Results from these focus groups add to the albeit still limited research base regarding e-cigarettes and their usefulness as smoking cessation tools. The information gained provides new insights into the social and group dynamics that may underlie the reasons why NRT has such low observed rates of effectiveness, and why e-cigarettes, at least anecdotally, appear to be more effective for many vapers. Most notably, these include e-cigarettes becoming part of the vaper’s social identity, the recognition of vaping as a hobby, and the ability of these devices to aid in smoking cessation without complete nicotine cessation.
These insights suggest that health practitioners should pay increased attention to the behavioral and social components of smoking addiction, many of which are not addressed by conventional NRTs, as noted by participants in this study. Greater understanding of these components could lead to more effective approaches to treating cigarette addiction, as the e-cigarette users in our focus groups experienced alleviation of withdrawal symptoms and achieved smoking cessation more effectively than they had with conventional NRT.
The ability for e-cigarette users to redefine themselves from “smokers” to “vapers” could be incredibly useful not only in helping tobacco smokers transition to a less harmful replacement tool but also in helping them maintain cigarette abstinence. Many participants in the focus groups reported having relapsed multiple times using the patch, nicotine gum, and prescription medications. This sense of identity as a vaper, both on an individual and group level, appears to give e-cigarette users a sense of ownership over their cigarette addiction. This identity also appeared to be formed and reinforced through the support provided by e-cigarette online forums, where e-cigarette users exchanged information, displayed pride over number of days cigarette-free, and received encouragement for quitting .
E-cigarette use being described as a hobby suggests that the experience is enjoyable and that having a variety of flavors, devices, and nicotine levels available reinforces the motivation to quit smoking and helps prevent relapse. However, due to this variety, further investigation into the concept of the learning curve that occurs with e-cigarette use is warranted.
Both groups emphasized the difference between smoking cessation and nicotine cessation and viewed the e-cigarette as being a safer form of nicotine delivery. Participants recognized that their addiction to nicotine had not subsided, but the means for nicotine administration was replaced by a perceived safer alternative.
The perceptions of e-cigarette users towards vaping as compared to smoking are relevant to legal and policy considerations regarding these products. The subjects in our study clearly viewed e-cigarettes as both a tool for smoking cessation and a safer alternative to cigarettes. However, the current legal and policy framework surrounding e-cigarettes precludes their being marketed with claims that they are safer than regular cigarettes or that they may be useful in smoking cessation. The former claim might be considered a reduced-risk claim under the Family Smoking Prevention and Tobacco Control Act , and the latter might be considered a therapeutic claim, which would put the product under the scrutiny of the US Food, Drug, and Cosmetic Act . Ironically, although e-cigarettes contain no tobacco, the courts have ruled that these products must be regulated as tobacco products rather than as drugs . The way in which actual users of e-cigarettes perceive these products should be considered by the US Food and Drug Administration, which is currently developing regulations for e-cigarettes.
This study was limited in that the sample of participants was not representative of all e-cigarette users; they were recruited from only two online forums and included only participants who were willing and able to drive to the focus group location. Furthermore, the sample represents e-cigarette users who were committed and involved enough with e-cigarettes to be on these forums. This presents an inherent bias in the sample, as those who participated in the focus groups likely favored e-cigarettes for smoking cessation. Therefore, the information gained within the focus groups may not be generalizable to e-cigarette users overall, and this inherent bias could lead to an overestimation of the successful use of e-cigarettes as smoking cessation tools. Although it is true that sampling bias exists, we do not believe this threatens the validity of our conclusions, as this study was intended to bring to light how e-cigarettes are perceived among those who have found them helpful. Further research with larger sample sizes from multiple sites would yield a greater representation of the e-cigarette user population, as would the inclusion of previous e-cigarette users who relapsed.