Comparing young adults to older adults in e-cigarette perceptions and motivations for use: implications for health communication

Abstract

Purpose: Use of electronic cigarettes (‘e-cigarettes’ is rapidly rising, and is especially prevalent among young adults. A better understanding of e-cigarette perceptions and motivations for use is needed to inform health communication and educational efforts. This study aims to explore these aspects of use with a focus on comparing young adults to older adults. Methods: In this qualitative study, the investigator conducted semi-structured interviews among a purposive sample of e-cigarette users. Thematic content analysis was used to analyze qualitative data and document themes. Results: e-cigarettes were most commonly used for smoking cessation among both age groups. Young adults described other motivations for use including doing smoke tricks, being able to consume a wide variety of flavors, and helping them study. Some interviewees (11%) believed e-cigarettes were a healthy alternative to conventional cigarettes, while many other users (30%) expressed concerns about the unknown risks of e-cigarettes. Conclusion: Findings were generally consistent across both age groups in their perceptions of harm from e-cigarettes and in subjective effects such as perceived addictiveness. However, individuals under 30 described unique motivations for e-cigarette use. Health messaging targeted to young adults should emphasize the potential health risks of e-cigarette use and recognize their distinct motivational aspects.

Introduction

Electronic cigarettes (or ‘e-cigarettes’) are non-combustible nicotine delivery devices that deliver an aerosol for the user to inhale by heating a mixture of liquid nicotine, propylene glycol, vegetable glycerin and flavorings. Although the adverse health effects on the individual user from e-cigarettes may be less severe than combustible tobacco products (e.g. conventional cigarettes), there are several points of concern related to their use, including the documented deleterious effects of nicotine on the developing brain [1]. Data from the 2012–13 National Adult Tobacco Survey show that e-cigarette use is on the rise for adults and is particularly high for young adults. In fact, findings revealed that young adults between the ages of 18–24 are significantly more likely to use e-cigarettes than adults 25 and older. Their prevalence of use ‘every day’, ‘someday’ or ‘rarely’ was 8.3% compared with 5.0% for adults 25–44 years of age, 3.4% for adults 45–64 year of age and 1.1% for adults 65 and older [2].

The US Centers for Disease Control and Prevention outlines probable reasons for e-cigarettes’ escalation in popularity, including increased availability, visibility and marketing, less expensive costs, and the belief that they are safer than conventional cigarettes [3]. Recent studies found that young adults are more likely to perceive e-cigarettes as less harmful than conventional cigarettes as compared with older adults [4, 5]. However, our understanding of how harmful individuals believe e-cigarettes to be in the absolute sense, rather than the relative sense (in which they are compared directly to tobacco cigarettes), as well as the factors that are weighed as individuals draw these conclusions, is limited. In addition, information on the user’s experience including subjective effects of e-cigarette use and the suppression of withdrawal symptoms due to abstaining from conventional cigarette use is also limited [6].

Prior research has shown that motivations for using e-cigarettes differ by age group. Two studies of a wide age range of adults found that e-cigarettes were primarily used for smoking cessation [7, 8], while studies focusing exclusively on college students [9] or young adults [10] found that use was not necessarily motivated by intentions to quit smoking. This is not surprising, given that college students are likely to identify as ‘social smokers’ [11], and therefore may not yet have strong commitments for cigarette smoking cessation. It is further important to note that a consensus has not emerged around the efficacy of using e-cigarettes for quitting conventional cigarette use. Atlhough limited studies have shown promise for e-cigarettes as a smoking cessation tool [12–14], others have questioned their efficacy for long-term cessation [15, 16]. One qualitative study included e-cigarette users who had successfully quit smoking conventional cigarettes and described themes found to facilitate the process such as social benefits, hobby elements, and personal identity, among others [17]. However, little is known about how these themes may differ between younger and older adult e-cigarette users.

Currently, few health communication campaigns developed for youth and young adults with a focus on e-cigarettes exist. At least two states, Texas and California, have developed such campaigns [18, 19]. The US Food and Drug Administration currently has a public education campaign concerning tobacco targeted to youth (‘The Real Cost’) which does not include messaging on e-cigarettes [20]. Given the paucity of resources and research for communicating health messages related to e-cigarettes, results of this study are framed in terms of their relevance for developing health communication campaigns related to e-cigarettes that are appropriate for young adult populations. The aim of this paper is to understand common perceptions, motivational aspects and subjective effects of e-cigarette use as reported by adult users, with a particular focus on comparing young adults (29 or less) to older adults (30 and older). This study adds to the literature by using qualitative methods to expand on our limited knowledge of why both age groups choose to use e-cigarettes; how they judge subjective effects such as perceived addictiveness; and how effective they perceive e-cigarettes to be for conventional cigarette cessation, including under what conditions. To achieve these aims, interviews with 50 current e-cigarette users (n = 32 young adults and 18 older adults) investigated: (i) motivations for use and perceptions of health impact; (ii) subjective effects of nicotine delivery and dependence; and (iii) self-reported efficacy for smoking cessation or reduction.

Methods

Study design and procedure

This study used a qualitative design to examine perceptions, motivational aspects and subjective effects of e-cigarette use. The university’s Institutional Review Board for human subjects’ research approved this study (reference number: HSC-SPH-14-0290). The lead investigator conducted in-depth, semi-structured individual interviews to explore patterns and behaviors associated with e-cigarette use among a purposive sample of 50 users. Before the start of the interview, consent was obtained, and the participants were assured their responses and identity would be kept confidential and that there was no right or wrong answers. Interviews lasted ∼30–45 min each. Recorded conversations were transcribed verbatim by an independent transcription service.

Participant eligibility and recruitment

Participant recruitment was conducted via a research opportunity posting on the university’s online calendar, a mechanism to advertise research opportunities. Interested individuals were screened online to verify eligibility which was: 18 years of age or older, 6 months of experience with e-cigarettes, and self-reported negative pregnancy status. Current e-cigarette use was verified by requiring that all participants bring their most commonly used device to the in-person interview. Given the recruitment methods, participants, whose ages ranged from 19 to 61, were primarily university students and staff. The lead investigator interviewed 50 individuals after which interviews were terminated as saturation was reached (i.e. data collected were determined to be adequate and comprehensive) [21]. This study included 32 young adults (29 years and younger) and 18 adults (30 years and older) who participated in interviews between December 2014 and April 2015. A $50 gift card was provided as a participant incentive.

Interviews

Semi-structured interviews were conducted based on an interview guide developed by the lead investigator. A comprehensive review of the literature (as of December 2014) was conducted prior to finalizing these questions to ensure an informed approach and adequate understanding of e-cigarette terminology. The interview guide was intended to address gaps in our knowledge of specific aspects of e-cigarette use, providing practical information for future studies and health communication. As such, pre-determined, open-ended questions centered around users’ experiences with e-cigarettes with a particular focus on subjective effects and motivations for use, as suggested by the theory of reasoned action [22].

Data analysis

QSR NVivo 10 software was used to code verbatim transcripts of the conversations for common concepts. Thematic content analysis was used to analyse qualitative data, whereby emerging trends across the data were extracted. First, the lead investigator considered the data in detail and developed initial codes based on topics present in the semi-structured questionnaire. Following standard qualitative methods, phrases and sentences were organized into these codes (e.g. ‘harm perceptions’) which allowed the investigator to begin to draw conclusions from the data [23]. Next, using an inductive approach, patterns and relationships were examined within and across codes to generate salient themes [e.g. ‘e-cigarettes as less harmful (but not harmless)’]. The following definition was used to develop themes during data analysis: ‘a theme captures something important about the data in relation to the research question and represents some level of patterned responses or meaning within the data set’ [24]. In some instances, the quotations presented below are shortened to improve clarity; however, the content in the quotations has not been altered, nor does it change the original intention of the participant.

Results

Participant demographic characteristics and tobacco use behaviors are reported in Table I. The average age of the young adults was 22.2 years and the average age of the adults was 38.9 years. The young adults reported using e-cigarettes for an average of 15.8 months and the adults reported an average of 17.3 months prior to the interview. Further, 63% of young adults were daily e-cigarette users, and 89% of adults were daily e-cigarette users. Dual use, or current use of cigarettes and e-cigarettes, was higher among the adults (56%) than the young adults (34%).

Table I.

Demographic characteristics and tobacco use behaviors of current e-cigarette users (n = 50)

	Young adults (n = 32)	Adults (n = 18)	All participants (n = 50)
Demographic characteristics
Average age (SD)	22.2 (0.6)	38.9 (2.0)	28.2 (1.4)
Gender
Male	14 (44%)	10 (56%)	24 (48%)
Female	18 (56%)	8 (44%)	26 (52%)
Race
White	18 (56%)	13 (72%)	31 (62%)
Black	2 (6%)	0 (0%)	2 (4%)
Asian	7 (22%)	2 (11%)	9 (18%)
Other	5 (16%)	3 (17%)	8 (16%)
Hispanic
No	25 (78%)	15 (83%)	40 (80%)
Yes	7 (22%)	3 (17%)	10 (20%)
Tobacco use behaviors
Average e-cigarette use duration in months (SD)	15.8, (1.2)	17.3, (2.3)	16.3, (1.1)
Frequency of e-cigarette use
Some days	12 (38%)	2 (11%)	14 (28%)
Daily	20 (63%)a	16 (89%)	36 (72%)
Ever use of cigarettes
No	2 (6%)	0 (0%)	2 (4%)
Yes	30 (94%)	18 (100%)	48 (96%)
Current use of cigarettes (i.e., dual use)
No	21 (66%)	8 (44%)	29 (58%)
Yes	11 (34%)	10 (56%)	21 (42%)
Past 30 day, number of days cigarettes (n = 21 dual users)
1–9 days	9 (82%)	4 (40%)	13 (62%)
10–19 days	1 (9%)	0 (0%)	1 (5%)
20–30 days	1 (9%)	6 (60%)	7 (33%)
Past 30 day, number of cigarettes/day (n = 21 dual users)
1–5 cigarettes	11 (100%)	5 (50%)	16 (76%)
6–10 cigarettes	0 (0%)	2 (20%)	2 (10%)
>10 cigarettes	0 (0%)	3 (30%)	3 (14%)
Intentions to quit smoking cigarettes (n = 21 dual users)
No	5 (45%)	1 (10%)	6 (29%)
Yes	2 (18%)	8 (80%)	10 (48%)
Don’t know	4 (36%)	1 (10%)	5 (24%)
Ever use flavored cigarettes
No	7 (22%)	4 (22%)	11 (22%)
Yes	25 (78%)	14 (78%)	39 (78%)
Nicotine dependence scaleb first cigarette or e-cigarette after waking …
Within 5 minutes	3 (9%)	5 (28%)	8 (16%)
6–30 minutes	2 (6%)	7 (39%)	9 (18%)
31–60 minutes	3 (9%)	3 (17%)	6 (12%)
After 60 minutes	24 (75%)a	3 (17%)a	27 (54%)
Duration quit smoking cigarettes (n = 26 former smokers)
<6 months	5 (28%)	1 (13%)	6 (23%)
6–12 months	6 (33%)	3 (38%)	9 (35%)
>12 months	6 (33%)	4 (50%)	10 (38%)
Missing	1 (6%)	0 (0%)a	1 (4%)

^aColumn percentages do not sum to 100% due to rounding error.

^bAdapted from Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO (1991). The Fagerstrom test for nicotine dependence: a revision of the Fagerstrom tolerance questionnaire. Br J Addict 86: 1119–27.

Several prominent themes related to e-cigarette perceptions and motivations emerged from study participants during the interviews, as organized below. Themes related to e-cigarette products and modifications; preferred flavors; frequency of use; and characteristics of e-liquid are discussed in a separate manuscript which includes the same sample of participants [25]. Given the study design, emphasis was placed on comparing and contrasting members of two a priori groups: young adults under the age of 30 and adults 30 years and older.

Motivations for use: e-cigarettes for cigarette smoking cessation

Participants were asked to describe their reasons for currently using e-cigarettes, and the most commonly cited reason, for both adults and young adults, was cigarette smoking cessation. Among the participants, 21 were current conventional smokers (i.e. dual users), and of these, 10 reported they were trying to quit smoking conventional cigarettes, 6 reported they were not trying to quit, and five reported they were not sure if they wanted to quit. Of the current cigarette smokers, the majority (62%) smoked cigarettes on between 1 and 9 days in the past 30 days; in addition, the majority (76%) smoked between 1 and 5 cigarettes per day in the past 30 days.

There were 27 individuals who previously smoked conventional cigarettes, but had not smoked in the past 30 days. Of those, 18 had used e-cigarettes to help them quit smoking. The overwhelming majority (eight out of nine) of the remaining individuals who no longer smoked cigarettes, but reported they had not used e-cigarettes to quit smoking were young adults and did not, in fact, identify as smokers who needed to quit smoking. For example, one young adult stated, ‘I only take a couple of cigarettes from friends’. Another remarked, ‘I was never a big cigarette smoker. If I did it, it was just in social settings, just as a way to pass the time or talk’. The sample contained two individuals who had never tried conventional cigarettes (one of whom reported using e-cigarettes for enhanced focus when driving and studying and the other reported using e-cigarettes for stress relief).

Those 18 young adults and adults who reported using e-cigarettes for cigarette smoking cessation were asked to describe their perceptions and experiences with using the e-cigarette to reduce or quit smoking. Half of them (n = 9) described a process of customizing the e-cigarette as an important step in using it effectively as a cessation tool. For example, one young adult elaborated, ‘I definitely think it depends on the person, what do they need for it to be satisfactory to them, and then finding the right combination. Because there [are] different batteries, and there [are] different tanks, and the combinations can change. And if you can up your voltage, and you can use this tank, then it might work for you’.

In general, young and older adults described the e-cigarette as effective for this process, though two emphasized that a strong desire to quit was requisite. One young adult stated, ‘I think it was really effective for me. But I think you also have to want to quit smoking anyway. Because I have friends that will just smoke both still, just because they like them both’. Another older adult stated, ‘There’s no way that without an e-cigarette I would've been able to smoke a single cigarette in a 30-day period without immediately going out and buying a pack of cigarettes, so I feel like it’s effective. I think it always is going to boil down to how much people want to stop more than anything else’. One young adult user shared his experience with the e-cigarette as a cigarette smoking cessation tool as well as concerns about the potential harmfulness of e-cigarette constituents, ‘I’m glad I started. I don’t know what’s in them and that’s the scariest part, but I also didn’t know what was in a cigarette. But it did help me quit smoking cigarettes, and I feel a lot better from it’.

Eight users mentioned using nicotine replacement therapy or prescription medication previously to assist in smoking cessation, without success. One adult user described using the e-cigarette as a last resort to successfully quitting conventional cigarette use: ‘It was like the last ditch effort for me. It was like, “Well, I’ve tried the patch. I’ve tried the gum. I’ve tried the lozenges. I’m not going to do Chantix or Welbutrin, because I just don't want to do that”. So I guess I’ll try e-cigs and I’ll try to be really determined this time’.

Motivations for use: e-cigarettes are not just for smoking cessation

Several other reasons for using e-cigarettes were noted by participants. For example, five users within both age groups described enjoying e-cigarettes as a pleasurable hobby or pastime. As one young adult user illustrated, ‘It’s become like a hobby in a way, and you want the new battery, and you want the new tank, and this brand just came out with the new juice, and then there’s another tank, and then there’s this, and it’s just like—people want everything’. Another adult participant described a similar idea, ‘Well, I think now it's just kind of like a fun thing that I do. Sometimes I’ll look at different YouTube videos and deconstruct my whole thing and reconstruct it. It’s kind of like a side hobby these days’. Six adult and young adult individuals described their primary reason for using e-cigarettes as therapeutic (i.e. for relaxation or enhanced focus) as one young adult described, ‘It relaxes me, kind of gives me a fresh start to my brain’.

There were three motivational aspects for e-cigarette use that were discussed by young adults exclusively. For example, three users, all young adults, described using e-cigarettes specifically for the purpose of ‘smoke tricks’. As one young adult interviewee described, ‘I don’t have any nicotine in it. I learned how to do smoke tricks, which can transfer over. If I'm with some friends at a hookah bar, I can do all these crazy tricks now’. Two young adult individuals described the availability of flavoring as a primary motivation for using e-cigarettes. For example, one young adult stated, ‘I’ve liked the experience since I can choose flavors that I prefer, or I could try out different flavors’. And three young adult individuals described a primary motivation for using e-cigarettes specifically for the purpose of helping them study.

Subjective effects: cravings and perceived addictiveness of e-cigarettes

When discussing the overall user experience of e-cigarettes, interviewees were asked to describe whether they experienced cravings for e-cigarettes and how they would compare them to cravings for conventional cigarettes. Although a minority of respondents stated they did not experience cravings for the e-cigarette, approximately half (n = 26) of the users felt that the cravings were less intense than conventional cigarettes, or the e-cigarette was less satisfying and less addictive than a conventional cigarette. For example, multiple interviewees in both age groups described being able to wait longer periods of time between e-cigarette use as compared with a conventional cigarette. One adult respondent described this concept:

‘I don’t think it's as intense I guess. I still do get that craving, but there will be times where maybe I left it in the car or I just don’t feel like pulling it out. I can wait till I get home. It’s definitely not as strong as it used to be where I’ll go outside and smoke a cigarette’.

Another young adult stated:

‘Well, it’s definitely not as addictive. I pretty much felt like I was scheduling my whole life around cigarette breaks when I was really smoking. And [the e-cigarette], I can go hours and be completely fine and not even have the thought of it’.

Perceptions of health impact: e-cigarettes as less harmful (but not harmless)

A common concept that emerged during the interviews was the idea that e-cigarettes were a healthier alternative to conventional cigarettes. This idea was described by 11 interviewees, eight of whom were former cigarette smokers. For example, one young adult user described, ‘It’s got to be better for you. It doesn’t have carcinogens, it doesn’t have carbon monoxide. It’s pretty much just a nicotine delivery system without all the bad stuff’.

However, 15 users in both age groups who made up a balanced group of former and current cigarette smokers, believed that e-cigarettes presented at least some degree of risk, comparing e-cigarettes to other substances or expressed concerns about the unknown risks of e-cigarettes. For example, one adult user stated, ‘Yeah, just less bad. I mean, I know it’s not … It’s still nicotine. It's still got risks, but I kind of think of it like the way I drink my coffee’. A young adult user described a similar notion, ‘I’m now treating nicotine like I treat caffeine. It’s an addictive substance and I’m aware of that. So is caffeine, so is alcohol, so is pretty much anything you do ritually’.

Several participants stated that if definitive research were to conclude that e-cigarettes were indeed harmful to health, it would motivate them to consider quitting. In fact, 17 interviewees expressed a desire to stop using e-cigarettes. As one adult participant stated, ‘That’s another reason why I want to quit, because who knows what we’ll find out in a couple years and it’s like, ‘Oh, crap. I’ve been doing this for like four years now, so that can’t be good”’. Fourteen current users, only two of whom were not under 30, stated they did not plan to quit using e-cigarettes. One young adult user described the ‘just for fun’ aspect of e-cigarettes in relation to perceived harm and intentions to quit using e-cigarettes: ‘But I don’t see myself quitting just to quit, I think it’s kind of a fun thing to do for now. I’d have to have some evidence that it’s bad for me, to actually decide to stop’. Eight users described searching the internet for information on the health effects of e-cigarettes. As one young adult interviewee said, ‘I looked them up online, looked at risks associated with them and stuff, and decided that [compared to conventional cigarettes] the benefits for now, at least, outweigh the risk’.

Discussion

Findings from these qualitative interviews deepen our understanding of motivational aspects of e-cigarette use as well as further describe young adults’ and older adults’ self-reported subjective effects and perceptions of these products. The themes identified help us understand why individuals choose to use e-cigarettes, offer insight into how individuals perceive e-cigarettes in terms of addictiveness or other harmful effects, and illuminate the cognitive processes that individuals undertake as they weigh the benefits and potential harms of these relatively new products. Results from this study are discussed with respect to their implications for health communication campaigns and future public health research.

Importantly, this study’s findings revealed distinct motivations for e-cigarette use among young adults as compared with older adults. For example, 9% of the young adults interviewed responded that they used e-cigarettes primarily for ‘smoke tricks’. These findings are consistent with other qualitative research on e-cigarettes. One study conducted among young adults in New York City found that e-cigarettes were viewed as ‘toys for smoking’ in a prevalent culture of technology [26]. In addition, 9% of young adult interviewees in this study reported that they used e-cigarettes specifically to help them study. To our knowledge, the concept of e-cigarettes used primarily for assisting studying habits has not been previously reported, although it is consistent with research reporting misuse of prescription stimulants to enhance academic performance [27]. These results should be considered by health professionals and educators for the development of future health communication campaigns. For example, such messaging could highlight alternative study tips such as getting adequate sleep, taking breaks as needed or other ways to enhance focus to discourage this practice among young adults. Additionally, future research with a representative sample should further explore these reasons for using e-cigarettes to enhance our understanding of: the prevalence of these beliefs are in the general population; whether this behavior may co-occur with or be a substitute for other drug misuse; and how this practice might influence the uptake and progression of young adult use of e-cigarettes over time.

When asked to describe the subjective effects of e-cigarettes, most users who had ever used cigarettes reported that e-cigarettes, at least partially, satisfied their cravings for conventional cigarettes and helped them quit or reduce using conventional cigarettes. Further, there was a common belief that e-cigarettes were less addictive products. These user descriptions are consistent with results from three studies which found that e-cigarettes were less addictive than conventional cigarettes according to self-reported dependence ratings [28–30]. Although a recent clinical laboratory study demonstrated that some e-cigarette device/nicotine concentration combinations are able to deliver more nicotine to the experienced user than a conventional cigarette [31], results from this study indicate that experienced users do not report higher perceived addictiveness or cravings in real world use settings. Future studies, both laboratory-based and population-based, are needed to fully understand the addictiveness of e-cigarettes and help us to draw conclusions on their abuse liability more definitively.

In terms of smoking cessation, similar to results reported in another qualitative study, users described e-cigarettes’ customizability as facilitating the smoking cessation process [17]. Our results expand on their findings by describing the iterative process that users recount as they find the type of e-cigarette device that is satisfying for them. Cigarette smoking cessation/reduction was defined broadly in our interviews as users were asked to reflect on how effective they believed e-cigarettes were in either helping them to quit smoking or reduce the number of cigarettes smoked. This study did not aim to determine e-cigarettes’ effectiveness for smoking cessation, but rather provide data on users’ perceptions and experiences of using e-cigarettes for this purpose. To this end, findings highlight the need to document product type in future studies focused on evaluating e-cigarettes as a cessation tool as users reported that finding the right fit, in terms of e-cigarette devices and components, was important for the cessation process.

Several studies have explored the perceived harmfulness of e-cigarettes, most commonly using a relative measure of risk perceptions in relation to conventional cigarettes. Although such studies have found the perception of e-cigarettes as less harmful than conventional cigarettes to be common among both the general public [32, 33] and e-cigarette users [7, 29, 34], our finding in which e-cigarette users describe to what extent they believe e-cigarettes present some degree of harm expands significantly on our limited understanding of how these products are perceived. This idea of unknown or uncertain risks associated with e-cigarette use was highly predominant in our sample equally among former and current cigarette smokers and appeared to be strongly related to users’ thought processes as they discussed their intentions (or lack thereof) to quit using e-cigarettes. According to our review, there has been little to no documentation of e-cigarette users’ intention to eventually quit e-cigarettes, and our finding that the vast majority of participants under 30 conveyed little desire to do so warrants attention and further exploration. Furthermore, targeted education about the potential health risks of continued e-cigarette use may prompt young adult e-cigarette users to stop using e-cigarettes after successfully using them for tobacco cessation.

This study’s findings on common perceptions of harm and addictiveness of e-cigarettes can inform the development of appropriate health messaging campaigns for these products tailored to young adults. Notably, some current users in this sample reported that e-cigarettes did not contain carcinogens, and, in general, believed that the only potentially harmful constituent in e-cigarettes was nicotine. However, a recent systematic review documented varying levels of aldehydes and tobacco-specific nitrosamines in e-cigarette refill solutions and aerosol [35]. Results from this study also suggest that adults seek information on e-cigarette’s harmfulness, commonly searching the internet for resources. Even though researchers currently do not fully understand the true consequences of long-term e-cigarette use, health professionals and educators should provide information on what we do know, such as the presence of toxins in e-liquid and aerosol as well as the adverse health impacts of nicotine alone, for example, on the developing fetus [36, 37]. Respondents also compared nicotine to other addictive substances such as caffeine. Health messaging should convey accurate information on the addictiveness of nicotine to dispel misunderstandings that it is comparable to caffeine, as there is evidence to the contrary based on results from animal studies [38].

Limitations

Interviews conducted provided rich context in which to better understand users’ experiences with e-cigarettes, and in particular their common perceptions, motivational aspects and self-reported subjective effects. However, we must caution that these results are not generalizable outside of the study population, which was a largely university-based sample. Specifically, our eligibility criterion of at least 6 months of experience with e-cigarettes may mean that these results do not apply to e-cigarette experimenters or former users. These qualitative findings should be tested in future studies with more rigorous study designs.

Conclusion

The results of this study should be interpreted in the context of our existing understanding of e-cigarettes. The reality is that the true degree of harmfulness and addictiveness of e-cigarettes is still poorly understood. Therefore, the public health community faces the challenge of how to effectively develop messages for health communication and education based on a body of evidence that is still nascent. Nevertheless, these findings help to fill the gap in our understanding of how young adults and older adults are similar and different in their perceptions of e-cigarettes and their motivations to use these products, suggesting that future communication campaigns will need to be tailored to meet the different needs of these two distinct target audiences. This study highlights different motivations among young adult users. Although findings were generally consistent across both age groups in their perceptions of harm from e-cigarettes and in subjective effects such as perceived addictiveness, individuals under 30 more commonly expressed little interest in quitting e-cigarette use.