User pathways of e-cigarette use to support long term tobacco smoking relapse prevention: a qualitative analysis.

Introduction:
This text reports the longitudinal qualitative follow-up data of a study examining user patterns of e-cigarette use and long-term smoking abstinence. The study aimed to understand user patterns of e-cigarette use over time in the context of either tobacco smoking abstinence or relapse. The study's findings provide insights into individual trajectories of e-cigarette use behavior over time, which might inform understanding of long-term patterns of behavior that best support complete tobacco cessation.

Key Points:

* The study used a qualitative longitudinal study design, repeating in-depth interviews at baseline and 12-month follow up.
* a purposive sample of 40 UK e-cigarette users were initially recruited, and 37 participants completed follow-up interviews.
* The study identified three trajectories of long-term e-cigarette use: maintainers, abstainers, and relapsers.
* Maintainers were those who used e-cigarettes and were abstinent from tobacco, abstainers were those who were abstinent from both, and relapsers were those who dual-used both tobacco and e-cigarettes or relapsed back to tobacco smoking only.
* The study found that individual experiences with using nicotine were critical in each pathway, but were heavily influenced by social factors.
* The maintainers reported that a social context supportive of vaping was important, while the abstainers believed in the need to overcome nicotine addiction.
* The relapsers expressed dislike of the 'vaping culture' and held beliefs such as a need for cigarettes at times of acute stress.

Main Message:
The study highlights the importance of understanding individual trajectories of e-cigarette use behavior over time in supporting complete tobacco cessation. The findings suggest that a social context that supports continued vaping was perceived to be helpful in preventing relapse to smoking. The study's main message is that policies supportive of vaping could be adopted by other jurisdictions concerned with smoking relapse. additionally, health efforts should prioritize intervention with younger people who may be less motivated to 'mature out' of dual use or tobacco smoking behavior, through targeting individual level beliefs, physical dependence needs, social level support, and cultural level reinforcement of reduced harm alternatives.

Notley C, Ward E, Dawkins L, holland R. User pathways of e-cigarette use to support long term tobacco smoking relapse prevention: a qualitative analysis. addiction (abingdon, England). 2021;116(3):596-605. doi:10.1111/add.15226