Social Influences Across Vaping Trajectories of Female Tertiary Students

ABSTRACT

Introduction

Vaping prevalence has risen rapidly among young people in Aotearoa New Zealand. This study aimed to explore social influences (e.g., norms and acceptability among peers), focusing on female university students, using a trajectory approach.

Methods

This qualitative research was set in Canterbury, New Zealand; six friendship dyad interviews (semi‐structured) were conducted with 12 female tertiary students aged between 18 and 24 who vaped at least daily. Data were thematically analysed.

Results

The young women in this study report finding ENDS attractive, and particularly noted social influences, flavours, device characteristics and mood management as important for both initiation and on‐going vaping. Gendered findings were identified, including ‘pinkification’ and device modification. Influences shifted across trajectories as addiction and dependence developed, and harms were experienced, with participants identifying barriers to vaping cessation.

Discussion and Conclusions

Policy such as stronger restrictions on flavours and visual characteristics of ENDS should be considered to reduce the appeal of vaping to young women. There is a need for stigma reduction surrounding vaping addiction and dependence, and peer support may improve cessation engagement and efficacy for young women. This research explores trajectories of young women's vaping from before first use, to experimenting, progressing to daily use and considering cessation. Throughout this trajectory, social influences form a significant influence on behaviour, emphasising the importance of considering social aspects in health promotion efforts. This study provides new insights on vaping in a tertiary education context and identifies gendered aspects of vaping through the focus on young women, which can then inform health promotion efforts.

Research Highlights

• Social influences encourage experimentation and on‐going use of vaping products. Peers facilitate access to vaping products and encourage use where vaping is perceived as normative.

• Factors influencing vaping shift as trajectories of use progress and as addiction or dependence develops.

• Young women experience harms associated with vaping, yet struggle to access appropriate cessation support.

1. Introduction

Electronic Nicotine Delivery Systems (ENDS), often called vapes, are vaporising devices used for nicotine consumption. Because ENDS use a heating method for nicotine delivery and do not contain tobacco, they are thought to be, and are marketed as, less harmful than tobacco cigarettes [1, 2, 3]. Though evidence of longer‐term health outcomes is still developing, vaping can result in acute harms to young people. This includes increased prevalence of chronic respiratory diseases [4], shortness of breath or throat and mouth irritation [5]; psychological harms, negative self‐perception including self‐blame, embarrassment and disappointment [6]; social harms, where relationships are damaged by substance use, or young people are excluded from school [7]; and financial harms, the cost associated with on‐going purchasing of vaping products [8]. On‐going ENDS use can result in nicotine dependence, where cessation results in withdrawal symptoms [9]. Young people who vape are at risk of developing cravings within a few weeks of on‐going use [10]. Prevalence of vaping has increased rapidly among young people in Aotearoa New Zealand (ANZ) since the introduction of vaping products to the market in 2018. Among 18–24 year olds, daily vaping has risen 22.1% between 2018/19 and 2023/24 while across the same time period, daily vaping among the total population (15+) has increased by only 7.8% [11]. The prevalence of vaping between men and women is relatively similar at 26.2% and 26.8% respectively among 18–24 year olds [11], however, gendered differences in motivations for use, patterns of use, flavour preferences and outcome expectations are emerging [5, 12]. Gendered differences in marketing have also been noted [12], following trends seen in tobacco cigarette and alcohol marketing [13, 14]. Although differences in vaping by gender are emerging, most female‐specific literature focuses on the impact of vaping on female reproductive health [15, 16, 17]. Further, women's substance use has historically been positioned as more deviant than men's substance use leading to underrepresentation of women's voices in this area of research [18, 19]. These gendered contexts informed the decision to focus on women's experiences in this research.

A low smoking prevalence among 18–24 years olds alongside a climbing prevalence of vaping raises concerns that young people are vaping despite being non or never smokers [20]. Increasing prevalence [11], evidence of inequitable use [11], and potential for acute and chronic harm [5, 8, 10] make vaping a relevant public health issue in ANZ.

Substance use trajectories locate young adulthood as a period where experimentation and the risk of negative outcomes increases [21]. Health messaging is less salient at this time than at other life stages [22]. A range of influences play a role across substance use trajectories, from initial experimentation, on‐going use and cessation [23]. Therefore, exploring these influences on vaping at a time when substance use tends to increase is valuable. Commonly identified factors for experimenting with ENDS include social influences, flavours and device characteristics [24, 25]. Social influences are frequently cited as the main reason for experimentation with vaping among non‐smoking young people; particularly through perceived norms, acceptability and pervasiveness among peers [26, 27]. Flavours are another key driver of experimentation; while former smokers tend to prefer tobacco, mint and menthol, young people are drawn to fruity and sweet flavours [28, 29]. Several studies have reported that young people tend to perceive fruity flavoured vaping products as having less negative health impacts than tobacco flavoured vaping products [30, 31]. Following experimentation, on‐going use can be influenced by enhancement or coping factors. Enhancement factors increase positive mood, while coping factors alleviate negative mood [23]. More than one factor can be in play at a time, and factors may shift as addiction and dependence develops.

The importance of social influences during young adulthood, and for experimenting or on‐going vaping highlights the advantage of qualitative research that centres young people's voices and experience. Social influences for substance use are particularly important among young women [32, 33]. Several qualitative studies on young people's vaping have been carried out [6, 26, 27, 34, 35], however, given the relative newness surrounding ENDS, several knowledge gaps remain. Existing research largely focuses on a younger age group [10, 36, 37, 38], and focus on the 18–24 age group is less common [39]. While vaping tends to start in secondary school, it often continues into tertiary education settings, which introduces unique contexts of use. Finally, gender‐specific literature on vaping tends to disproportionately focus on women's reproductive capacity, highlighting the importance of exploring diverse aspects of women's ENDS use.

This study aims to address these gaps by exploring how young women begin vaping, influences on on‐going use, and their experiences of addiction and dependence. Given the clear importance of social influences on young people's vaping, there will be a strong focus on these across the paper.

2. Methods

Social constructionism was used as the guiding framework for this research, with the concept of knowledge being developed and communicated within human interaction lending itself to exploring social contexts of young women's vaping. The principles of social constructionism further informed the use of friendship dyad interviews in this research [40].

A key step in this research was ensuring person‐centred and strengths‐based language was used to ensure a safe experience for participants. It was made clear to participants that the purpose of the research was not to stigmatise or judge their choices, but rather to give meaningful voice to their experiences. Efforts have been made to ensure participants' quotes carry similar weight, although there may be some difference based on engagement across interviews.

2.1. Participants

Participants were female tertiary students aged between 18 and 24, who began using ENDS daily while at university. Recruitment was carried out at the University of Canterbury (the largest University in the South Island of New Zealand). The study was advertised through physical posters displayed on the UC campus and the ‘UCSA Noticeboard’, a large Facebook group used by UC students. Participants were intentionally recruited in pairs with an existing friendship. Basic demographic information was collected through a Qualtrics form. Participants named their intended interview partner who also completed the form to ensure voluntary participation. Written consent was obtained and each participant was thanked with a $30 (NZD) supermarket voucher. The 12 women who participated were aged between 19 and 23 years of age and were predominantly of NZ European ethnicity (n = 11). They were studying across a range of disciplines including education, engineering, psychology and science. Participants' quotes in the results sections are followed by a notation in parentheses including a pseudonym and the number of the dyad interview in which they participated, for example, (Hannah, d1).

This research was approved by the Otago Human Ethics Committee (24/0226 UOHEC) and the Māori Health Research Committee.

2.2. Interviews

Dyad pairs offer unique strengths for data collection such as the interactions between participants [41], and the centring of co‐construction of knowledge around the participant pair [42]. Participants as the experts benefitted this research by allowing for exploration of themes potentially missed by the researcher (non‐vaper) and reducing the risk of perceived stigma.

Interviews were conducted in‐person, in private rooms at the University of Canterbury campus during June and July 2024. A semi‐structured interview guide was followed. Given the relevance of substance use trajectories to the participants' age group [21], a timeline approach informed the interview guide. This involved questions which explored vaping trajectories from prior to vaping, to first time vaping, to how the progression to daily use occurred. The longest interview ran for 69 min, the shortest for 43 min. The mean interview run time was 57 min.

2.3. Data Analysis

Data were analysed through the process of thematic analysis [43]. NVIVO 14 software [44] was used for coding. Early coding was largely deductive, drawing on relevant theories in drug and alcohol literature such as the Motivational Model for Alcohol Use [45] and Social Learning Theory [46]. Later stages of coding were inductive to identify interpretive and overarching themes. Codes were identified and organised into draft themes and sub‐themes, before being refined to create a cohesive narrative. GS carried out the coding; codes and themes were discussed with RC and HF throughout the analysis.

3. Results

3.1. Trajectory of Young Womens' Vaping

This section provides an overview of the trajectory of young women's vaping from prior to vaping, to their experience of vaping for the first time and the progression to daily use. At the time of interviews, all 12 participants had progressed to daily use, although three had not made cessation attempts or planned to reduce or quit vaping.

3.1.1. Prior to Vaping

Three participants were first exposed to vaping as adolescents through parents or older family members vaping.

My mom and my stepdad vaped quite a bit when I was younger. Maybe early teens or something. (Martina, d6).

Other participants' exposure to vaping occurred during the final years of secondary school through peers who used ENDS. Older participants reported less exposure to vaping in secondary school than younger participants.

I left high school and then all of a sudden, she's telling me about all these stories of kids vaping in classrooms and teachers having no control over it because there was so many. I was there last year, what do you mean, we didn't even have vapes then? (Hannah, d1).

Several participants recalled that prior to vaping themselves, they had negative perceptions of peers who vaped, highlighting an aspect of the stigma the young women later felt as vapers themselves.

I remember hearing stories about people who would be caught vaping in the bathroom and that kind of thing, and I thought it was just a looser‐y habit. (Kaia, d5).

However, others had more neutral perceptions of peers who vaped.

We had a very diverse friend group and we were friends with different types of groups. But there were a few people that we knew that vaped but we didn't really see the big deal of it? (Jordan, d2).

Increased visibility of vaping and personal connections with vaping peers appeared to mitigate initial negative perceptions and cultivate an openness to experimenting with vaping.

3.1.2. Vaping for the First Time

Vaping for the first time occurred across a range of settings including the family home, a friend or partner's home, public parks and parties. Access to ENDS was generally facilitated by peers, and the normalisation of sharing vapes created an organic and casual environment for participants to vape for the first time.

I was hanging out with our friend … she offered it to me one time, so I had some. But we were just kind of hanging around … It was just like oh, ‘do you want to try’ and like, OK, yeah. (Julia, d2).

For some, the first time vaping was unpleasant.

I was coughing and spluttering and I remember thinking who would ever like this? I'll never do this again. (Iris, d5).

In contrast, other participants recalled a positive experience of vaping for the first time. Head spins and a nicotine rush were commonly identified as pleasurable.

My sister gave me her vape and it was a big chunky vape and it had a lot of nicotine in it and I hit it, and I died! The thing is, I loved it, and I loved the feeling of that euphoric sort of 20 s high (Jordan, d2).

Several of the older participants vaped for the first time before restrictions on nicotine content were introduced, although higher nicotine content did not always facilitate a positive experience.

I know sometimes I'd try someone's and actually feel like I was gonna vomit just from it being such high strength. (Julia, d2).

For most participants, their first time vaping was experimental.

I started sneaking out and experimenting a little bit with alcohol and stuff … and it became a thing that we would all sneak out and vape until we felt sick. (Martina, d6).

When discussing their first time vaping, participants largely focussed on the physical feelings they experienced, and whether they desired or intended to use ENDS again in the future. However, several participants also noted the role of marketing in their perceptions of vaping, namely the how the colours and patterns of the packaging were exciting, as were the wide range of flavours.

It was very pretty, it had the same colour as my piercing. It was like holographic, which matched my piercing, and I was like that's really, really cool. (Martina, d6).

Marketing in the form of package and product design contributed to the appeal of vaping, while advertising on social media and other platforms was not identified by participants.

3.1.3. Progression to Daily Vaping

The next few times participants vaped were largely social settings where peers facilitated access to vaping. For those who started vaping in secondary school, bathrooms were a key location for vaping without detection.

Lots of my friends had their own, and then between classes you'd meet up in the bathrooms to see each other and talk. So, then you'd also have a vape as well because you're in there. (Tess, d1).

In a tertiary context, social settings involving alcohol were more common.

We'd pass them around and then I kind of got used to it and started doing it when we were drinking and stuff. (Hannah, d1).

Sharing vapes in social settings prompted participants to buy their own vape. Some rationalised the decision as a harm reduction strategy to reduce the risk of communicable disease spread through sharing vapes. Others wanted autonomy over their vaping.

You have to ask someone to use theirs, so you wouldn't just do it whenever you wanted because you don't want to be annoying, and you don't want to be a bum (Iris, d5).

For both themselves and peers, the young women discussed that purchasing or owning a vape marked a transition from being a ‘social vaper’ to being a ‘vaper’. Participants identified both their frequency of use, and number of puffs per use increased significantly following owning a vape.

After I bought my own one was when I started using it most days. (Emma, d4).

Alongside increased frequency of vaping was a change in settings for vaping to occur. Previously, where sharing vapes dictated vaping happening in social settings, owning a vape meant participants could now vape alone, or at times they would not have prior to owning a vape.

So it was kind of special occasions, there's a time and place where for vaping. But then it just became whenever. Cooking dinner, you'd have the vape next to you, or doing anything. (Iris, d5).

The progression to vaping daily was facilitated by owning a vape as it allowed for more regular vaping, and access to vaping in across a range of settings.

3.2. Influences of Ongoing Vaping

Key themes of social, enhancement and coping were identified as factors influencing on‐going vaping. These echo Kuntsche et al. [45] outlines of drinking motivations. In the context of this research, social influences revolved around friendships, social settings and interactions. Enhancement factors focused on flavours, colours and customisation potential which enhance the experience of vaping. Coping factors involved using vaping to manage stress, often within the contexts of work or university study.

3.2.1. Social

Social influences for vaping were identified in several forms. In secondary school settings or during experimentation stages, vaping grew social capital among peers.

Between classes you'd meet up in the bathrooms to see each other and talk … It got quite common that people, even if you didn't know them, they'd be like, ‘oh can I have a hit of your vape?’ And that you'd just let them. (Tess, d1).

Ongoing vaping was largely facilitated by social settings, as social settings were perceived as acceptable settings for vaping.

I started off only using it at parties and stuff, and then I started using it on my work break because I'd go sit outside and debrief about the day with the girls. (Hannah, d1).

Turning 18 meant that participants could buy their own vaping products, which offered a further opportunity to grow social capital.

But when I first went in, it was kind of, I just felt grown up because, just like the first time buying yourself alcohol legally, it just feels like oh yay I'm legal age and stuff like that. Probably didn't feel too much more than that, just like cool, mature. (Julia, d2).

Entering tertiary education introduced new settings for vaping such as bars and clubs. In these settings, vaping offered an avenue to meet new people and form social connections.

If you're in a bar or something, and there's the outside area where people are vaping, maybe you go and talk to some of the other groups outside. You get a little bit of a rapport with them just because you are out there and you're all vaping together, even though you might be from different groups. (Iris, d5).

Growing social capital, engaging in a shared behaviour and social settings were key social influences on early on‐going vaping.

3.2.2. Enhancement

Flavours were a key enhancement factor across all six interviews. Several participants discussed their preferences and the importance of a ‘nice’ flavour.

It's got to have a nice flavour, I don't want to be vaping something that tastes really bad. (Emma, d4).

Eleven of the 12 participants preferred sweet or fruity flavours. The other participant preferred mint or tobacco. Interestingly, she was the only participant to be a dual user of ENDS and tobacco cigarettes.

I usually go for mint and then I would get tobacco flavour because I do sometimes have a cigarette as well, but that was more in Switzerland, coming here it's too expensive. (Amelia, d3).

Participants were asked how a restriction on flavours to mint, menthol and tobacco would affect their vaping behaviour. Responses varied, some said they would quit immediately, others thought it would be less appealing and so their vaping would slowly reduce, and a few thought it would make no difference.

I wouldn't do it at all. (Hannah, d1).

Initially I would still do it … but I wouldn't be vaping as much anymore … I potentially would just stop, because it's not really appealing. (Iris, d5).

I'm purely addicted to the nicotine, so anything … I don't care, I hit on anything. (Jordan, d2).

Device characteristics such as packaging, colours and potential for customisation were identified as another enhancement factor for ongoing vaping.

I love the packaging … That's the main thing I really liked about it was the unboxing. (Jordan, d2).

The colour of the device itself was a further factor, creating the opportunity for vaping products to be treated as an accessory.

Yeah, people match it with their phone and stuff. (Iris, d5).

Device colour may be an emerging gendered difference in factors for ongoing vaping. Several participants noted that the devices had to be aesthetically pleasing.

Yeah, the colour is hugely important. Even my one now it's pink and orange. Like she's cute. They have to be girly. (Hannah, d1)

One dyad pair discussed seeing videos of young women customising their vaping products to further enhance the aesthetics of vaping.

I've also seen things online where it's like ‘bejewel your vape’ or whatever, make it look pretty. (Iris, d5).

Both flavours and device characteristics were important influences for ongoing vaping.

3.2.3. Coping

All of the participants discussed stress and anxiety management as a factor for ongoing vaping. A significant stressor was tertiary education, with several participants mentioning exam periods as a specific influence on their vaping.

I would only really buy it when it's like stressful, end of semester, end of term periods of uni when I am needing to destress somehow. (Amelia, d3).

I try not to but it's exam season, so I'll give myself a pass. (Jayla, d4).

Most of the participants also had a part time job and noted vaping helped them cope with anxiety and stress associated with their jobs.

Yeah, I couldn't go to work without a vape. It's just so stressful. (Kaia, d5).

In the workplace vaping offered an escape or excuse to take a break from a stressful environment.

Let's say a customer has been horrible to you, and you say you're going outside to have a vape, they'll let you do it. (Tess, d1).

One participant explicitly noted that having her vape nearby had a calming effect on her, even if she wasn't using it.

And it's so easy. Even if I'm going through an interview, or something stressful, it's okay because I have this little thing next to me. (Kaia, d5).

Mood management was a significant factor for ongoing use for all participants. Managing feelings of anxiety or stress were particularly relevant in tertiary or work settings.

3.3. Addiction and Dependence

The words addiction and dependence were deliberately not used in the interview guide to avoid participants feeling stigmatised by the interviewer. Any identification of addiction and/or dependence in this section is self‐reflections made by the participants about themselves or others. No formal diagnoses of addiction or dependence are made, although indicators of addiction and/or dependence are discussed. Consistently identified indicators of addiction and/or dependence included cravings, cued vaping, habitual vaping and withdrawal symptoms.

Several participants experienced cravings, which could be intense and disruptive to daily and study routines.

I woke up, and my vape was dead. It kind of scared me how strong the craving was, because I was half asleep. (Martina, d6).

If I came to uni without it … I would want to go home and just hit my vape. I would get a little bit agitated. (Amelia, d3).

Certain settings cued the desire to vape. In the quote below, Tess paints a clear picture of how vaping became a cued behaviour for her.

It's like that, what is it? Classical conditioning, the dog and the bell thing? If you constantly go to work with your vape, and then one day you go to work without your vape, it's like ‘where's my vape’. You put work and vape together. (Tess, d1).

Where a cue and behaviour are repeatedly paired, the behaviour can become habitual. Several participants vaped without realising they were doing it, and the design of vaping products meant they could be used nearly anywhere, at any time.

I've conditioned myself to, even if I'm just in the car and not even driving, I'm using the vape. (Kylie, d3).

The design of e‐cigarettes meant they could be used nearly anywhere, at any time. This further facilitated the ease of habitual vaping.

I find it super annoying because the first and last thing I do in the day is reach for my vape, and I'm like what am I doing? Why is this the first thing I'm doing in the day? (Iris, d5).

As well as addiction symptoms, all 12 of the young women discussed aspects of nicotine dependence. Tess noted that she would structure her routine to avoid settings where she would be unable to vape.

I prefer to study at home just so I can vape while studying. (Tess, d1).

Most participants experienced withdrawal symptoms when they went without vaping. Common symptoms included difficulty concentrating, headaches and increased feelings of anxiety or depression. Some also mentioned difficulty sleeping, cold sweats, nausea or trembling.

But it probably only took 3 months to be waking up every morning and needing to have a hit right now or I'm going to have a headache or whatever. (Kylie, d3).

Honestly, sometimes I feel really, really anxious … I would feel like pins and needles, butterflies in my stomach. Actual nerves and the anxiety of not being able to vape. (Julia, d2).

Several participants identified a shift in their relationship with vaping, echoing findings from Graham‐DeMello, Sanders [6]. As tolerance to nicotine develops, coping as an influence may no longer look like vaping to move to a positive mood, but simply to prevent or alleviate withdrawal symptoms [47]. This highlights how the initially positive experience of vaping can negatively impact mental health as dependence develops. Future research could further explore this shift and the impact of nicotine dependence on young people who vape.

3.4. Challenges of E‐Cigarette Cessation

Participants were asked if they had ever thought about or tried quitting vaping, and if yes, what their reasons were. Although motivation to reduce or quit vaping was mixed among the participants, they all agreed there were significant barriers to quitting vaping. Some were apprehensive of the time it would take to quit.

I've just been doing it for too long. I don't think I would be able to quit very easily. It would take a good couple of years to actually properly quit. (Tess, d1).

Loss of social benefits was a significant barrier which presented in two ways. First, the young women noted that vaping offered a way to start a conversation with new people and were reluctant to lose this.

You get a little bit of a rapport with them just because you are out there and you're all vaping together, even though you might be from different groups. (Iris, d5).

Secondly, the pervasiveness of vaping among friend groups presented a further challenge as seeing friends vaping prompted cravings. This made some participants feel they had to reduce socialising with friends to successfully quit vaping.

Some people more than others, who are close mates, and you feel bad for not seeing them because I'm immediately fiending for a vape when I see them. (Kylie, d3).

Behavioural gratification was the final significant barrier. The young women did not feel motivated to quit vaping, because they enjoyed it.

Yeah, you need it to be unpleasant [to make you want to quit] because there's nothing unpleasant about a vape. It's addicting. (Hannah, d1).

Previous unsuccessful cessation attempts impacted future cessation attempts. Participant comments indicated it was not unusual for people to quit vaping, only to start again.

I feel like a lot of people go on and off, they'll quit for a few months and then you know, they're back on it. (Krista, d6).

Those who wanted to reduce or quit vaping felt there was a lack of appropriate support.

Even the idea of a quit coach, would be really cool because you could just go to a counsellor or something but then it makes your problem feel like, oh, I have to go to a counsellor to stop vaping. (Kaia, d5).

The women were concerned that seeing a counsellor for vaping cessation would open further discussion about mental health they didn't want to have, and generalised that older professionals were more judgemental about vaping having a lack of personal experience with the contexts of vaping.

4. Discussion

4.1. Implications for Policy and Practice

This study aimed to contribute to gaps in research on ENDS use among women aged 18–24 years, specifically within a tertiary education setting. A trajectory approach was used to explore women's perceptions of ENDS prior to vaping, their experiences of vaping for the first time and progression to daily use, as well as their experiences of addiction and dependence, and challenges for vaping cessation. Although this study did not set out to identify possible interventions to reduce vaping, key findings highlight areas where interventions may be implemented to either reduce uptake of vaping or support young people who already vape.

Consistent with existing research, the results show vaping is appealing to young women, particularly the range of flavours and device characteristics such as colour [29, 30, 48, 49]. In Aotearoa New Zealand, policy has since been introduced which limits flavour descriptors to an approved list. While this is a positive step, given the significant appeal flavours pose, stricter restrictions such as reducing flavour availability in Aotearoa New Zealand to mint, menthol or tobacco could further reduce the appeal of vaping to young people with minimal impact on those using ENDS for smoking cessation [48]. Restrictions on the design (such as colours and patterns) of ENDS packaging could be introduced with a similar effect on appeal. Restrictions on flavour and design would further work to reduce ENDS as a ‘badge product’ [50], associating the user with the product brand and marketing. These findings suggest marketing, and use of, ENDS products may be gendered. This is supported by identified gendered contexts of both alcohol and smoking marketing [51], and should be explored further in future research.

Regarding ongoing ENDS use, anxiety and stress management were identified as key factors. This presented as vaping for the pleasurable effects of nicotine (generally in the earlier stages), or as vaping to relieve or prevent withdrawal symptoms (generally in the later stages). These findings go beyond existing literature to identify how unique stressors associated with tertiary study may influence young women's ongoing vaping. Given that workplaces were also discussed as a stressor which influenced vaping, future research could expand on ENDS use, stress and tertiary study. Gender differences in the pharmacology of nicotine are well‐evidenced and show that women are more likely to smoke for stress management than men [52, 53, 54, 55], which would be important to consider. Further, given that tertiary study and work will often come with stressors by nature, tertiary institutions could consider student‐led programmes supporting students to engage in healthier coping strategies. This should be complemented by upstream interventions to reduce chronic drivers of stress, such as healthcare accessibility, economic stability and social relationships, as suggested by other research [54].

Further, these findings highlight the overarching influence of social contexts and peers for both vaping initiation and ongoing use. Consistent with a growing body of research [24, 25, 26, 56, 57, 58], norms and acceptability around vaping encouraged experimentation. The findings offer new insights on vaping in a tertiary context where the importance of peer socialisation increases, young people have access to environments like bars and clubs, and age restrictions on the purchase of vaping products no longer applies. Given the significance of peer influence across stages of vaping, challenging norms and acceptability of vaping among young people may reduce e‐cigarette uptake. Further, the findings of this research highlight young women's use of self‐exempting strategies, similar to those seen regarding smoking [59]. This highlights the need for public health messaging which combats tobacco industry arguments of ‘free choice’ and promotes the benefits of smoke and vape free communities. Aotearoa New Zealand had a strong public health campaign which successfully shifted the acceptability of smoking, particularly among younger generations [59, 60]. Learnings from anti‐smoking campaigns could inform public health approaches to a campaign around vaping.

All 12 participants referred to nicotine addiction or dependence at least once during their interviews. Signs of addiction and dependence were consistent with smoking literature, although e‐cigarette specific contexts were identified, also consistent with current research [9, 61]. Similarly to other studies [6, 8], several participants identified disliking dependence on ENDS yet felt unable to stop. Some participants structured their routines around vaping to avoid onset of withdrawal symptoms, which could be intense and disruptive. Additionally, participants noted that existing support was limited to counselling, which made them feel as though they were seeking emotional support when they desired vaping cessation specific support. Peer or vaping specific support was identified as desired by current vapers, and many also supported stricter regulations to protect young people from initiating vaping.

4.2. Study Limitations and Strengths

Time and resource constraints limited the number of participants to 12. The participants were all young women engaged in tertiary study in Christchurch, New Zealand, and while this provides important context for how female tertiary students use e‐cigarettes, there are limitations around who has access to tertiary education. The diversity of ethnicity among participants is a further limitation, and although more Māori participants would have been desirable, a Kaupapa Māori research approach [62] may hold higher appeal. This research would, however, be best carried out by a Māori researcher.

However, strengths of this research were the use of friendship dyad interviews where the social nature of friendship dyads was well positioned to explore social contexts of young women's vaping. Centring women's voices in an area of literature where women have historically been under‐represented was a further strength. The focus of gendered ENDS literature on reproductive health often comes at the expense of investigating other contexts of women's substance use, something this research contributes to.

5. Conclusions

This study explores nuances of young women's vaping, including experiences of initiating vaping, factors for ongoing use, and addiction and dependence. The findings show that young women experience harms related to vaping, compounded by a lack of appropriate support for cessation. To reduce vaping among young people, interventions to cut the appeal of ENDS such as stronger flavour restrictions or plain packaging could be introduced. Similarly, given the role of social influences, interventions aimed at shifting norms and acceptability around vaping may further reduce vaping among young people. Further support is required for young people who already vape and experience harms associated with addiction and dependence. Future research could consider methods of support service delivery that young people would feel safe accessing and supported through cessation.

Author Contributions

Gabriella Sims: conceptualisation, formal analysis, investigation, methodology, project administration, writing – original draft preparation, writing – review and editing. Rose Crossin: conceptualisation, resources, supervision, writing – review and editing. Helen Fitt: conceptualisation, resources, supervision, writing – review and editing.

Funding

This work was supported by a Postgraduate Publishing Bursary provided by the University of Otago.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Data S1: Supporting Information.

Sims G., Crossin R., and Fitt H., “Social Influences Across Vaping Trajectories of Female Tertiary Students,” Drug and Alcohol Review 45, no. 2 (2026): e70116, 10.1111/dar.70116.

Data Availability Statement

Research data are not shared.