of e-cigarettes within a policy landscape marked by weak enforcement, fragmented information, and social normalization. Our findings reveal a complex interplay between recreational appeal, social influence, and institutional ambiguity. E-cigarette initiation, in our sample, was frequently framed as playful and casual, introduced in social settings through peer networks or gift-giving, and often perceived as harmless or trivial. Over time, however, participants’ narratives reflected growing uncertainty and ambivalence regarding the health risks of e-cigarette use, particularly in the absence of clear labeling, public education, or scientific consensus. Many participants described relying on social media and anecdotal information to make sense of e-cigarette’s risks and benefits. Yet, this dynamic could reinforce perceptions of safety and helped embed the practice into their daily routines. As e-cigarettes became more visible and accessible, especially in nightlife and work settings, it also became normalized, with users describing it as a generational habit or socially accepted behavior. Crucially, this normalization occurred within what many participants described as a "limbo" or ambiguous state of legal and informational uncertainty, shaped by contradictory evidence and lack of regulatory clarity. These dynamics are in line with recent findings from Ecuador, where e-cigarette use is also widespread (27.9% ever-use) and normalization is taking place despite negative public perceptions and limited regulation [14]. Nonetheless, opposite results have been observed in regions where e-cigarette harm-reduction policies already exist such as the United Kingdom. This recent study found that conflicting information regarding e-cigarettes increased perceptions of harm among users, compared to official harm-reduction information [25]. Therefore, our findings suggest that in the absence of strong public health communication and enforceable policies, e-cigarette use behaviors in Chile are shaped less by regulation and more by social dynamics, unofficial messaging, and individual interpretations of risk. These issues suggest areas of concern for future regulatory consideration, particularly in contexts with similar market conditions.

Across interviews, participants consistently emphasized that e-cigarettes were often introduced in social settings, such as parties or through peer influence. In these contexts, e-cigarettes were not perceived as tools for nicotine replacement, but rather as recreational and socially embedded objects. This normalization phenomenon in our sample seemed to unfold within a liminal space shaped by two forces: effective unofficial branding, often spread through social media, that downplays the health risks of e-cigarettes compared to traditional cigarettes, and a lack of clear institutional messaging or oversight regarding product sales and quality. Thus, based on our interviews, it seems that regulatory gaps in Chile, have allowed flavored and luxury-styled products to proliferate, embedding e-cigarette use into environments such as clubs, workplaces, and even schools' establishments. This phenomenon develops within a current legislation that classifies e-cigarettes as pharmaceutical products [9] and restricts their sale and use in public spaces [6, 20].

Participants’ narratives reflected a consistent state of uncertainty regarding the legal status, health risks, and e-liquids' content. This uncertainty and anxiety were intensified by inconsistent scientific findings and the absence of clear public health messaging. This situation resembles what [3, 4] identifies as a “risk society,” where individuals confront emerging technologies, such as e-cigarettes, without reliable institutional guidance, leaving them to navigate risk through personal judgment and informal sources like TikTok, Instagram, or peer anecdotes. Moreover, within this regulatory void, participants operated in what [13] call a “zone of epistemic uncertainty,” where insufficient scientific authority prevents a clear understanding regarding these devices’ harm or benefit. Rather than viewing e-cigarette use as a safe or harmful device, participants expressed ambivalence: some perceived delayed or less immediate risks, while others admitted they felt “like an experiment” awaiting long-term outcomes; phenomenon that is consistent with many prior studies that have reported consistent low risk of bias towards these devices [17]. However, this liminal stance did not inhibit use in our sample. Instead, the lack of urgent, authoritative information softened perceived danger and permitted normalization. Participants felt more comfortable adopting e-cigarette use in their daily lives, not because of a strong belief in its safety, but due to the absence of clear risk signals. As [28] and [27] describe, liminality occurs when prior norms have eroded but new ones have yet to be established, creating a threshold space in which social behaviors become fluid and ambiguous.

As e-cigarettes gain visibility and they might become socially embedded, Beck’s theory suggests that e-cigarette use normalization delays the institutional response: regulatory frameworks lag behind the rapid popularization of the behavior, which in turn might create societal inertia that resists change [3, 4]. Yet, this inertia exists in tension with growing individual concerns about health effects, misinformation, and product safety. In this context, normalization is not merely the result of industry promotion or peer behavior, but is co-produced by the lack of coordinated scientific, regulatory, and public health interventions capable of reducing uncertainty and reshaping how risk is understood and acted upon.

This state of liminal uncertainty, where e-cigarette use is perceived as neither clearly safe nor overtly harmful (compared to tobacco cigarettes), further enables its social normalization, particularly in the absence of strong regulatory guidance. In our findings, e-cigarette was not simply framed as a recreational novelty, but as a widespread, normalized practice embedded in daily routines and collective behaviors. Such ambiguity, propelled by lack of labeling, warnings, or product standards, represents a critical policy concern. Participants described how “everyone vapes” (perceived as people of different backgrounds and ages) positioning e-cigarette use as a collective habit rather than an individual vice. This aligns with [22] notion of normalization as the point at which behaviors become routine, no longer requiring justification. Distanced from the stigma of smoking, e-cigarette use was described as clean, discreet, and socially acceptable, further reinforced by its strong digital presence, customizability, and lack of clear and strong institutional messaging.

While Law 21.642, passed in October 2023, and its 2025 transitional provisions represent a legislative attempt to address this gap [6, 20], participants’ concerns indicate a need for robust, enforceable policies that address product composition, importation information, sales channels, quality controls, youth access, and health, related consequences. Moreover, many users were unaware of Law 21.642 and its restrictions. The continued use of e-cigarettes in enclosed public spaces, despite explicit legal prohibitions, seems possibly reflect the associations between weak enforcement undermines and the credibility and effectiveness of existing regulations. Participants’ concerns point to the need for clearer, more visible policies addressing product content, youth access, and public health communication.

Latin America’s fragmented approach to regulating e-cigarettes has enabled the tobacco and vaping industries to shape public perception while also producing divergent national narratives about the risks and benefits of nicotine vaporizers [9, 10, 15, 24]. These inconsistencies have hindered regional coordination, making it more challenging to develop unified reforms or implement cohesive regulatory frameworks across countries. In Chile, as in much of the region, this fragmentation has led to a disconnect between the legal classification of e-cigarettes and their widespread commercial availability and use. This gap not only generates public confusion but also reinforces behaviors that are difficult to reverse. Perceptions of minimal harm, distrust in conflicting scientific evidence, and the normalization of everyday use and easy access have created a regulatory landscape that is increasingly misaligned with public health objectives. Findings from Ecuador further reinforce these concerns. In a study based on a convenience sample, participants expressed negative perceptions of e-cigarettes, despite their widespread use (27.9% reported ever using them and 19.4% were current users). The study also highlighted perceptions of increasing e-cigarette use among youth [14].This pattern highlights how regulations on age and indoor use restriction, yet insufficient sales oversight may accelerate normalization across the region.

Based on participants' experiences, our findings suggest a need for more comprehensive and clearly communicated regulation of vaping products tailored to Chile’s evolving social and market context. Participant responses reflect a perceived need for improvement in regulation and public messaging. For instance, they emphasized the need for clearer labeling on nicotine content and type, greater transparency around health risks, as well as more accessible and trustworthy information. Others expressed concerns about the appeal of flavors and marketing strategies of e-cigarettes in social media that target youth, as well as the easy access through online markets. These insights suggest some gaps that users encounter and that can help inform more grounded, context-sensitive regulatory approaches. While Law 21.642 (2023) represents an important step forward by establishing, for example, age restrictions, bans on use in enclosed public spaces, and updated labeling requirements, it still falls short in several critical areas [8].

Limitations

This study has limitations. First, the sample size was small (n = 18), composed predominantly of female participants (77.8%), and drawn exclusively from the Metropolitan Region of Chile (capital urban city). This limits the generalizability of the findings to other regions, genders, or demographic groups. However, as is common in qualitative research, the goal was not statistical representation but rather to explore diverse user experiences in depth. Importantly, the findings from this study have directly informed the design of a survey currently being implemented with over 250 adult users of nicotine vaping products. This is the first survey of its kind in Chile to include questions on motivations, consumption preferences, family context, social networks, regulatory awareness, and policy priorities; thus, expanding the reach and applicability of our initial qualitative insights.

Second, snowball sampling may have further introduced selection bias, as participants were likely to refer individuals within their own social or behavioral circles. Given our sample size, urban concentration, and use of snowball sampling, which might have captured participants already embedded in vaping-friendly social networks, our findings should be interpreted as exploratory. As a result, perspectives from individuals who use e-cigarettes less frequently, have discontinued use, or do not engage with typical social vaping settings may be underrepresented. Third, the study focused exclusively on adult users and did not include adolescents or non-users, whose perspectives are critical for understanding the full range of vaping public health implications. Fourth, the interview guide included questions about both nicotine and THC vaping, although the present analysis focused on nicotine-related narratives, there is a possibility that a few quotes or themes reflect dual-use experiences. Thus, despite efforts to exclude THC-specific content, some overlap in device types and terminology may have been introduced leading to interpretive ambiguity.

Finally, the cross-sectional design of our study limits our ability to capture evolving attitudes and behaviors over time, particularly in the context of recent regulatory changes in Chile. All health-related perceptions and product content descriptions obtained in our interviews were based on self-report and were not verified through clinical or laboratory measures.

Conclusions

E-cigarette use in our sample points out to a possible socially normalized behavior, perceived as low-risk and integrated into daily routines, despite its legal ambiguity. E-cigarette initiation occurred in recreational settings and was shaped by peer influence, attractive product design, and informal social norms. While some of our participants view e-cigarette use as a harm reduction strategy, most operate within a space of uncertainty, lacking clear information on health risks, product content, and legal status. This epistemic ambiguity, reinforced by weak regulation and inconsistent public messaging, highlighted the normalization of e-cigarette use, among our adult sample.

Our study suggested that normalization is not driven solely by industry tactics or consumer demand but is also sustained by institutional silence and the absence of robust regulatory oversight. Although recent legal efforts, such as Chile’s Law 21.642, aim to address these gaps, implementation and enforcement remain limited. According to participants narratives, we believe that in the absence of stronger regulation and enforcement, the normalization of e-cigarette use may continue to expand, even to younger populations.

This study contributes to the field by offering the first qualitative examination of e-cigarette behaviors and perceptions on a limited sample of Chile. By foregrounding the voices of users and informal sellers, it provides critical insights into how participants navigated risk, legality, and social norms in an unregulated market. These insights are particularly valuable for Latin American countries facing similar regulatory challenges and rising e-cigarette use trends. These findings may offer useful insights for policymakers in the region seeking to develop more context-sensitive harm reduction strategies that consider both product regulation and the social dynamics influencing use, yet they are not intended to be representative of the broader Chilean population. Efforts to address the normalization of e-cigarette use could benefit from coordinated, participatory public health approaches that reflect users lived experiences.

Authors’ contributions

CSG (corresponding author) led the conceptualization of the study, secured funding, conducted participant sampling and interviews, performed data analysis, drafted the initial manuscript, and oversaw revisions of the final draft. GA contributed to data analysis, drafting of the manuscript, and revision of the final version. FC supported participant sampling and data analysis and participated in drafting and revising the manuscript. TRJ conducted interviews and contributed to both the writing and revision of the manuscript. ACC contributed to the drafting and revision of the final manuscript. All authors read and approved the final version.

Funding

This study was funded by the Agencia Nacional de Investigación y Desarrollo (ANID), FONDECYT de Iniciación No.11240213.

CSG receives funding from the Millennium Science Initiative Program, Grant No. NCS2021_003.

TRJ receives funding from the Agencia Nacional de Investigación y Desarrollo (ANID) FONDECYT Regular No. 1231102 and Anillos No. ATE230065.

ACC receives funding from the Millennium Science Initiative Program, Grant No. NCS2021_003 and Agencia Nacional de Investigación y Desarrollo (ANID), FONDECYT regular No. 1240138.

Data availability

The transcript data generated and analyzed during this study are not publicly available to protect participant privacy, as they contain demographic and sensitive information related to substance use. Additionally, these data are part of a grant-funded research project and are currently undergoing further analysis for subsequent publications. Reasonable requests for non-identifiable methodological information may be considered by the corresponding author.

Declarations

Ethics approval and consent to participate

This study was approved by the Ethics Committee for Research on Humans of Universidad Mayor (Resolution No. 0447). All participants provided written informed consent prior to participation, including consent for audio recording and the use of anonymized quotes in publications. Ethical procedures were conducted in accordance with institutional guidelines and the principles of the Declaration of Helsinki.

Consent for publication

This manuscript includes anonymized excerpts from interview transcripts. All participants provided written informed consent for the use and publication of their responses, in accordance with the procedures approved by the institutional ethics committee.

Competing interests

The authors declare no competing interests.