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Notley, Caitlin 
ORCID: https://orcid.org/0000-0003-0876-3304, Ward, Emma ORCID: https://orcid.org/0000-0002-7579-3215, Dawkins, Lynne and Holland, Richard
(2021)
User pathways of e-cigarette use to support long term tobacco smoking relapse prevention: A qualitative analysis.
Addiction, 116 (3).
pp. 596-605.
ISSN 0965-2140
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Abstract
Background and aims: E-cigarettes are the most popular consumer choice for support with smoking cessation in the United Kingdom. However, there are concerns that long-term e-cigarette use may sustain concurrent tobacco smoking or lead to relapse to smoking in ex-smokers. We aimed to explore vaping trajectories, establishing e-cigarette users' perspectives on continued e-cigarette use in relation to smoking relapse or abstinence. Design: Qualitative longitudinal study collecting detailed subjective data at baseline and ~12 months later. Setting: United Kingdom. Participants: E-cigarette users (n = 37) who self-reported that they had used e-cigarettes to stop smoking at baseline. Measurements: Semi-structured qualitative interviews (face-to-face or telephone) collected self-reported patterns of e-cigarette use. Thematic analysis of transcripts and a mapping approach of individual pathways enabled exploration of self-reported experiences, motives, resources, and environmental and social influences on vaping and any concurrent tobacco smoking. Findings: Three broad participant pathways were identified: ‘maintainer’ (e-cigarette use and not smoking), ‘abstainer’ (neither smoking nor using e-cigarettes), and ‘relapser’ (dual-using, or relapsed back to tobacco smoking only). In each pathway, individual experiences with vaping nicotine appeared to play an important role and appeared to be related to psychological and social factors. A social context supportive of vaping was important for the maintainers, as was a belief in the need to overcome nicotine addiction for the abstainers, and dislike of the ‘vaping culture’ expressed by some in the relapser group. Dual-users held beliefs such as a need for cigarettes at time of acute stress that affirmed dependence on tobacco. Conclusions: In a sample of UK e-cigarette users who report having used e-cigarettes to quit smoking, a social context that supports continued vaping was perceived to be helpful in preventing relapse to smoking.
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