Pathways of Nicotine Product Use: A Qualitative Study of Youth and Young Adults in California.

Introduction:
This document is a manuscript of an article titled "Pathways of Nicotine Product Use: A Qualitative Study of Youth and Young Adults in California" published in Nicotine & Tobacco Research. The manuscript presents the findings of a qualitative study examining the initiation pathways of vaping and smoking among Californian youth and young adults, with a focus on their experiences and reasons for using nicotine products. The study aims to provide a deeper understanding of the role of vaping among youth with different pathways into vaping and smoking.

Key Points:

* The study conducted in-depth qualitative interviews with 49 Californian youth between 15 -25 years old who reported ever vaping nicotine.
* Participants were categorized into initiation pathways by self-reported use and age of initiation of ANDS and cigarettes, and compared the meaning and role of vaping across 3 distinct pathways of use: smoking to vaping, vaping to smoking, and vaping only.
* The most common pathway reported was smoking to vaping (74%).
* Analysis of participants' narratives emphasized that youth in the study, regardless of initiation pathway, were generally aware of the health consequences of smoking and negotiated their use of nicotine products, considering relative risks.
* The study suggests that ANDS serves as a transitional tool for youth who are keenly aware of the health consequences of smoking, challenging conventional discourses about ANDS as a threat to youth’s health.

Main Message:
The main message of the study is that ANDS, such as e-cigarettes, may serve as a harm reduction tool for youth who are aware of the health consequences of smoking and are using ANDS to transition away from smoking. The study highlights the need to acknowledge harm reduction in constructing public health messaging and policies for smoking cessation. It also emphasizes the importance of understanding the nuances of youth's experiences with nicotine products and the need for tailored prevention, treatment, and policy efforts to address their unique needs.

Antin TMJ, Hess C, Kaner E, Lipperman-Kreda S, Annechino R, Hunt G. Pathways of Nicotine Product Use: A Qualitative Study of Youth and Young Adults in California. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco. 2020;22(5):722-727. doi:10.1093/ntr/ntz028