Perspectives on e-cigarette emong young e-cigarette smokers and the intention to Switch to cigarette smoking: a qualitative study / Siti Khamsiah Abd Shukor

Smoking is a major risk factor for non-communicable diseases. With the uprising popularity of e-cigarette smoking among young adults, and the risk of switching to tobacco smoking from e-cigarette use, could dampen efforts towards smokefree generation by 2045. Evidence on reasons for e-cigarette smoking among young Malaysian adults and their intention of switching to cigarette smoking is scarce. Hence, this study aimed to explore reasons for e-cigarette smoking and intention to switch to cigarette smoking among young Malaysian adults who smoke e-cigarette. This study employed a qualitative exploratory case study design. Current e-cigarette smokers aged between 18 and 30 years who can speak either Malay or English language were recruited via purposive and snowball sampling through three e-cigarette shops in Shah Alam, Glenmarie and Sungai Buloh. In depth interviews (IDIs) were conducted from 1st April 2017 until 15th July 2017 using semi structured interview guide based on Theory of Planned Behavior. Interviews were transcribed verbatim and data were analysed using thematic analysis using the Nvivo 11 software. Fourteen IDIs were conducted to achieve data saturation. The participants were between 20 and 26 years old, with majority male participants (n=12, 86 %) and had tertiary education level (n=11, 78 %). All participants were Malay. Duration of e-cigarette use ranged between two and five years. Four themes emerged such as ‘harmless, flavorsome and handy’; ‘desirability’; ‘endorsement’ and ‘futile regulations’. The participants perceived that ecigarette smoking is safe, non-addictive and an adjunct to quit smoking. Their social circle such as family members, peers and community approved e-cigarette smoking and influenced the uptake of e-cigarette smoking. The under regulation of e-cigarette smoking at public places, promotion and selling of e-cigarette become the facilitators for e-cigarette smoking among our participants. None of our participants had the intention to switch to cigarette smoking due to cigarette smoking is harmful and for having the intention to quit e-cigarette smoking completely. Facilitators perceived to promote switching include dissatisfaction with e-cigarette use, curiosity and loss of ecigarette popularity. In conclusion, e-cigarette smoking is perceived as safe and nonaddictive. This warrant effective dissemination of accurate information on e-cigarette smoking to young adults. Under regulation of e-cigarette advertising and selling; and labelling of e-liquid highlight the importance of regulations on e-cigarette smoking across sectors.