Motivation and emotion/Book/2025/E-cigarette use motivation

E-cigarette use motivation:
What motivates starting and continuing vaping of nicotine e-cigarettes?

Overview

Figure 1. Example of an e-cigarette
Case study

A 19-year-old female who has a history of seizures and neurocysticercosis status post-stereotactics brain biopsy treated in childhood presented themself at the hospital with a complaint about shortness of breath that was worsening. She had admitted to vaping for two years and denied that she had used any drugs. After being tested for human immunodeficiency virus (HIV) and rapid influenza and returning negative results for both a surgical lung biopsy of the left lower lobe was performed. She gradually improved and was discharged 15 days after admission, in a follow up one month later symptoms had resolved and repeat imaging of the chest showed improvement in bilateral pulmonary opacities (Pourshahid et al., 2022).

[1] Electronic cigarettes (e-cigarettes) are a device often designed to replicate a standard cigarette used to consume vapours that can contain nicotine, flavours, propylene glycol, and vegetable glycerin.[2][3] The first documented appearance of electronic cigarettes was in the early 20th century in the state of New York in a patent filed by Joseph Robinson in 1927.[4] However, despite the fact that a patent for e-cigarettes was filed in the early 20th century it was not until the early twenty-first century that e-cigarettes were popularised with the introduction of the "Ruyan" in China manufactured in 2004 and patented by Hon Lik in 2003.[5] Since 2003 e-cigarette use has increased dramatically with the Australian Bureau of Statistics reporting that one in seven adults have used e-cigarettes with men being more likely to consume e-cigarettes than women and at almost double the rate.[6] In 2018 the estimated number of people who vaped was 58.1 million people by 2023 it was estimated that 114 million people globally had vaped, an increase of 55.9 million people over a 5 year period.[7]

Figure 2. Conventional Cigarette [8]

History of e-cigarettes

Whilst e-cigarettes can be traced back to the early 20th century, they have only been popularised recently with the release of the modern e-cigarette occurring in 2003.

First Documented Mentions of E-cigarettes

The first documented mention of e-cigarettes was in a patent filed in New York state by Joseph Robinson in 1927, although the product was not introduced commercially. In the 1960s, there was another attempt to take e-cigarettes to the commercial market by Herbert Gilbert who is credited with having invented the e-cigarette that most closely resembles the modern cigarette. Although Gilbert created multiple prototypes, he was unable to secure any funding and was unable to commercialise his inventions.[9]

Introduction of The Modern E-cigarette

The creation of the modern e-cigarette that is widely available today is largely credited to Hon Lik who filed for a patent in China, the European Union, and the United States in 2003 and was manufactured in 2004. After releasing the e-cigarette in China Hon Lik received such positive feedback he felt empowered enough to release e-cigarettes in to the European Union.[5] Although e-cigarettes have been found to be more healthy than conventional cigarettes, there have been health consequences associated with using e-cigarettes. Some common motivations for using e-cigarettes are socio-economic status, perceptions on the healthiness of e-cigarettes, and attempting to quit smoking conventional cigarettes.

E-cigarette use over time

Figure 3. Provided motivations for why people started to use E-cigarettes (EU 2018).

General E-cigarette Use Over Time

According to Euromonitor International since 2011 the adult smoking population of vapour products has risen from seven million people to forty-two million people in 2018 (see Figure 2).[10] An indicator of growing e-cigarette use if the prevalence of specialised vaping and tobacco shops opening. An example being in the United Kingdom where vaping and tobacco shops were the sixth most common new store opening, ahead of convenience stores and sports & health clubs.[10]

E-cigarette use by age demographic

E-cigarette use has increased over time with more young people using e-cigarettes than traditional cigarettes. [why are young people using them more?] The estimated global prevalence of e-cigarette use among young people is that 16.8% of young people have used an e-cigarette at least once and 4.8% of young people constantly used e-cigarettes.[11] Between 2014 and 2018 the increased use of e-cigarettes among young people has led to the conclusion that e-cigarettes are an initiation to nicotine whereas older people are more likely to be near quitters.[12] Although people over the age of 60 are more likely to have used e-cigarettes within the last 30 days.[13]

The 60+ age group is more likely to have used e-cigarettes in the last 30 days than 40-49.

True
False


Motivation for e-cigarette use

The most self-reported and well researched motivations for e-cigarette use are an individual's socio-economic status, their perception on the health consequences of e-cigarette use, attempting to quit smoking traditional cigarettes, and the taste and flavours that e-cigarettes have that are not available with more traditional cigarettes. The common reasons as to why individuals continue to regularly use e-cigarettes after having them the first time is the chemical reaction induced from using e-cigarettes that contain nicotine, an addictive substance that overtime requires more nicotine in order to feel the effects of dopamine. [why do people continue to use e-cigarettes once they start?]

Socio-economic Situation

Adolescent individuals who live in low-income households are more likely to be exposed to cigarettes and cigarette use.[14] Which leads to Adolescents in low-income households to be more likely to consume e-cigarettes. Those living in disadvantaged areas according to the Australian Bureau of Statistics were more likely to smoke than those who did not, 18.1% in disadvantaged areas and 5.4% not disadvantaged areas.[15]

Perceptions on the Health Consequences of E-cigarette Use

It has been found that younger people not only believe that e-cigarettes are more health than conventional cigarettes but are also healthy in the general sense.[16] However, while it has been found that younger people, especially in high income countries have more positive perceptions of e-cigarettes than traditional cigarettes the primary reason for this has not been concluded with too many clashes of perspective in advertising, health advice, and personal advice for researchers to be able to conclusively determine what the primary cause of the positive perception relative to traditional cigarettes.[17] It has been found that when people are questioned on whether or not there was less harmful chemicals within an e-cigarette compared to a conventional cigarette 20% percent of respondents replied they viewed the chemicals in e-cigarettes as less harmful than conventional cigarettes and another

Attempting to Quit Smoking Traditional Cigarettes

As shown in figure 2 the primary reason for using e-cigarettes among respondents in 2018 was too quit smoking traditional cigarettes. However, this has since been disputed as the primary motivation of e-cigarette use, at least among Australian adolescents, young adults, and adults, with curiosity being the main motivation for e-cigarette use among those who had never tried cigarettes and the taste and flavour of e-cigarettes being the main motivation for those who continue to use e-cigarettes and flavours were also the primary motivation of individuals who smoke traditional cigarettes.[18] While a significant number of people cite using e-cigarettes as an attempt to quit smoking comparisons attempting to discern whether e-cigarette use has been more effective than no help in attempting to quit found that e-cigarettes were five times more likely to help individuals stop smoking after a monthly follow up of 1 moth of e-cigarette use.[19]

However, health advice from the American Centre for Disease Control (CDC) recommend that when using e-cigarettes to in an attempt to quit smoking they should switch from conventional cigarettes to e-cigarettes immediately as extended periods of dual use delays quitting smoking completely.[20]

Taste and Flavour of E-cigarettes

Unlike traditional cigarettes, e-cigarettes are able to contain flavours and tastes that are often found to be more appealing and help to incentivise younger customers who may be hesitant to use traditional cigarettes due to the well-known health consequences. The flavours that e-cigarettes contain such as Boosted, No.32, and Fuji Apple Strawberry Nectarine are also widely cited as one of the reasons younger people especially children are more attracted to e-cigarettes than traditional cigarettes.[21] In America e-cigarettes are available in all types of shapes and sizes, with more than 400 brands and an estimated 15,500 flavours.[22]

Motivations for the regular use of e-cigarettes

Nicotine

Figure 4. 3D Model of Nicotine[23]

Nicotine is a highly addictive chemical that causes your brain to release dopamine, commonly referred to as a feel-good chemical. The longer an individual has been smoking the more nicotine they need for the extra dopamine their brain craves.[24] Once a person develops a dependency for nicotine they begin to start feeling withdrawal symptoms which can cause people to be irritable, nervous, and anxious often driving individuals to smoke.[24] Nicotine initiates addiction by latching on to neural circuitry which functions as a way to reinforce behaviours that lead to rewarding goals. There are many brain structures that help this reward system function but one particular system, mesocorticolimbic dopamine (DA), plays a particularly important role in the adoption of behaviours that are inappropriately reinforced by psychostimulant drugs such as nicotine[25]. Nicotine increases the firing activity and phasic burst activity of midbrain DA neurons and elevates DA in other targets, this is what underlies nicotine's ability to enhance rewards from brain stimulation, reinforce conditioned preferences, and support self-administration.[25]

Social Influences

Figure 5. Social Media Networks[26]

There has been a substantial amount of research done on the influence that social factors such as social interactions, social norms, and advertising. Social media itself within the research is considered a conduit for these social factors. While there are substantial gaps in the research, advertising played a significant role when it came to what social factors were influencing people to use e-cigarettes, people who reported seeing advertising for e-cigarettes had an increased intention to use e-cigarettes[27]. Advertising conducted through social media had the same effect. A study conducted attempting to see how many people were exposed to advertising e-cigarettes found that across four countries, Australia, China, India and the UK, 85% of respondents had been exposed to e-cigarette advertising through advertisement in real life as well as advertisement through popular social media platforms.[28] People who may have already used an e-cigarette containing nicotine and are experiencing withdrawal would be more likely to use e-cigarettes again if exposed to advertising for e-cigarettes. The World Health Organisation has recommended that countries ban all forms of advertisements, sponsorship, and promotion of e-cigarettes.[29]

Coping with Mental Health Challenges

Figure 6. Mental Health Display[30]

In a survey conducted of youth and young adults , people aged 15-24 years of age, the most common reason for using e-cigarettes was coping with mental health challenges. The people that cited coping with mental health challenges as their reason for using e-cigarettes most common response when asked why that the e-cigarettes helped them relax, help them feel calm or less anxious, and that it helps them stay focused.[31] The perceived ability of e-cigarettes to help youth and young people feel calm or more relaxed is likely associated with the nicotine content that can be found in many e-cigarettes and initiate a process that reinforces conditioned process in the form of using e-cigarettes.

Sensation Seeking

Sensation seeking has also been found to be a popular reason for youth and young adults to engage with e-cigarettes. When asked about why they were using e-cigarettes the replies consisted of responses such as they gave me a good buzz, they came in flavours that I liked, just to try, and just curious.[31] These responses hint at a lack of knowledge on the health consequences of using e-cigarettes whether they contain nicotine or not.

Health consequences of e-cigarette use

Lung damage

E-cigarettes containing vitamin e acetate have been associated with life-threatening acute pulmonary illness, this is specifically distinct from typical health consequences associated with the long term use of e-cigarettes.[32] E-cigarette use has also been associated with inflaming conditions such as bronchitis, asthma, and respiratory tract irritation.[33] A review of toxicological analyses of non-nicotine e-cigarettes found that of the identified 243 unique chemicals thirty-eight were listed as poisons.[34]

Developmental consequences

E-cigarette use among children has been linked to adverse physical and mental health outcomes such as acute lung injury, reported cough, dyspnea (shortness of breath), cracked teeth, mouth/cheek pain, and constitutional problems.[35] However there is a deficit in the research on what affect e-cigarette use has on an adolescents development. A study also found that adolescents who had used e-cigarettes within the last year had 29% higher odds of reporting sleep-related complaints, and the association was found to be statistically significant and adolescents who had reported dual-product use within the last year had 57% higher odds of reporting sleep-related complaints.[36]

Cardiovascular health consequences

Acute exposure to e-cigarettes has been associated with increased blood pressure and an increase in heart rate compared to those who do not use e-cigarettes.[37] Lower resting heart rate and lower diastolic BP compared to those who have not use e-cigarettes.[37] However, because of how recent the e-cigarette trend is, there has not been a lot of longitudinal research examining the effects that sustained use of e-cigarettes can have on an individual's cardiovascular health.

Conclusion

A significant amount of people that regularly use e-cigarettes use them to attempt quitting conventional cigarettes and the nicotine within e-cigarettes is the most significant reason as to why they continue to use e-cigarettes. E-cigarettes in comparison to conventional cigarettes are not as restricted when it comes to their ability to market the product. E-cigarettes come in a variety of different colours, shapes, sizes, and flavours that attract the attention of children and provide greater incentives to give e-cigarettes a try. Knowledge of the long-term health consequences of e-cigarettes is largely unknown given how recently e-cigarettes have been popularised there has not been an opportunity to conduct longitudinal studies on the health consequences of regular e-cigarette use over time. Many e-cigarettes also contain nicotine which can lead to addiction and reinforces the behaviour of using e-cigarettes while long term use also leads to larger doses of nicotine to feel the induced effects, as well as withdrawal symptoms when attempting to quit using e-cigarettes. While some e-cigarettes do not contain nicotine, they can contain dangerous chemicals that can cause serious damage to vital organs. The e-cigarette industry has taken off since its introduction in the early 2000s and has become especially popular with children and young adults, although there is research suggesting that certain types of e-cigarettes are healthier than conventional cigarettes, there has not been an opportunity to examine the long-term health consequences of regular e-cigarette use.

See also

Referencews

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