Knowledge, perceived harms and reasons for use of disposable electronic cigarettes among youth: a qualitative study in Switzerland

Abstract

Background

Disposable electronic cigarettes (DECs) have rapidly gained popularity among adolescents and young adults (AYAs), raising public health concerns related to nicotine dependence, exposure to potentially harmful substances and environmental burden. While motivations for e-cigarette use have been explored, little is known about how AYAs perceive and use DECs, in particular within a changing regulatory context such as Switzerland.

Objectives

This qualitative study explored AYA’s knowledge, perceived harms and reasons for DEC use through a developmental lens, to better understand vulnerabilities specific to this age and inform prevention strategies targeting this population.

Methods

Eight focus groups were conducted via videoconference between October and December 2022 with 51 participants aged 14–25 years living in the Swiss cantons of Vaud and Valais. Discussions were transcribed, anonymised and analysed using a thematic analysis approach.

Results

While DECs were largely known and consumed, participants had limited and often imprecise knowledge regarding product composition and nicotine content. Perception of harm was heterogeneous and influenced by packaging and insufficient product information. DEC use was primarily described as driven by experimentation, transgression, peer dynamics and identity construction rather than by nicotine effects, although nicotine addiction was sometimes described as a consequence of use. DECs were often described as interchangeable with conventional cigarettes. Accessibility and marketing features such as flavours, design and social media visibility were central to product appeal. Differences in cantonal legislation did not seem to clearly influence perceptions or reported behaviours.

Conclusions

DEC use among AYAs reflects both developmental vulnerabilities and the influence of targeted marketing strategies. Alongside age restrictions, effective prevention should address product design, marketing and packaging practices, as well as information transparency. Further research on vaping-related harms is needed to inform healthcare professionals, and surveillance of DEC and other tobacco-derived product use following legislative changes will be essential to guide future regulations.

WHAT IS ALREADY KNOWN ON THIS TOPIC.

WHAT THIS STUDY ADDS

• Substantial gaps in knowledge regarding DEC content and vaping harm exist and tend to lower harm perception. DECs have specific marketing features putting AYAs at risk of use, because of developmental specificities such as experimentation, peer dynamics and identity construction.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

• Age-based restrictions targeting specific products could be insufficient and regulation of existing and future nicotine-derived products must consider the underlying attributes that appeal to youth. Continued research on vaping-related harms and post-ban surveillance are essential to inform healthcare practice and adapt regulations.

Introduction

The use of vaping products among adolescents and young adults (AYAs) has emerged as a major public health issue over the past decade. Disposable electronic cigarettes (DECs), introduced in the early 2020s,¹ have gained particular popularity among AYAs due to their accessibility and design, but pose specific risks, notably nicotine dependence, exposure to harmful substances and a significant environmental burden through plastic waste and lithium battery disposal.^2,3 While the gateway from DECs to other nicotine products remains uncertain,⁴ there is concern about a possible increase in nicotine dependence among youth.^5–7 Their use of such products differs from adults and requires specific attention.⁸ Indeed, most AYAs—including who have never smoked—choose devices with nicotine,⁹ and studies show that DECs are particularly popular among younger adolescents,^9,10 supporting the idea that AYAs are vulnerable due to marketing strategies and particularities of this stage of life. Developmental specificities of AYAs include influence of peers, exploratory behaviours, growing autonomy and shaping of identity. These factors can impact substance use, which most often begins during these years and reaches its highest prevalence during adolescence.^11,12

DEC use among AYAs has risen sharply in recent years worldwide.^13,14 In Switzerland, a 2022 survey reported that 60% of AYAs aged 14–25 had tried DECs and 30% had a regular consumption, that is several times during the past 30 days,⁹ rates higher than in other western countries.^15,16

Legislation, particularly age restrictions and retail regulation, influences e-cigarette prevalence and initiation among youth.¹⁷ In Switzerland, where combination of individual freedoms and presence of tobacco lobbies have an important impact on regulation, DECs were initially considered as utility articles and were legislated by the Federal Act on Foodstuffs and Utility Articles, allowing their sales to minors and their use in public spaces.¹ In response to growing concern, Switzerland reclassified DECs as tobacco-derived products and, in 2024, included them in the Federal Act on Tobacco Products and Electronic Cigarettes, which prohibited sales to minors and restricted advertising as well as nicotine concentration to 20 mg/mL.¹ In 2025, following the example of several European countries, the Swiss Parliament voted in favour of a ban on DECs. Furthermore, a popular initiative was approved to better protect AYAs from advertising and should strengthen legislation from 2027 onwards.¹⁸

While several qualitative studies have explored motivations behind e-cigarette use,^19–21 DEC specificities have received less attention. Despite the forthcoming ban, it remains important to understand why AYAs use these products and how they perceive potential harms. This can help develop more effective prevention strategies—not only to better understand past behaviours but also to anticipate a possible shift toward other nicotine or vaping products. Moreover, given the potential for continued access through import or through reusable e-cigarettes with similar features, such insights remain highly relevant for prevention strategies. This qualitative study therefore aims to explore knowledge, perceived harms and reasons for use of DECs among youth.

Methods

Qualitative methods allow for a deeper understanding of a social phenomenon through participants’ testimonies, opinions and interpretations^22,23 and are particularly recommended in an exploratory approach on new topics.

Focus groups

Between October and December 2022, we conducted eight focus groups (FGs) with 51 participants aged 14–25 years, from the cantons of Vaud or Valais in Switzerland, who were interested in sharing their opinions on DEC.²⁴ FG size ranged from four to eight participants (mean=6.4). The number of FGs was determined pragmatically based on available resources and feasibility, while ensuring variation in age, gender, canton of residence and experience with DEC use. This sample was considered sufficient to generate a broad range of perspectives relevant to the study objectives.

The interviews were conducted via videoconference using a secure version of the Zoom platform. This choice was motivated by the fact that we included participants from two cantons and encountered difficulties in recruiting young people for in-person discussions, possibly due to habits developed during the COVID-19 pandemic. To ensure the safety and comfort of each participant, while allowing for a certain level of control over the activity, several rules were implemented: participants were asked to turn on their camera, use either their real name or a pseudonym, be alone during the session and refrain from connecting in public locations.

Prior to each session, each participant received an online link for a questionnaire on the secure Research Electronic Data Capture (REDCap) application, including an information letter explaining the study objectives and confidentiality rules as well as an electronic consent form that participants were required to sign. A short, self-administered questionnaire was also provided to collect sociodemographic data and information regarding their use of conventional cigarettes and DEC.

YB-D and LC moderated the discussions. LC took notes on who was speaking, to facilitate transcription, as well as on participants’ non-verbal communication. Each FG lasted approximately 1 hour. The interviews were conducted by two female researchers trained in public and adolescent health research. None of the researchers were physicians or clinicians, and no prior relationship existed between the researchers and participants. Data were collected online, further reducing potential power differentials. At the beginning of each interview, participants were informed that the researchers were not acting as healthcare providers, teachers, parents or authority figures and that the purpose of the study was to understand their experiences rather than to evaluate or judge their behaviours. As researchers working in public health, we acknowledge that some participants may nevertheless have perceived certain behaviours as socially undesirable or contrary to health recommendations. To minimise this potential influence, a non-judgemental stance was maintained throughout the interviews, and confidentiality was emphasised.

FGs were recorded using an offline Dictaphone, then transcribed manually and anonymised, procedures which were explained orally to the participants. At the end of each session, participants received a CHF30 electronic voucher for a department store.

An interview guide, based on the literature and prior quantitative results,⁹ was developed (see online supplemental appendix 1). Key topics explored included: general knowledge of DECs, advertising, consumption, prevention and environmental issues.

Recruitment

Participants were mainly recruited via a sponsored advertisement posted on the social media platform Instagram and on the website www.adosjob.ch, which is dedicated to jobs for 15–20 years old. The initial advertisement—which was adjusted every 2 weeks to better reach the targeted population—invited young people aged 14–25 who were interested in discussing DEC in a FG to contact us. Professional partners also shared the advertisement on their social media and/or newsletters. It was not necessary to use a DEC, as we were seeking general opinions.

Additionally, at the end of the quantitative questionnaire which was the first part of the study,⁹ we invited participants to leave their contact information if they wished to participate in an FG. In a few cases, snowball sampling was also used: some participants told friends, acquaintances or family members about the study, who subsequently contacted us.

Participants

We conducted eight FGs with a total of 51 young people aged 14–25, including both users and non-users of DEC, living in the cantons of Vaud or Valais.

We chose to separate the groups by gender (no non-binary participants took part in the FGs), as gender differences in tobacco product consumption are reported²⁵ and also emerged in our quantitative study on DEC use.⁹ Additionally, gender-homogeneous groups are often recommended when conducting FGs with young people to minimise self-censorship or discomfort related to gender differences and to encourage discussion based on shared characteristics.^23,26

We separated participants from Vaud and Valais, as legislative differences existed when interviews were conducted, particularly regarding the sale and provision of e-cigarettes (including DECs) to minors (prohibited in Valais; legal modifications in progress in Vaud).

Finally, we divided the groups by age: minors (14–17 years old) and young adults (18–25 years old), given that the sale of DECs is prohibited to minors in the canton of Valais and that tobacco sales to minors are prohibited throughout Switzerland.

DEC use status was not used as a stratification criterion for group composition, as our aim was to explore themes transversally across the sample rather than by consumption profile.

Analyses

Thematic analysis was used to identify themes that emerged during the FGs. This classification process involves categorising and coding data and allows for the collection of participant perspectives without any preconceived theoretical framework from the research team. The interviews were first read multiple times to gain a general understanding of the collected data, which led to the creation of an analysis grid, which was then used to code the interviews and organise the qualitative data. The interviews were analysed by LC, YB-D, A-EA and RD using MAXQDA software. Researchers came from different backgrounds (clinical and public health fields), which shaped their initial perspectives on adolescent DEC use. Discrepancies in interpretation were discussed collectively until consensus was reached, allowing clinical and non-clinical readings of the data to inform and challenge one another. This approach allowed for a form of triangulation at the level of analysis and facilitated discussions in case of discrepancies, thereby minimising the risk of bias.

Patient and public involvement

Patients and public were not involved in the design, conduct, reporting or dissemination of this study.

Results

In this section, F refers to female, M to male, VD to Canton of Vaud and VS to Canton of Valais. The numbers indicate the age range.

Sociodemographic characteristics

Sociodemographic characteristics per FG can be found in table 1.

Table 1. Sociodemographic characteristics and DEC use status of participants by FG.

FG (date)	Canton	Age group	N	Gender	Age, mean (range), years	Educational/occupational status, n (%)	DEC use status, n (%)
FG1 (20 October 2022)	Vaud	18–25 years	8	Female	21.4 (18–25)	Higher education: 6 (75.0); Employed/job-seeking: 2 (25.0)	Multiple times, past 30 days: 4 (50.0); Multiple times, not past 30 days: 2 (25.0); Once only: 2 (25.0); Never: 0 (0.0)
FG2 (14 November 2022)	Vaud	18–25 years	5	Male	21.6 (18–25)	Higher education: 4 (80.0); Gap year: 1 (20.0)	Multiple times, past 30 days: 1 (20.0); Multiple times, not past 30 days: 2 (40.0); Once only: 1 (20.0); Never: 1 (20.0)
FG3 (17 November 2022)	Vaud	14–17 years	8	Female	16.5 (15–17)	Postcompulsory school/preapprenticeship track: 8 (100.0)	Multiple times, past 30 days: 4 (50.0); Multiple times, not past 30 days: 2 (25.0); Once only: 1 (12.5); Never: 1 (12.5)
FG4 (22 November 2022)	Vaud	14–17 years	7	Male	15.6 (15–17)	Compulsory school: 3 (42.9); Postcompulsory school/preapprenticeship track: 3 (42.9); Apprenticeship: 1 (14.3)	Multiple times, past 30 days: 1 (14.3); Multiple times, not past 30 days: 1 (14.3); Once only: 3 (42.9); Never: 2 (28.6)
FG5 (23 November 2022)	Valais	14–17 years	6	Female	15.5 (14–17)	Compulsory school: 2 (33.3); Postcompulsory school: 3 (50.0); Apprenticeship: 1 (16.7)	Multiple times, past 30 days: 2 (33.3); Multiple times, not past 30 days: 2 (33.3); Once only: 2 (33.3); Never: 0 (0.0)
FG6 (12 December 2022)	Valais	18–25 years	8	Male	20.6 (18–24)	Higher education: 5 (62.5); Postcompulsory/transition track: 3 (37.5)	Multiple times, past 30 days: 1 (12.5); Multiple times, not past 30 days: 6 (75.0); Once only: 1 (12.5); Never: 0 (0.0)
FG7 (13 December 2022)	Valais	18–25 years	5	Female	22.2 (20–25)	Higher education: 5 (100.0)	Multiple times, past 30 days: 1 (20.0); Multiple times, not past 30 days: 3 (60.0); Once only: 0 (0.0); Never: 1 (20.0)
FG8 (14 December 2022)	Valais	14–17 years	4	Male	15.0 (14–16)	Compulsory school: 2 (50.0); Postcompulsory school/preapprenticeship track: 2 (50.0)	Multiple times, past 30 days: 2 (50.0); Multiple times, not past 30 days: 2 (50.0); Once only: 0 (0.0); Never: 0 (0.0)
Total	Vaud: 28; Valais: 23	14–17 years: 25; 18–25 years: 26	51	Female: 27 (52.9); Male: 24 (47.1)	18.6 (14–25)	—	Multiple times, past 30 days: 16 (31.4); Multiple times, not past 30 days: 20 (39.2); Once only: 10 (19.6); Never: 5 (9.8)

Age is reported as mean (range) in completed years at the time of the FG. FGs were homogeneous by gender and by canton of residence (Vaud or Valais) by design; ‘age group’ reflects the minor (14–17 years)/adult (18–25 years) stratification used for recruitment, matching the legal age of sale for e-cigarettes in Valais. Educational/occupational status categories: compulsory school (up to grade 11H); postcompulsory school/preapprenticeship track (upper-secondary general or vocational transition programmes); apprenticeship; higher education (university, university of applied sciences, higher vocational school); employed/job-seeking/gap year. DEC use status categories, based on self-report: ‘multiple times, past 30 days’ (used several times, including within the last 30 days); ‘multiple times, not past 30 days’ (used several times, but not within the last 30 days); ‘once only’; ‘never’.

DEC, disposable e-cigarette ; FG, focus group.

We conducted four FGs with participants living in VD, for a total of 28 participants. The average age was 18.6 years (range: 15–25 years), with a median age of 17 years. Girls represented 57.1% (n=16) of the total sample. Among the participants, one-seventh (n=4) had never used a DEC, half (n=14) had tried DECs once or several times but not in the past 30 days and more than one-third (n=10) had used DECs multiple times within the past 30 days.

We also conducted four FGs with young people living in VS, totalling 23 participants. The average age was 18.6 years (range: 14–25 years), with a median age of 20 years. Girls represented 47.8% (n=11) of the total sample. Among these participants, only one had never used a DEC, more than two-thirds (n=16) had tried DECs once or several times but not in the past 30 days and one-quarter (n=6) had used DECs multiple times within the past 30 days.

Product knowledge

Composition

Participants across groups had limited knowledge of the components of DECs, linked to the fact that product information was not clear or accessible.

Well it doesn’t say what’s inside, that’s actually what’s annoying, like there’s no way to know (F14–17, VS)

They were aware that they contain a battery, sometimes citing the presence of lithium.

[…] it’s a lithium battery […] with a little resistor that makes it produce the vapor (M14–17, VS)

They referred to other components, for example, DEC flavours, as ‘chemicals’ but underlined the fact that they were generally non-comprehensible to the general public.

So I was curious and I already checked out what goes into a disposable, and I don’t really understand any of the ingredients […] You’d probably need a chemistry degree to get it (M18–25, VD)

Some participants stated that they had better knowledge of the composition of conventional cigarettes, which was more predictable in comparison with DECs.

[…] you’re like, in a cigarette at least you kind of know what’s inside […] you sort of know what to expect, but in a disposable […] you can get fake ones and get sick (F14–17, VS)

Nicotine content and equivalents

Across the FGs, participants knew that DECs can contain varying levels of nicotine or none at all. Pharmacological properties of nicotine were unclear apart from the potential for addiction.

[…] ok there’s nicotine but what even is that… ‘cause we say nicotine all the time, but what is nicotine really? (F18–25, VS)

Furthermore, participants found it difficult to interpret the exact doses contained in DECs or compare them to those in conventional cigarettes or other nicotine-derived products.

I was wondering ‘cause it’s written as a percentage […] [the conversion] I don’t know how it works (F18–25, VS)

A participant said that nicotine percentage could make it seem low, affecting harm perception in regard to nicotine strength.

The percentages are usually pretty low, I think it never goes over…I’d say like 10 percent, I’ve seen a bunch with 2 percent, and 0, 3 and 4. […] the numbers are really low, I end up just telling myself that it’s nothing (M18–25, VD)

Participants from two FGs of 14–17 years old from vs claimed having access to products with high levels of nicotine (50 mg/mL) in a store, although such high levels are prohibited in Switzerland (max 20 mg/mL).

[…] anyways, there are new disposables in corner stores where it’s written like 2% but there’s some kind of sticker over it, […] and you realize that it’s not the actual amount, ‘cause I had a few that made me dizzy, but the 2 [percent]’s don’t usually make me feel that way […] (F14–17 VD)

Most participants claimed they avoided buying DECs with 50 mg/mL of nicotine because of side effects.

5% is massive. […] I usually buy the 2% but sometimes without noticing I buy the 5% and it’s impossible to smoke, like… it’s terrible (F18–25, VD)

Nicotine properties were mostly linked to short-term effects and addiction, with a participant underlining the risk of tolerance.

But then often when you take a hit, since there’s a ton of nicotine, it makes your head spin so much, like all at once. But then you get used to it and it gets even more addictive» (F14–17, VS)

Perceived harms

Short-term physical health risks

Different negative effects after consumption were mentioned, including dizziness, abdominal pain and nausea, which participants associated with nicotine.

[DEC with 5% nicotine] […] it really hits you hard, it makes your stomach ache and makes you feel sick with like two hits, but the others not that much (F18–25, VD)

Throat pain and respiratory issues were also described, sometimes motivating participants to limit DEC consumption.

For a while I had a few with peppermint, […] my throat was dry like crazy, […] my tonsils were really swollen and, well they said it was the vape so I stopped for a bit (F14–17, VD)

Furthermore, participants reported that short-term physical effects were sometimes linked to a higher number of inhalations with DEC in comparison with conventional cigarettes. This was attributed to the device’s longer duration, the absence of inhalation limits and the possibility of using it in almost any context.

[…] you don’t know what you’re smoking, I mean with a cig you see it… when you’re done you see how much you’ve smoked […] but you’re not gonna count each time you take a puff so, […] I guess you smoke way more than, I mean there actually isn’t really a way to measure, right? (F18–25 VD)

Long-term physical health risks

Participants expressed uncertainty about the effects of the substances in DECs, often comparing them to conventional cigarettes or food additives, with various potential health risks. Younger participants (14–17) tended to express more severe health consequences.

It’s kind of like… you’re paying to die, you know? […] it increases your chances of dying. (M14–17, VD)

Compared with conventional cigarettes, participants were unsure of the risks of DEC, which was sometimes considered as equally harmful, while others considered health risks were lower with DECs.

Anyway it’s not like there’s one that’s better than the other for your health (F14–17, VS)

A vape, actually […] I don’t know, I feel like it kills you less… than a cigarette (M14–17, VD)

On the other hand, participants highlighted features of DECs that made them seem ‘healthy’, for example, fruit or menthol tastes.

It’s very sugary, or even fruity […] it kind of feels healthy, I mean things that are healthy like fruits […] (M14–17, VD)

DEC packaging was also described as having the potential to minimise perception of health risks in comparison to conventional cigarettes.

[…] with the packaging, if you look at traditional cigarettes where you really see open lungs with a bunch of things on it like “smoking kills”, compare that with a vape with a fruit salad on it (laughs) (M18–25, VS)

Addictive risk

Risk of addiction was widely discussed in all groups. Many participants highlighted the nicotine-related addiction risk of DECs, which is facilitated by accessibility of the product.

Right now it’s really nicotine [addiction]. So for example I spend 4 hours in class and then I get out and I’m like “I need nicotine” (F18–25, VD)

Participants described higher nicotine intake with DECs than with conventional cigarettes, linked to its accessibility and possibility of vaping in almost any context.

[…] I tried a vape and, well, since I could smoke inside well I would actually smoke all the time, and it became super addictive, […] and so I don’t buy it anymore ‘cause I know that, like, I smoke way more than if I just smoke cigarettes (F18–25, VS)

Participants also underlined the habitual nature of the gesture itself, leading to addiction, independently of the presence of nicotine.

[…] just taking it into your lungs and blowing it out, whether there’s nicotine or not, I feel like that’s enough for me, […] I guess it’s more about the gesture, the ritual, than anything else (M18–25, VD)

Across the FGs, participants hypothesised, observed or experienced risk of starting conventional cigarette consumption after using DECs (gateway effect).

[…] I used to smoke vapes a couple of years ago, in the very very beginning […] it kinda got me into smoking cigarettes, you know. It’s partly because of that that I smoke (M14–17, VD)

A participant described how low harm perception in people who do not smoke could be easily tempted to try DECs with nicotine.

[…] people who aren’t addicted to nicotine yet aren’t necessarily careful and won’t be interested in buying vapes without nicotine, […] it can be a gateway to nicotine addiction (M18–25, VD)

Reasons for use

Experimentation and risk-taking

Participants across the FGs said they were driven by curiosity and the appeal of the product.

It’s colorful, there are a bunch of flavors, you can try it and everything (F14–17, VD)

They underlined the attractiveness of the different flavours and the fact that DECs tasted good. One participant drew a parallel with chewing gum.

I always choose the sweet ones […], or the fruity ones like raspberry, strawberry or whatever. […] it feels like having something sweet in your mouth all the time, as if it were like chewing gum or something (F18–25, VD)

Experimentation or game through ‘tricks’ was also a reason to try DECs, even for adolescents who described themselves as people who do not smoke.

« I’m not a smoker at all but I know that if someone hands me a vape or something, well you kind of want to take a hit to blow it out or try making circles or stuff like that » (M18–25, VS)

Autonomy and transgression

For some participants, the ‘forbidden’ nature of DECs and breaking parental rules was a reason for consumption.

[…] there’s the whole idea of breaking the rules… ‘cause even if it’s not explicitly forbidden it it’s still frowned upon, I mean it’s still kind of like small rebellion against your parents (M14–17, VD)

In this context, the accessibility and absence of smell made it easier for adolescents to use DEC without their parents knowing.

[…] something that you can’t smell, that you can smoke under your blanket at night without your parents knowing, it’s too easy (laughs) (M18–25, VD)

Peer relationships and group belonging

Across FGs, DECs were seen as social tools—promoting bonding, fitting in or being part of a group.

Yeah, like it’s a way to socialize, I mean having a crew, […] you have your vaping crew and… yeah well it creates a sort of identity in the end (F18–25, VS)

On the other hand, one participant mentioned that in group settings, adolescents can be tempted to switch from DECs to conventional cigarettes to fit in older looking groups.

[…] If you get to a balcony and people are smoking cigs and you show up with your vape, well it’s very easy to then go « oh could I get a cig or something », instead of using your vape which will make you come across as the little kid of the group (M18–25, VD)

Initiation was described as often a consequence of group influence.

But you usually don’t get started by yourself, there’s always people pushing you into it (M14–17, VD)

Concerning regular consumption, many said they only vaped in groups and some reported feeling peer pressure.

[…] I felt like I had to do it (vape) because I was with them […] (F14–17, VD)

Some participants even discussed the potential of using group dynamics to quit.

Don’t you want to stop ? (laughs) Create a stop-smoking group (laughs) (F18–25, VD)

Identity and social image

Smoking initiation and continuation was strongly linked to social image and identity.

Young people who start, let’s stay between 14 and 16 years old, don’t have that conscience yet, they smoke to smoke. It’s to give yourself an image, to show off, to look a certain way. They don’t really care what’s in it or what the consequences are, at least for now (M18–25, VS)

Especially in older groups, participants associated DEC use with younger adolescents, which in some cases motivated them to quit.

I feel like I completely stopped vaping […] it made me look younger (F18–25, VD)

While some participants did not witness a gender inequity in DEC use, a few male participants described a gendered perception, linking DEC use more frequently to girls.

I have a bit of a cliché in mind of like… more of a young girl, I’d say […] I know way more women or girls who use them than men. (M18–25, VD)

Participants, mostly from younger FGs (14–17 years old) mentioned seeing DECs on social media and described them as part of a fashion trend.

At the end of the video, she (influencer) always had a vape […] as if it were an accessory. (F14–17, VS)

In light of this, several participants mentioned that DECs, as other trends, would naturally disappear or be replaced by another product.

[…] vaping, well it also became a trend […] a few months, a few years they’re like disappointed by it and they just move on to something else (F14–17, VS)

Substitute to conventional cigarettes or for smoking cessation

Participants across FGs mentioned using DECs as a substitute for conventional cigarettes, describing DECs and conventional cigarettes as largely interchangeable.

[…] when I’m out… either I lose my vape or it’s out of battery, I’m usually always asking for cigarettes from other people but my goal is to smoke as little cigs as I can […] (F18–25, VD)

Others, however, described using DECs or nicotine-free DECs to quit conventional cigarettes, highlighting the role of the DEC’s “hand-to-mouth” gesture and the possibility of gradually reducing nicotine intake.

Personally, I do it to cut down on cigarettes, To try and keep my mouth busy with something else without having the taste of cigarettes […] (F18–25, VD)

This sometimes led to unintended dual use when trying to stop using traditional cigarettes through DECs:

For a friend of mine, it was the same, she… well she thought she would cut down on cigs by smoking vapes, but actually it’s the opposite, she smokes (cigarettes) as much as she used to and on top of that she vapes (F18–25, VD)

Discussion

These results highlight how AYA’s specific developmental characteristics make them major targets of DEC marketing, increasing the likelihood of experimentation and potential nicotine dependence.

Composition

Despite DECs being largely known and consumed, product composition remains unclear for participants. This could encourage DEC consumption, as knowledge of tobacco and nicotine-derived products is associated with intention to quit.²⁷ Nicotine was described as ‘addictive’, yet its properties, dosage and equivalence to conventional cigarettes were poorly understood, consistent with previous findings showing that youth tend to underestimate nicotine strength.^28,29 Given that nicotine concentrations and device sizes have increased since DECs entered the market,³⁰ such knowledge gaps may increase the risk of higher exposure and dependence. This supports the necessity of legislating information given concerning composition and labelling of DECs with easily accessible information.³¹ Since 2024, the Federal Act on Tobacco Products requires the indication of mg/mL of nicotine on electronic cigarettes. However, AYAs may need more information, as our findings suggest that legislative labelling alone may not be sufficient, given the gaps in understanding of nicotine dosage and equivalence.

Perceived harms

Perceptions of harm were heterogeneous, with DECs generally viewed as less or equally harmful than conventional cigarettes, aligning with prior research among adolescents.³² Flavours and colourful design were frequently described as contributing to a ‘healthier’ image. Fruitful flavours have been shown to be the most commonly used flavours during initiation and subsequent DEC use,³³ suggesting that flavour may not only encourage experimentation but also reduce perceived harm.

While participants acknowledged physical and addictive risks, knowledge of long-term health effects was limited. A systematic review showed that vaping is associated with other substance use (predominantly marijuana and alcohol) and an increased risk of asthma diagnosis and exacerbation.³ The limited research on vaping risks and relative benefit of vaping compared with smoking in adults might explain why prevention messages for AYAs lack detailed information about vaping-related harm.

Although nicotine effects were not discussed as the main reason for use of DECs, several participants witnessed developing an addiction, suggesting that perceived harm of nicotine is under-rated. Poor visibility of nicotine warnings likely contributes to this gap.³⁴

These findings support the urgent need of regulating packaging, notably with plain packaging and impactful health warnings,^31,35 which have been shown to be effective with conventional cigarettes.^36,37 Participants discussed the presence of DECs on social media, which can lower harm perception and increase intention of use, especially in people who have never smoked,³⁸ while environmental support and exposure to anti-tobacco marketing are known to significantly mitigate this effect.³⁹

Notably, no substantial differences in knowledge or harm perception were observed between cantons with differing regulations at the time of the study, suggesting that age restrictions alone could be insufficient to affect DEC perception and should be accompanied by comprehensive prevention measures.

Reasons for use

The main self-reported drivers emerging for why AYAs try or use DECs are: experimentation, transgression as well as group belonging and social image.

Experimentation and transgression

Adolescence is a key period for experimentation and exploratory behaviours,⁴⁰ and participants emphasised the appeal of variability of colours, flavours, tricks and novelty. Moreover, the sleek design and absence of smell make it easy for adolescents to ‘transgress’ parental or social rules, which also appeared as a reason for use, making it ‘exciting’ to use DECs. The facility to vape in public areas where smoking is normally prohibited may renormalise and heighten nicotine consumption.

The psychoactive effects of nicotine were rarely cited as motivations for use, in opposition to other types of substance use, for which the effects—such as intoxication, symptom relief or staying awake—are the primary motivators.⁴¹ Instead, DECs appeared to function as tools for experimentation and perceived low-risk transgression,⁹ often resulting in unintentional nicotine exposure and dependence.

Group belonging and identity

Relationship with peers is central during adolescence, from early adolescence and peaking during middle adolescence.⁴² Group belonging was central to both initiation and continued use, consistent with evidence showing that peer smoking is a strong predictor of nicotine use.⁴³ Some participants discussed the potential of leveraging group dynamics to encourage cessation; ideas for future intervention included peer-led cessation programmes, social group commitments to quit and participation of youth in prevention messages. Although group-based treatment programmes seem effective in adult populations,⁴⁴ future research should focus on youth to determine whether it is effective.

DECs were also described as identity markers, particularly among younger users, while some older participants distanced themselves from DEC, which suggests that age-related identity construction may also contribute to DEC cessation in some cases. Gendered perceptions of DEC use, sometimes associated with girls, echoed epidemiological findings,^9,14 and may be explained by marketing strategies on social media⁴⁵ and product features that may be more appealing to female youth.⁴⁶

DECs and smoking cessation

Studies have raised concerns about a potential increase in conventional cigarette consumption after a DEC ban,^47,48 as observed after the e-cigarette flavour ban in the USA.⁴⁹ Although some participants reported using DECs as a substitute for cigarettes, dual use was often described. Epidemiological data suggest that DECs are rarely used by AYAs for smoking cessation in Switzerland⁹ and conventional cigarette use has not decreased in parallel,⁶ questioning these concerns. Research tends to show that the arrival of electronic cigarettes and DECs on the market have increased the overall users of inhaled nicotine,^6,7 although most DEC consumption is exploratory and not regular. An American cohort study showed that young people who smoke and never used vaping products did not tend to use DECs for smoking cessation when they appeared on the market.¹⁵ It is possible that e-cigarettes represent a clear alternative to conventional cigarettes to reduce harm or to quit smoking,^50,51 whereas DECs tend to target people with no smoking history, a prior smoking history, or current dual use. Additionally, it is crucial to take into account that these debates concern mostly adult users and do not take into account the particularities of AYAs, whose use of such products differs from adult users.⁸ Nonetheless, continued monitoring and access to appropriate cessation support remain essential following the DEC ban. A related concern is that reusable e-cigarettes sharing DEC’s key attractive features (similar design, flavours, size and price) have recently entered the market and will not be affected by the upcoming ban. This raises the possibility that the appeal driving DEC use among AYAs may simply migrate to an alternative product, underscoring that banning DECs specifically may be insufficient without broader regulation of nicotine-derived products sharing these characteristics.

Strengths and limitations

This is the first qualitative study exploring DEC use among AYAs in Switzerland and, to our knowledge, the first to apply a developmental lens to this issue. The findings enhance understanding of knowledge, perceived harm and reasons for use of DEC and may inform the design of preventive interventions and regulatory measures to better safeguard this population.

However, several limitations should be acknowledged. First, social desirability bias may have influenced participants’ narratives, some individuals may have minimised behaviours perceived as risky or socially disapproved, or emphasised narratives portraying responsible use. Second, sampling bias may have occurred, as participants were primarily recruited through youth-oriented networks and social media, potentially limiting the inclusion of less engaged groups. Third, the study was carried out on a sample of AYAs in French-speaking Switzerland. Therefore, the extent to which these findings may be transferable to all DEC users in Switzerland is uncertain, and caution should be used when considering broader generalisation. Finally, data saturation was not formally assessed, and the study was not specifically designed to achieve saturation. Although the sample included 51 participants across eight FGs and captured diverse perspectives, additional FGs may have yielded further insights.

Conclusion

Findings show that DEC composition and nicotine characteristics remain poorly understood among AYAs, that harm perception is heterogeneous and shaped by product design and flavours while nicotine’s addictive potential is underrated. Reasons for use are diverse and developmentally rooted—driven by experimentation, transgression, group belonging and identity, with DECs generally used interchangeably with conventional cigarettes rather than for cessation.

While banning DECs is a necessary step to protect youth and reduce environmental harm,³¹ regulation of nicotine-derived products must consider the underlying attributes—composition, packaging and marketing—that appeal to youth.³¹ Research concerning vaping harm, especially in AYAs, is also needed, to inform healthcare professionals and the population. Gendered and age-specific social norms must be considered in prevention strategies, with youth included in their design and testing.³⁵ As parental knowledge and harm perception have been reportedly poor,⁵² interventions should also target adults of reference. Finally, continued surveillance is critical to assess the ban’s impact and anticipate shifts toward alternative products.

Data availability statement

Data are available upon reasonable request.