Determinants of e-cigarettes among adolescents and young adults: A scoping review of qualitative studies

Background: Globally, prevalence of e-cigarettes use among adolescents and young adults varies between 6% and 62%. To date, no study has systematically synthesized knowledge about factors influencing youth use from qualitative research on e-cigarettes. Qualitative research allows in-depth understanding of experiences, values, and opinions that is critical for intervention development. Methods: We conducted a systematic scoping review of qualitative studies of the context and determinants of e-cigarette use among youth (10-24 years). We searched 6 databases for peer-reviewed literature, published in English up to April 2019. Abstract/title and full text review was conducted in duplicate. We then coded and analyzed results of included papers. Results: The search strategy yielded 2676 records, of which 36 unique studies met inclusion criteria. These studies described research from 8 countries. Interviews and focus groups discussions were equally common as forms of data collection. Initiation of e-cigarette use often occurred with peers in school, at parties, concerts or other social gatherings or after viewing social media posts. Consistently, youth noted perceived harm reduction and addictiveness (relative to traditional cigarettes), ease of access and use, flavors, social acceptability, and ability to control nicotine content as influencing factors for both initiation and continued use. Smoke shops, websites and friends were sources of procuring e-cigarettes. Youth discussed motivations to quit e-cigarettes, including future family responsibilities and costs of e-cigarettes. Cessation strategies included gradual lowering of nicotine content and using flavored cartridges without nicotine. Conclusion: This scoping review highlights the voices of youth to understand the context and determinants of e-cigarette use. Further, it provides a landscape of what we know about the topic, as well as gaps for further research to guide intervention and policy development. An assessment of the quality of the published studies indicated the need for the application of more robust methodology.