Introduction
Methods
Study population and recruitment
Procedure
Quantitative measures
Statistical analysis
Results
Participant characteristics
Characteristic | N (%) or M (SD) |
---|---|
Gender, N (%) | |
Male | 49 (79.0%) |
Female | 13 (21.0%) |
Race, N (%) | |
American Indian or Alaska Native | 2 (3.4%) |
Asian | 10 (16.9%) |
Black or African American | 5 (8.5%) |
Native Hawaiian or Pacific Islander | 2 (3.4%) |
White | 35 (59.3%) |
Multiethnic or Multiracial | 7 (11.9%) |
Other | 8 (13.6%) |
Ethnicity, N (%) | |
Hispanic/Latino | 16 (26.7%) |
Non-Hispanic/Latino | 44 (73.3%) |
Age, M (SD) | 20.9 (1.3) |
Currently enrolled in higher education, N (%) | |
Yes | 33 (55.0%) |
No | 24 (40.0%) |
Don’t know | 3 (5.0%) |
Current subjective financial status, N (%) | |
Don’t meet basic expenses | 1 (1.7%) |
Just meet basic expenses | 13 (21.7%) |
Meets needs with a little left | 24 (40.0%) |
Live comfortably | 22 (36.7%) |
E-cigarette/combustible cigarette user, N (%) | |
Sole e-cigarette user | 31 (50.0%) |
Dual e-cigarette/combustible cigarette user | 30 (48.4%) |
Past 30-day combustible cigarette use, N (%) | |
0 days | 12 (28.6%) |
1–5 days | 18 (42.9%) |
6–19 days | 8 (19.0%) |
20 or more days | 4 (9.5%) |
Past 30-day number of days vaped nicotine product, N (%) | |
0–5 days | 7 (11.7%) |
6–19 days | 12 (20.0%) |
20–29 days | 13 (21.7%) |
All 30 days | 28 (46.7%) |
Ever tried to stop or cut down use of electronic nicotine devices, N (%) | |
No | 15 (25.0%) |
Yes | 45 (75.0%) |
No nicotine dependence symptomsb | 6 (13.3%) |
Any nicotine dependence symptomsb | 39 (86.7%) |
Primary Device Usedc | |
JUUL | 21 (33.9%) |
Other pod-based product | 14 (22.6%) |
Mod | 16 (25.8%) |
Missingd | 11 (17.7%) |
Thematic analysis
Themes that align with nicotine and tobacco dependence
Cravings and urgency to use
It’s crazy because we call “fiending” when you just really want to hit something and you can’t. I’ve really felt that a lot where I get irritable like damn I really wish I had my vape right now…and there’s this overwhelming satisfaction when you do hit it after a long day or you haven’t hit it in a while - it’s dangerous how good it feels. [ID02, Asian, male, age 19]
There was a period where I really craved the Suorin [vaping device] because it became a thing where if I was stressed during classes or during an essay or something or some homework, I would definitely take a puff, get lightheaded, feel my whole body relax… [ID25, Hispanic/Latino, male, age 18]
Increased quantity and frequency of use to achieve desired effects
Once you start getting used to these pods, you’re going to need more to get to that same level. So, you’re just constantly running through them faster and faster. [ID35, white, male, age 20]
I think by the end of that semester it became less of something I did to “release stress” because of the head buzzes and it was just something I needed to do for a sense of normalcy. [ID11, Asian, male, age 20]
I have 50 [mg] cause I started with the 30 and then I was like let me go up and see if I can feel any more lightheadedness and I do. [ID37, African American, male, age 25]
Before I was just doing it just for fun. But now I was like oh that’s kind of cool, so I started at maybe 3 mg per mL and then eventually [increased to] 6 mg per mL. [ID53, Hispanic/Latino female, age 22]
Unsuccessful quit attempts and withdrawal symptoms
This past summer… I tried quitting on a family vacation…I was really killing the vibe for the rest of my family so I went two full days without [vaping] and honestly on that second day I was like I know that I can do this. I know that I can drop it, but I don’t know how to stop myself from being irritated and angry when I’m off of it and I know that I’m really upsetting the rest of my family…I accepted that the day I quit will have to come another day and then I just [vaped] so I could enjoy the vacation. [ID11, Asian, male, age 20]
I rip it so many times throughout the day that I am scared to stop ...my blood composition has got to have nicotine in it. Like a lot of nicotine. I’m going to go through some sort of withdrawals if I try to cold-turkey it or wean myself off of it less and less. [ID61, white, female, age 19]
I get headaches, I get more irritated, it gets a little harder for me to concentrate in class. [ID11, Asian, male, age 20]
Sometimes if I have difficulty sleeping and I know I’ve been using it more, I’ll be like “it’s probably the nicotine withdrawal” and I’ll hit it once and go to bed. [ID32, Asian, female, age 21]
Themes unique to e-cigarette dependence
Greater nicotine consumption due to ease of accessibility and lack of vaping restrictions
I definitely consume more nicotine than I would if I was smoking cigarettes because I can vape inside, can vape everywhere. [ID13, white, male, age 22]
When I started [the Juul] I just found myself using it all the time. With the cigarettes, at least I’d have to get myself up, go outside, light the cigarette, and then put it out and then walk back in, it’s a whole process. I could just be sitting there doing homework and I’m just smoking [vaping], and I’m like hold up, this is supposed to help me quit. [ID01, male, age 20]
The worst thing is like - first thing in the morning, it’s under my pillow. This is my [rock] bottom, it’s under my pillow [when I sleep so I can use it] first thing in the morning. [ID61, white, female, age 19]
I wake up and I hit my vape. I sleep next to it. [ID34, white, male, age 23]
Habitual vaping
You sit there and you mindlessly puff. You get such a high nicotine intake that you’re growing accustomed to [it]. Even if you’re a pack a day smoker, you’ll smoke a whole pod and a half in a day or something. It’s a lot. [ID01, male, age 20]
You use it [vape] to a point to where it’s like muscle memory, so like you’re doing homework or relaxing and I’d find myself wanting to reach for it. [ID30, white, male, age 20]
I kind of just carry it around…before class, after class, in between class, like right after meals especially and right before I sleep. It’s just out of habit…I’m hitting it constantly. [ID11, Asian, male, age 20]
I try not to start until later in the day like I’ll try to hold off until I like can’t. It’s usually like 11-12ish around mid-day and then I usually Juul on my way to class, between classes, every time I exit a building and I’m walking in open air. [ID01, male, age 20]
Inability to track vaping frequency
I wish that I was able to measure how much I was [vaping]. I have no idea how much nicotine I’m taking in. I really don’t. I always have it, so I don’t even really know how often I’m ripping it. [ID61, white, female, age 19]
Immediate gratification and comfort from vaping devices
When I’m in class, when I need to be distracted, when I’m feeling anxious and like literally, anything, if I pick up my Suorin [vaping device] it’s like an adult pacifier. I feel like in our society, I have a bad habit, I chew a lot of gum, I rip that nicotine device, and checking your phone. And that somewhere between those three things in my life, it’s like one of those is constantly going on. Just an immediate gratification. [ID61, white, female, age 19]
I just think there’s something about the oral fixation, like I always kind of jokingly call it like the adult pacifier. Like that’s what the Juul is. It’s like, it’s just something we put to our mouths because it makes us feel safe. [ID58, white, male, age 22]
Social acceptability and norms impact e-cigarette use patterns
I think I’m more addicted to nicotine than I am to vaping because I feel like vaping is the social aspect too. It’s kind of like taking pride in that you’re showing off this device that you have, kind of like a new phone. [ID51, Hispanic/Latino, male, age 20]
There’s a game called baseball where a whole party is like a tap Juul and you pass it to one person. They inhale, keep it inside – Pass it to me. I inhale, pass it back, they exhale. Hit again and we just keep going and the longer you have it inside, the more you absorb so then someone quits and is like “I’m done” and the other person wins or whatever. So, yeah, it’s really intense. [ID25, Hispanic/Latino, male, age 18]
[The hard part is] trying to quit [among] a group of friends [who vape]. We all can [quit if], we can all be isolated and be by ourselves for three weeks... It wouldn’t be hard to quit and just stop using all together, but then the social aspect of it comes into play. [ID32, Asian, female, age 21]
Awareness of vaping dependency
[Vaping] is something that I’ve integrated into like everything that I do. There are posts on the internet that say how do you know that you’re addicted to vaping, and it’s like [vaping] becomes a part of you, like you look down and you realize it’s in your hand, you don’t even know. [ID20, white, male, age 21]
I kind of gave in to that addiction and got onto it [vaping] full-time, and I’ve not gone a day without it since last April, which is pretty weak. It’s in my hand all the time, even in photos and stuff. [ID61, white, female, age 19]