a thesis statement about vaping

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• v.12(3); 2022

A Scoping Review of Vaping, E-Cigarettes and Mental Health Impact: Depression and Suicidality

a Nishtar Medical University, Multan, Pakistan

Sadia Usmani

b Dow University Health Sciences, Karachi, Pakistan

Zouina Sarfraz

c Fatima Jinnah Medical University, Lahore, Pakistan

Azza Sarfraz

d Aga Khan University, Karachi, Pakistan

Aunsa Hanif

e Sharif Medical and Dental College, Lahore, Pakistan

Amena Firoz

f Pondicherry Institute of Medical Sciences, Puducherry, India

g Shadan Institute of Medical Sciences, Hyderabad, India

Medha Sharath

h Bangalore Medical College and Research Institute, Bengaluru, India

Namrata Walia

i Baylor College of Medicine, Houston, TX, USA

Ivan Chérrez-Ojeda

j Universidad Espíritu Santo, Samborondón, Ecuador

k Respiralab Research Group, Guayaquil, Ecuador

Saeed Ahmed

l Rutland Regional Medical Center, Rutland, VT, USA

Electronic cigarettes have grown in popularity due to natural curiosity, novel flavors, and advertising as both a means to aid smoking cessation and a “safe” smoking option. There is a substantial body of research on the harmful physical health effects of vaping, but there are relatively few studies on its mental health effects, particularly in adolescents 10–21 years of age. The purpose of this review is to examine the negative effects of vaping on mental health, in particular depression and suicidality. Using the databases PubMed, Scopus, Cochrane Library, and the search engine Google Scholar, we focused on observational studies looking into association between vaping, depression and suicidality. We found 7255 studies; after removing duplicates and other irrelevant articles, 106 articles were left. After reviewing the abstracts and titles, 99 citations were manually removed, 7 studies were included in the final review. Suicide attempts were significantly higher among e-cigarette users compared to non-users. E-cigarette use was associated with depression, suicidal ideation and suicide attempt. Suicide attempts were significantly higher among e-cigarette users compared to non-users. It is critical to raise awareness about the association between electronic cigarettes and adolescent mental health.

1. Introduction

Vaping devices, also known as electronic nicotine delivery systems, are used to inhale vapors containing nicotine and other potentially harmful substances. 1 These devices, more commonly known as e-cigarettes (electronic cigarettes), were introduced to primarily assist adult smokers in quitting the use of combustible tobacco cigarettes. 1 Vape pens, e-hookahs, pod mods, and tanks are some other names for these devices. These are battery-powered devices containing a proprietary liquid that is heated into an aerosol that users inhale. 2 The cartridges’ liquid commonly contains propylene glycol or glycerol, nicotine, tetrahydrocannabinol, or flavoring chemicals. Volatile organic products, heavy metals (nickel and lead), Diethylene glycol, acrolein, and diacetyl are also harmful ingredients. 2

The use of e-cigarettes among adolescents is on the rise. According to the 2019 National Youth Tobacco Survey more than 5 million middle and high school students used e-cigarettes in 2019. 3 Some of the reasons for the significant increase in adolescent vaping include 1) misconceptions about the safety of e-cigarettes, 2) lower prices than traditional cigarettes, 3) a variety of flavors such as fruits and candy, and 4) social or peer pressure. 4 Eight out of every ten users preferred flavored e-cigarettes, with menthol being the most popular flavor. 3

Vaping has been shown to have numerous harmful effects on the physical and mental health of individuals. E-cigarette or Vaping use Associated Lung Injury (EVALI) was first identified in 2019. 5 A total of 2807 EVALI hospitalized cases, or deaths have been reported since February 2020. 2 Additionally, nicotine (one of the components of E-cigarettes) use in adolescents has been shown to cause severe impairment to the growing brain leading to cognitive and psychiatric issues 6 like depression, anxiety, violence, other substance abuse, and suicidality. 7 Because of the growing public health crisis and health consequences, the Food and Drug Administration (FDA) recommended a ban on most flavored vaping cartridges and pods in 2020. 4 To protect youth from the harmful side effects of vaping, the minimum age for purchasing tobacco-containing products was raised from 18 to 21 years old. 4

This review aims to present comprehensive evidence from the literature on the association of e-cigarette use and mental health outcomes particularly depression and suicidality. We hope to raise awareness among adolescents, their parents, teachers, healthcare providers, and the entire community and subsequently decrease the incidence of mental health disorders associated with the use of EC through various public health measures.

We use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement 2020. 8 A review of white literature was conducted using the electronic databases PubMed, Scopus, the Cochrane library, and for grey literature Google Scholar was utilized, with a focus on studies on E-cigarettes and their mental health consequences. The review included observational studies that looked at the impact of vaping on adolescent mental health, particularly depression and suicidality. This review included studies published in the previous 5 years up until April 30, 2021, examining the impact of vaping on adolescent mental health. Search terms included: Vaping OR Electronic cigarettes OR E-cigarettes AND Depression AND Suicidality. Two authors (SJ and SU) blindly screened all articles obtained from the search using titles and abstracts to identify relevant articles for full-text consideration. Disagreements were resolved through discussion, and a consensus was reached. On the initial search, we found 7255 articles in the literature; after removing duplicates and other irrelevant articles, we were left with 106 articles. 99 citations were manually removed after reviewing the abstracts and titles. The final review included 7 studies in total (see Fig. 1 ).

PRISMA flowchart.

The characteristics of included studies are listed in Table 1 . Synthesis of key findings is presented below.

Characteristics of included studies. EC = Electronic Cigarettes; CC: Combustible cigarettes; F= Female; M = Male; N/A: Not available; YRBS - Youth Risk Behavior Survey, MTF -, RCADS - Revised Children’s Anxiety and Depression Scale, MDQ - Mood Disorder Questionnaire, DTS - Distress Tolerance Scale, CASI - Childhood Anxiety Sensitivity Index, SHAPS - Snaith-Hamilton Pleasure Scale, TCI - Temperament and Character Inventory Impulsivity Scale, UPPS-P - Positive and Negative Urgency Subscales, EATQ - The Early Adolescent Temperament Questionnaire-R-Inhibitory Control Scale, DAST - Drug Abuse Screening Test-Adolescent Version, CAST - Cannabis Abuse Screening Test, RAPI - Rutgers Alcohol Problem Index.

3.1. Depression

Five of the seven studies included depression as a primary outcome. Lechner et al. (2017), discovered that continued use of electronic cigarettes (EC) with or without concurrent use of CC worsened depressive symptoms, resulting in a deterioration of the individual’s mental health. 9 Lechner and colleagues showed a bidirectional relationship between EC use and depression and noticed that adolescents who were depressed were more likely to initiate EC use and dual-use than non-users. They found that the past 30-day frequency of EC use was positively associated with depressive symptoms at the final follow-up. The authors suggested a longer follow-up period to observe depressive symptoms. These findings were reinforced by many other studies (i.e., Lee & Lee, 2019; Chadi et al., 2019 and Jee, 2016), all of whom reported finding higher levels of depression in EC users. 10 – 12 Female EC users, as compared to males, were found to have a greater risk of mental health issues, including depression and suicide ideation. 10 , 11 , 13

Leventhal et al. (2016) reported higher internalizing outcomes of depression in EC only users compared to non-users. 14 However, these outcomes were lower compared to CC only or dual users (p < 0.0001). 14 Also, the prevalence of mental health issues including depression, anhedonia was found to be higher in EC users compared to non-users. 14 The risk of developing depression or anxiety was higher in dual users and CC users compared to adolescents who only used ECs. 14 Pham et al. (2020) examined the prevalence of depression, suicidal ideation, and attempts among various age groups, genders, education, employment, geographical region, income, and relationship status. 10 In the age group 12–18 years, the prevalence of depressive symptoms was 9.1% and the prevalence of serious suicidal ideation/attempts was 3.2%. Adverse mental health impact was more prominent in dual users. Smoking status and gender were identified as important modifiers for the association between EC use and mental health.

3.2. Suicidality

Chadi et al. (2019), described in their study, the link between single or dual-use EC and depressive symptoms and suicidality in high school students (n = 26,821) using the risk behavior survey. 11 They reported 9.1% of exclusive EC users (vs non-use) were associated with suicidal ideation (AOR = 1.23, 95% CI: 1.03–1.47) and depressive symptoms (AOR = 1.37, 95% CI: 1.19–1.57). 11 30.7% of participants reported experiencing depressive symptoms for more than 2 weeks and 17.3% reported seriously considering attempting suicide in the past year. 11 EC only and dual EC and marijuana users reported more depressive symptoms and suicidality compared to non-users. 11 In addition, Jee (2016) explored the comparison between the use of e-cigarettes and psychological and emotional health indicators in Korean youth smokers by using the data from the 2015 Korean youth risk behavior web bases survey. 12 They reported higher rates of sadness and hopelessness, suicidal plans, and suicide attempts among the past-12-month EC users (compared to non-users). 12 Males were more adversely affected than females, mostly used EC in high school, 10% started using EC because of curiosity and would buy these from friends or seniors at school. 12

The results were consistent with another study where Kim & Kim (2019) who reported higher suicidal ideation (AOR = 1.58, 95% CI: 1.31–1.89, p < 0.05), suicidal plans (AOR = 2.44, 95% CI: 1.94–3.08, p < 0.05), suicidal attempts (AOR = 2.44, 95% CI: 1.85–3.22, p < 0.05), and serious attempts (AOR = 3.09, 95% CI: 1.51–6.32, p < 0.05) among the past 30-day EC users (versus non-users). 15 However, as compared to the above-mentioned study Kim & Kim (2019) reported that most high school EC users were females, had very high or low socioeconomic status and very high or low school performance, making the user profiles and associated factors bimodal in distribution; had very high or low subjective health status, reported greater awareness about depression, lifetime drinking and habitual drug use. 15

3.3. Depression and suicidality

Some studies analyzed both depression and suicide as their primary outcomes. Lee & Lee (2019) found that male adolescents, who were EC-only users had a higher suicide attempt prevalence of 5.9%, whereas female adolescents showed the prevalence of suicide planning of 16.8% and suicide attempt of 14.3%. 10 Male dual users showed the highest prevalence in the depression of 34.2%, suicidal ideation of 16.1%, and suicide planning of 7.0%. 10 Female dual users showed the highest prevalence in the depression of 53.2% and suicidal ideation of 29.4% (53.2% and 29.4%, respectively). 10 EC only users compared to non-EC or CC users were associated with depression, suicidal ideation, suicide planning, and suicide attempt. EC current users compared to non-EC or CC users were associated with depression, suicidal ideation, suicide planning, and suicide attempt. The adjusted Odds Ratio (AOR) for suicide plans and attempts were much higher in female than male EC users. Alternatively, Leventhal et al. (2016) described lower levels of internalizing symptoms (depression, GAD, panic disorder, social phobia, OCD) in EC users compared to CC and dual users. 14 Overall, it was found that adolescents who used ECs were more likely to consider attempting suicide and had a higher-than-average number of suicide attempts. 11 – 13 , 15

4. Discussion

There has been an alarming increase in the popularity and usage of e-cigarettes among adolescents 10–21 years of age. In addition to the detrimental physical effects, e-cigarettes have been found to have a negative impact on mental health among this age group. EC is advertised in attractive packaging with a variety of unique flavors, which entices curious adolescents who want to try nicotine and smoking products. The use of EC has been particularly promoted by social media fads in which ‘influencers’ encourage teenagers to use e-cigarettes in the belief that it is safe and socially acceptable. The risk of EC use is greater in adolescents with impulsive personality traits as they tend to initiate EC at an earlier age and use them more often. 16

At present, there are more than 30 annual vaping conventions in the US; vape clubs tend to hold national and local conventions with upwards of thousands of attendees at each event. This is of drastic concern to public health and healthcare workers due to the emerging vaping culture and its connection to adverse mental health outcomes. 17 Flavors such as “captain crunch berries” and “cookies and cream” appeal to audiences in middle and high school that have a high rate of e-cigarette update. 17

A systematic thematic analysis of 808 e-cigarette/vaping-related videos in TikTok that is a video sharing service presented a synthesis of likes, themes, and categories of the users. 18 The study found that the shortlisted videos were viewed around 1.5 billion times; moreover, 63% of the videos depicted vaping in a positive manner. The themes in the videos included 52% being comedic, 20% showing vaping tricks, 20% targeting nicotine and addiction, 16% being creative in nature, and only 11% had a warning. 18

The findings illustrate the vaping and e-cigarette postings are available without age restrictions in TikTok, a video-sharing platform that is popular among adolescents; effective disclaimers and age restrictions ought to be imposed by public health professionals to reduce exposure to positive vaping portrayals. 18

There is compelling evidence from published data that there is a higher incidence of depression in adolescent users of ECs than in those who do not use these products. 9 – 12 Adolescents who have pre-existing depression or depressive symptoms are more likely to begin using ECs, suggesting a bidirectional relationship between depression and EC use. 9 An association between suicidality and e-cigarette use has been observed in adolescents, with increased suicide ideation, suicide planning, and suicidal attempts. A higher rate of suicidality has been observed among dual users. 10 Lee and Lee examine the relationship between suicidality and depression among Korean adolescents from the 2017 Korean Youth Risk Behavior Web-based Survey. Including a total of 62,276 students, significant differences were found among users where dual (EC and CC) users had a higher prevalence of suicidality and depression for both current and lifetime users. Whereas, EC only users had higher levels of suicidality and depression compared to non-users. Among female adolescents, CC-only and EC-only users, and dual users had a higher prevalence of suicidality and depression as compared to male adolescents. 10 , 13 Lee and Lee’s study was the first to assess the associations of suicidality and depression to CC and EC use using a nationally representative Korean adolescent sample. The findings suggest that there is an urgent need for the intervention and evaluation of e-cigarette use by healthcare professionals to provide smoking cessation programs for users. 10 , 14 This relationship suggests that while exclusive use of ECs is associated with unfavorable psychological outcomes, its use by current or lifetime conventional smokers can lead to a greater exacerbation of existing symptoms of mental illnesses.

Due to the increase in the use of EC and its impact on mental health, multiple policy changes have been implemented in the United States to mitigate the public health threat. These include increasing the minimum age to buy nicotine-based products including e-cigarettes to 21 years of age, and a ban on the sale of disposable and cartridge-based e-cigarettes with mint, candy, and fruit flavors. 19 Also, the use of packaging with highly identifiable logos or cartoon characters has been deemed illegal. However, menthol and tobacco-flavored e-cigarettes and ENDS like open tank vaping systems can still be sold and concerns have been raised that this might lead to teenagers switching to menthol or tobacco flavored pods or even switch to more dangerous and addictive substances. Eliminating the EC from the market might lead to a relapse amongst people who have quit smoking. This could result in a hazardous rise in health issues associated with smoking traditional cigarettes. The implementation warrants new innovative preventive strategies. 20 , 21

The most important prevention strategy is educating the youth about the development of potential mental health effects or deterioration of pre-existing conditions that can result from using EC. A program like “The Real Cost”, an excellent example, was launched by the FDA in 2014 to educate youth on the dangers of tobacco use. The program aggressively prioritized spreading awareness about e-cigarettes to dispel the misconception that e-cigarettes are harmless. Similar campaigns at schools and colleges may help reduce the use of EC and prevent the negative impact on the mental health of adolescents.

Outreach programs via social media can be an effective way to propagate awareness. Primary care physicians including pediatricians should screen the youth on the usage of EC along with the recommended alcohol and drug screens during preventive healthcare visits. The youth must be encouraged to quit the use of vaping devices to avoid dependence on nicotine as a coping strategy. Resources on the symptoms of dependence and withdrawal should be shared with them. Potential breakthrough responses by primary care physicians may be offering insurance discounts for those with negative nicotine testing, conducted regularly. It may also be beneficial for healthcare professionals to receive additional training in motivational interviewing to facilitate change among the population that wishes to quit e-cigarettes.

4.1. Strengths and limitations

Our study is unique as it focuses mainly on the adolescent age group (10–21 years) which is the more vulnerable age group. We included studies carried out in different parts of the world to get a broader perspective on this issue. The main limitation was the restricted number of studies showing the effect of vaping on adolescent mental health. In the included studies, we did not take into account any pre-existing mental health conditions in adolescents to prevent confounding. Another limitation was that we did not consider the frequency of e-cigarette use or the concentration of nicotine because some of the studies had limited data in this regard.

5. Conclusion

This review finds that e-cigarette adolescents are more likely to have mental health problems such as depression and suicidality. The combination of conventional and electronic cigarettes exacerbates these conditions. Also, females develop higher adverse effects on mental health as a result of vaping. To further understand the mechanisms which lead to mental illness in E-cigarette users, more research needs to be done. Although the FDA has taken commendable steps to restrict adolescent access to E-cigarettes, more work needs to be done to identify and close loopholes. We anticipate our review findings to be a critical piece of information for healthcare professionals and public health practitioners.

List of abbreviations

No funding was obtained.

Conflict of interest

All authors declare no conflict of interest.

• Research article
• Open access
• Published: 15 October 2020

Motivations for use, identity and the vaper subculture: a qualitative study of the experiences of Western Australian vapers

• Kahlia McCausland   ORCID: orcid.org/0000-0001-7071-6491 1 ,
• Jonine Jancey 1 ,
• Tama Leaver 2 ,
• Katharina Wolf 3 ,
• Becky Freeman 4 &
• Bruce Maycock 1 , 5  

BMC Public Health volume  20 , Article number:  1552 ( 2020 ) Cite this article

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Vaping is a relatively new practice, and therefore its symbolic meanings and social practices are yet to be fully understood, especially within Australia where the practice is strictly regulated. This study aimed to examine vapers motivations for use, reinforcing influences, and association with the vaper subculture.

Working from a constructivist epistemology and a symbolic interaction framework, in-depth interviews were conducted with a purposive sample of 37 current (89%) and former (11%) adult vapers, 70% male, mean age of 32.5. Data was analysed via thematic analysis.

Vapers largely started vaping to quit smoking and underwent common experiences during their initiation phase. Subsequently, vapers tended to adopt one of two dominant identities, that of the ‘cloud chaser’ or the ‘substitute’, which some users moved between during different stages of their vaping career. The social and symbolic meaning of e-cigarettes and vaping varied and involved concepts of harm reduction, addiction, pleasure, stigma and community, and for some, connection to the vaper subculture.

Conclusions

Understanding the complexities of vaping, and the nuanced differences of ‘cloud chasers’ and ‘substitute’ vapers may have important implications for health communication, research and policy. E-cigarette users within this sample were not a homogeneous group and differed in their motivations for use, association with the vaper subculture and relationship with the vape community. These findings provide new insights into the socialisation process and subsequent identity adoption of vapers within the unique regulatory environment of Western Australia.

Peer Review reports

Since entering the American market in 2007 [ 1 ], e-cigarettes have undergone a rapid evolution, with three broad classifications of vaping devices now recognised i) disposable (cig-a-like), ii) closed reusable (vape pen, pod-based), and iii) open reusable (mod) [ 2 ]. Cig-a-likes closely resemble a cigarette with a glowing tip that lights up upon inhalation and is disposed of once the e-liquid is consumed. Closed reusable systems use replaceable pre-filled cartridges which tend to be limited in functionality (i.e. inability to adjust the temperature) and were originally designed to resemble cigarettes. However, the most recent generation of closed reusable vaping devices, pod-based systems, have diverged from cigarettes and now resemble USB sticks [ 2 ]. Finally, open reusable systems comprise a refillable liquid reservoir or ‘tank’, which users fill with their preferred choice of e-liquid.

E-cigarettes were originally developed as an alternative form of nicotine delivery and potential smoking cessation device [ 3 ]. However, over the short period since their inception, they have transformed into high-tech nicotine delivery devices appealing to both non-smokers and youth [ 4 ], an outcome largely stemming from increased investment by the tobacco industry [ 5 ]. This investment has contributed to their use moving beyond their touted role as a nicotine replacement and tobacco cessation device, to a social, recreational and sensory delivery device [ 6 ] associated with new rituals and social practices [ 7 ].

Smokers cite numerous reasons for starting vaping, these include: to ease nicotine cravings and withdrawal symptoms; to quit smoking or avoid relapse; to use e-cigarettes where smoking is prohibited; reduce cost; and the belief that e-cigarettes are less harmful than tobacco [ 8 , 9 , 10 , 11 ]. However, recently, research has investigated the rise in ‘alternative’ e-cigarette use behaviours such as dripping (i.e. applying e-liquid directly on the atomiser) [ 12 ] and vape tricks (i.e. creating shapes from exhaled aerosol) [ 12 , 13 ] which may contribute to the perception that e-cigarettes are ‘cool’ or to be used for recreation [ 13 ].

Research from Europe has explored e-cigarette user’s motivations, self-identity as vapers and involvement in vaping subcultures. Farrimond [ 14 ] identified differing motivations for use of, and varying political engagement in, vaping regimes among a sample of vapers in the United Kingdom (UK) and constructed three main typologies to describe these users: vaping for pleasure, vaping as medical treatment and ambivalent e-cigarette use, suggesting that the motives of vaping may be linked to different social identities. Similarly, a study of Norwegian vapers identified two dominant vaper identities, who Tokle and Pedersen [ 15 ] labelled ‘cloud chasers’ and ‘substitutes’. Cloud chasers were dedicated vapers who identified with symbols and values in the subculture, many of whom were politically engaged in improving e-cigarette regulation, describing a sense of belonging to the vape community. Whereas substitute vapers were former daily smokers who used e-cigarettes for smoking cessation, to improve their health, escape the stigma of smoking and manage nicotine addiction. These studies echo other international research pointing to the symbolic and identity aspects of vaping [ 16 , 17 , 18 , 19 ].

Vaping is a relatively new practice, and therefore its symbolic meanings and social practices are yet to be fully understood. However, it appears that through the uptake of vaping, personal and collective identities have been established and a vaping subculture has emerged [ 14 , 15 , 20 ]. Considering the limited extant research investigating e-cigarette use within Australia, this study aimed to examine vapers motivations for use, reinforcing influences, and association with the vaper subculture within Western Australia.

In Australia, liquid nicotine is classified as a ‘Schedule 7-Dangerous Poison’ under the Federal Poisons Standard [ 21 ]. Hence, the only legal avenue for obtaining it is through a personal importation scheme [ 21 ], which states the user must have a prescription from a physician. E-cigarettes that do not contain nicotine can be sold in some Australian jurisdictions, provided manufacturers do not make therapeutic claims. However, in Western Australia, the context of this study, it is currently an offence under the Tobacco Products Control Act 2006 [ 22 ] to sell products that resemble tobacco products, regardless of whether they contain nicotine or not.

Since the early 1990s, Governments in Australia have enacted progressive comprehensive legislation to reduce the impact of tobacco [ 23 ], and as a result, smoking rates have steadily declined. The 2019 National Drug Strategy Household Survey (NDSHS) [ 24 ] reports daily tobacco smoking rates in Australia have more than halved (11.0%) since 1991 (24.3%), and the daily use of tobacco products is most common among people aged 40–59 years (31.7%). Conversely, e-cigarette use has increased and current use is most common among those aged 18–29 (32.4%). During the time this study was undertaken the number of vape retail stores within the Greater Capital City Statistical Area (GCCSA) of Perth, Western Australia, had multiplied exponentially [ 25 ], which has resulted in increased exposure and access to these products, and perhaps reflects an increase in demand.

Vaping devices are referred to by users and scholars by a multitude of terms, including e-cigarette, ENDS (electronic nicotine delivery device), vape and mod. In this paper, the term e-cigarette is used to represent all of the various consumer products available.

Theoretical framework

Symbolic interactionism is a micro-level sociological theory providing the theoretical framework underpinning this study [ 26 ]. Symbolic interactionism is situated in a constructivist epistemology, focussing on the interactions between individuals rather than large scale social structures, examining how people navigate their interactions with others and allocate meanings based on their interpretation of those interactions [ 26 , 27 ]. Symbolic interactionism has a history of being used to investigate drug use, the creation of deviance, and the exploration of meaning associated with new phenomena [ 28 , 29 , 30 ]. The symbolic interaction framework, therefore, assists in understanding a society (e-cigarette users) which is created through the repeated interactions between vapers [ 26 , 27 ].

Participants were purposively sampled for maximum variation in demographic characteristics (i.e. sex, age, Index of Relative Socio-Economic Advantage and Disadvantage (IRSAD) - a ranking derived from the economic and social conditions of people and households within an area [ 31 ]) within the sampling frame. Data collection and analysis occurred simultaneously (March – November 2018), facilitating appropriate and targeted recruitment. Eligible participants were current and former (vaped within the last 12 months) vapers, aged over 18 years residing within the GCCSA of Perth, Western Australia [ 32 ]. Eligibility criteria were stipulated on all recruitment material.

Recruitment

A multipronged approach to recruit participants was utilised. Recruitment flyers and posts were placed on four online vaping forums (AussieVapers, Vaping in Australia, Vaper Café Australia and E-Cigarette Forum); seven subreddits on Reddit; and 30 closed vaping Facebook groups. The lead author created personal accounts on each of the forums and social media. Facebook groups were accessed by requesting permission to enter the group as a researcher to recruit study participants. Vape retail stores, online and bricks and mortar, within the GCCSA of Perth were contacted via email, social media and webpage submission forms. Snowball sampling was also utilised.

Interested individuals were invited to contact the lead author via email or telephone to express their interest in participating and receive further details about the project and what their participation entailed. After reading the participant information statement and providing informed consent, interviews were arranged at convenient safe public locations (e.g. local café, university campus). Interviews were conducted in English by the lead author who has experience in qualitative data collection. Interviews lasted on average 49 min (range 25–86 min) and were audio-recorded with participant consent. Participants were provided with an AUD$25 gift voucher at completion of the interview as an honorarium for their time.

Data collection

A semi-structured interview guide was developed to allow flexibly and adaptability within each interview [ 33 ], and pilot tested with two participants. The interview guide addressed the following topic areas: reasons for vaping; pathway to using; knowledge, attitudes, and beliefs associated with e-cigarette use; devices and products used; means of accessing products; attitudes of friends, family and society towards vaping and their use; and emergent subculture (see Additional file  1 ). As new ideas and concepts were identified within the data these data-driven concepts were fed back into the data collection process and further guided sampling and adaption of the interview guide [ 34 ]. Sampling was terminated when thematic saturation was reached [ 35 ], which was determined through the constant comparison of data with preceding data until few new themes were generated.

Analysis and interpretation

All interviews except one (file corrupt) were transcribed verbatim by an independent professional transcription service and checked for accuracy by the lead author. The detailed notes taken by the lead author during and after interviews were sent via email to the participant the following day to review for accuracy and validation. Amendments from the participant were returned via email. Transcripts and interpretations were not provided to participants for respondent validation. Interview transcripts and detailed notes were anonymised and imported into NVivo (v12) to facilitate data organisation and linkage. The lead author conducted all coding, allowing for a single researcher to be immersed in both the data collection and analysis, thereby ensuring that the coding frame adequately described the intentions and content of the interviews [ 36 ].

The analytical process followed the steps proposed by Braun and Clarke [ 37 ] for thematic analysis and drew upon the initial and axial coding process of grounded theory [ 38 ]. The lead author played an active role in the analysis by searching for and identifying themes “to theorize the sociocultural contexts, and structural conditions, that enable the individual accounts that are provided” [ 37 ] (p. 85). Line-by-line analysis was undertaken to look for patterns of meaning and issues of interest important to the research objective and to generate a range of initial codes [ 38 ]. Codes were developed based on theoretical interest and emergent concepts that arose during interaction with and interpretation of the data. Axial coding examined the initial codes at a conceptual level to combine and connect codes to form overarching ‘candidate’ themes and subthemes in a meaningful way for the phenomenon under investigation [ 38 ]. Revision of the candidate themes then occurred at two levels. Level one involved reviewing all the data collated under each candidate theme to consider whether the data formed an intelligible pattern [ 37 ]. Some themes and sub-themes were refined during this process to create new themes/subthemes and to separate and combine others [ 37 ]. Level two involved a similar process, whereby the data were reviewed and further refined. This process, however, concerned the validity of the individual themes in relation to the data set ensuring participants meanings and voices were accurately reflected [ 37 ]. A detailed analysis was then written for each theme to report the content and meaning of patterns [ 37 ]. Working theme titles were reviewed to ensure they accurately reflected the respective analysis and the most vivid quotes were selected that best illustrated the essence of the point being described [ 37 ].

Strategies to enhance the rigour of the research included the use of a codebook to provide structure and agreement about code definitions, constructs, and themes; in-depth rich description of the research methods through field notes, personal reflections and analytic memos [ 39 ]; and discussions with team members about meaning and interpretation of findings and conceptual maps [ 40 ].

Demographic and behavioural data were analysed using descriptive statistics (SPSS v26). The reporting of this study is guided by the consolidated criteria for reporting qualitative research (COREQ) checklist [ 41 ] (see Additional file  2 ).

Participants

Thirty-seven interviews were conducted with current ( n  = 33, 89%) and former vapers ( n  = 4, 11%) (Table  1 ), with a mean of age of 32.5 ( SD  = 7.411, range 20–45 years). Thirty-two participants (87%) were current or former cigarette smokers and five (13%) were vaping despite having never been a regular smoker. Five participants were dual users of tobacco and e-cigarettes. Former ( n  = 24, 65%) and current ( n  = 8, 22%) smokers had been using tobacco on average for 14 years ( SD  = 8.268, range 3–38 years). In comparison, participants had been vaping on average for 2.4 years ( SD  = 2.011, range 1 month – 7 years).

Two identities and approaches to vaping emerged from the data, which we labelled ‘substitute’ vapers and ‘cloud chasers’ after the dominant vaper identities constructed by Tokle and Pedersen [ 15 ]. Cloud chasing is the act of expelling large amounts of vapour using an e-cigarette, we use the term in a broader, more symbolic sense. As such, the ‘cloud chaser’ identity is formed by the experiences articulated by 19 dedicated vapers who connect with at least some aspect of the vaper subculture, whether that be engaging with hobbyist activities, the trick culture or technological aspects of vaping. Whereas the experiences of the ‘substitute’ vaper are derived from 18 vapers who primarily viewed vaping as a means to manage their nicotine addiction and quit smoking. The identity prescribed to each user was not ‘fixed’ as some participants described their movement between the two identities over time as the meaning they attributed to vaping changed (i.e. hobby to primarily smoking cessation).

The narrative summary describes the commonalities experienced by vapers and then the experiences unique to the ‘substitute’ and ‘cloud chaser’ identity. Quotes from participants are provided in italics, followed by their pseudonym, attributed identity and age.

The common experience

“can i have a go of that”: an introduction to vaping.

Participants were predominantly introduced to e-cigarettes through work colleagues, friends, and during their time abroad in locations where e-cigarettes were more readily available (e.g. the UK). For the majority of participants, this introduction marked the first occasion they had seen or heard about e-cigarettes. Subsequently, participants asked if they could “have a go on that” or the e-cigarette user suggested they try their vape. No one spoke of being pressured into trying their first e-cigarette with experimentation occurring spontaneously, either alone with the user or in the company of friends. Rarely did participants report communal experimentation where the vape was passed around to multiple people, rather it was most commonly a discrete encounter. Participants were mostly curious to try this device which in most instances functioned like a cigarette, however, were told it was not. Participants regularly reported coughing upon trying their first vape which could be attributed to several factors including the type of device (e.g. first/second versus third/fourth-generation device), device functionality (e.g. variable temperature, wattage, airflow or resistance), nicotine concentration, and the users smoking history, if any. Those who were smokers described this experience as being similar to that of their first drag of a cigarette, whereas non-smokers had difficulty articulating their experience as they had nothing to compare it to.

“As a non-smoker, it was really hard for me to grasp the concept. Everyone was trying to explain it to me like it's either like a cigarette or a bong. I was like, ‘I don't know what you're talking about.’ They were like, ‘mouth-to-lung, or direct-to-lung’ and I still can't even understand the concept. If I had to explain to you what I do, I don't know what I do. I press the trigger, I breathe it in, it comes out.” Karis, cloud chaser [ 33 ]

The inhalation of vapour reportedly took some time to get used to as the vapour from the e-cigarette was “moist” compared to the “dry heat” of a cigarette. Participants went on to purchase an e-cigarette for themselves after enjoying their first experience, or after disliking the encounter chose not to pursue it until another opportunity arose, years later in some instances.

“I was a silly teenager”: motivations for vaping

Thirty-two users were tobacco smokers for many years and described themselves as being “very addicted” which had resulted in several failed quit attempts. Participants had tried multiple methods to quit smoking, including going ‘cold turkey’, hypnotherapy, and nicotine replacement and drug therapies. The increasing cost of tobacco, real and feared deterioration of their health, and encouragement from loved ones to quit smoking were other significant drivers to commence and subsequently maintain vaping. For those users who had never been committed smokers, their motivations for initiating vaping were varied and included socialisation with other vapers, to appease food cravings, and as a diversion from alcohol or illicit drugs.

“On their way to their vaping journey”: starting off

Most participants opted to start their “vaping journey” with a disposable (cig-a-like) or pen-style closed-system device which introduced them to vaping at a rudimentary level, as explained by River [ 42 ] “… something basic, where you push the button, you suck on it…” . Most, however, described these devices as unsatisfying (e.g. mute flavour, inadequate throat hit), poorly fabricated and not producing enough vapour. Subsequently, most participants progressed to an open-system device which provided functionalities to enhance and personalise their flavour profile, adjust temperature, voltage, resistance, airflow and nicotine concentration, and comprised a refillable tank and rechargeable batteries. These features were particularly important for tobacco smoking participants, and were conducive to replicating the “throat hit” they were accustomed to.

“It [e-liquid] had no nicotine in it, as is Australian rules. I ended up actually putting my own [nicotine] in it because it was just, too smooth basically, you could taste it, but you couldn't feel it which is what I want, I want to feel it [throat hit].” Brody, substitute [ 34 ]

Transitioning to vaping from “analogue cigarettes” was a daunting process for some, and more so for those who had never been committed smokers. Participants explained that other vapers had tried to describe to them how they were required to inhale to achieve the desired throat hit and experience the best flavour.

“My friends were kind of just like, ‘Just pull it in. You'll cough if you do it hesitantly.’ I was super scared of just going-- [inhales], on this thing that's firing. The first few times that I did it, I don't think I was doing it properly because I was firing it for a really short amount of time, taking like really small puffs. Then when I did do it properly, I was like, oh this is what it's meant to feel like and taste like." Karina, substitute [ 24 ]

For those who were smokers, they described the inherent challenges, actions and processes of transitioning from cigarettes to e-cigarettes which took perseverance, including no longer lighting a cigarette, maintaining a charged device, importing, mixing and storing liquid nicotine, and accepting the physicality of the device compared to the slender profile of a cigarette.

“Filling it up, charging it up, carrying it around, because it f***ing weighs a ton, as well. It just became too hard filling it up. It was always leaking, and it's not as simple as clicking a button and smoking it. You have to set it to what you want and all that.” Jonathan, substitute [ 27 ]

“A bit of a learning curve”: gaining knowledge and understanding

The majority of users reported being proactive in conducting intensive ‘self-learning’ through the internet and social networking platforms, other vapers, and to a lesser extent, retail stores, to acquire relevant skills (i.e. nicotine strength, mixing and safety; steeping; inhalation style “direct-to-lung” or “mouth-to-lung” ; building and changing coils), information on health and safety, the meaning of vaping specific language and jargon, and troubleshooting techniques. Vape forums, social media (i.e. Facebook) and content sharing platforms (i.e. YouTube) were usually the first resources accessed to acquire knowledge and support. Participants reported simultaneous active (i.e., contributing content) and passive (i.e., viewing content posted) engagement in multiple local and international vaping groups and forums to discuss personal experiences, exchange information, and obtain new knowledge. Passive engagement provided newcomers with an opportunity to observe the online community and its rules, whereas more established vapers kept their “finger on the pulse” by monitoring the rise of new products. Conversely, active contribution to these fora provided opportunities for learning among ‘newbies’ and mentorship for more experienced vapers.

“Well, that's where I got most of my knowledge from [online vaping groups]. It's hard to explain, it's a little family sort of thing, like whether it's starting off fresh or you know plenty of s**t you can always go there, get the advice that you need. That's definitely a helpful thing as well. … You've got people in those groups that have been vaping for 10 or so years, like starting off when it was just a tiny industry, a fresh industry. Then you've got people that are trying to get off the smokes and they ask for advice from there.” Timothy, cloud chaser [ 20 ]

“There is something for everyone”: finding the right product

During the transition phase from cigarettes to vaping, some respondents reportedly struggled to quit smoking, relapsing on occasion, and/or dual using with cigarettes until they found the right combination of flavour, nicotine concentration and device. Finding the right combination was the moment many sensed they could quit smoking, citing the sophisticated features of the second (closed reusable) and third-generation (open reusable) devices most effective for smoking cessation.

“For me, it was getting used to the action but also … finding the right flavours and then it was getting the nicotine level right, then it was finding the right device that was going to satisfy my intake, my draw in and my exhale… I’d buy one and go, ‘Oh it’s a bit crap. I still want a cigarette. Why do I still want a cigarette?’ Then eventually I found another device which was a bit more powerful and I found flavours that I actually liked and so when I found that flavour I can tell you it was 48 hours between finding this particular flavour blend to when I had my last cigarette.” Ursula, cloud chaser [ 43 ]

“I haven’t quit I’ve upgraded”: from one addiction to another

Smoking cessation was viewed very differently to nicotine cessation, with the majority of users opting to continue using nicotine in their vapouriser to keep them from relapsing to cigarettes. Three of the five users who had never been committed smokers chose to use nicotine in their vapouriser after being introduced to it by a romantic partner or friend. All three users described themselves as not being addicted and that they could easily give it up if they tried. The end goal for many participants was not to be reliant on nicotine at all, and they explained how they were, or had, implemented strategies to reduce the concentration of nicotine they were using, such as alternating between nicotine and nicotine-free vapourisers and gradually tapering down the nicotine concentration. Four users had successfully quit smoking and were continuing to vape nicotine-free. Those users who were happy to continue to use nicotine in a “cleaner” and “healthier” form (e-cigarettes), or felt they were not ready to “wean” themselves off for fear of relapsing to smoking, recognised that they had completely transferred the behavioural and sensorimotor aspects of smoking to vaping. However, they believed because they were no longer smoking any potential ill-health inferred by vaping seemed inconsequential.

“As it stands, I have no intention of stopping [vaping] because whilst I'm using that [vapoursier] I have no intention to have a cigarette. That's how passionately I don't want to smoke again, but I'm not prepared to risk it at this time, but who knows? … Do you know what, I often think I probably do need to cut back a little bit and I think, well I'm not smoking?” Ursula, cloud chaser [ 43 ]

Previous cigarette users observed that vaping fit nicely into their routine, which was once occupied by cigarettes (i.e. driving, coffee). Vaping allowed them to continue to enjoy the social aspects of smoking (i.e. drinking alcohol) and to placate feelings of stress or anxiety.

“Yeah, I still make a point of, especially when I first quit, of keeping that routine of going outside to smoke, or vape, just so it felt a little bit more like I was having a cigarette. It wasn't such a drastic change. You know like straight after a meal or things like that, my trigger moments. I would still get up, keep it to that little bit of a routine. Get up, go outside, have my vape, go back inside.” Ella, substitute [ 41 ]

Socialising with other vapers and smokers was said to reinforce and maintain their use of e-cigarettes. Even amongst those who were never committed smokers and those who were now vaping nicotine-free.

“I’m not a smoker. I’m a vaper”: breaking free of tobacco

In general, users referred to their device as a vape, themselves as a vaper, and the practice as vaping. Some felt the term ‘e-cigarette’ too closely aligned with smoking discourse and supported associations with negative connotations of death and disease. Vape products were generally not considered to be tobacco products, especially with the evolution of vaping devices and how they no longer resembled a cigarette, as earlier generations had.

“They need to stop calling them e-cigarettes because they're not cigarettes. That s**ts me up the wall, they're not cigarettes.” Ian, cloud chaser [ 29 ]

Several users documented how they had experienced the “ignorance” of both smokers and non-vapers, and many seized the opportunity to “educate” these people. They highlighted the features which distinguished vaping from smoking, such as not containing tobacco and the production of vapour, not smoke, and the perceived positive changes to their health they had experienced since starting vaping, in the hope of reducing the stigma and the estrangement they felt.

“… people will say, ‘why don't you just smoke cigarettes?’ which I think is a strange thing to say. People just misunderstanding the health risks.” Julia, substitute [ 26 ]

For some, they could not escape their internalised feelings of smoking-related stigma, and as a result, avoided vaping in public.

“I generally try not to vape in public because it is not stealthy unless you're using a little stealthy device … People can see you a mile away, and I get really embarrassed. But I used to hide when I was a smoker as well. At least when I was a smoker I could hide in my car. Even with my vape, I get in my car and there's big clouds coming out.” Ursula, cloud chaser [ 43 ]

The substitute vaper

“a means to an end”: vaping to quit smoking.

For those ‘substitute’ vapers who were former smokers, they viewed their vaping experience as a practical means to quit smoking and valued the positive effect vaping had on their health and wallet. They were aware of the existence of more enthusiastic vapers, however, at the time did not associate with the vaper subculture as ‘cloud chasers’ did.

“I see people, and it's kind of a sport for them, they make big clouds … I don’t really buy into that. … It's not where my mindset is. For me, yeah it [vaping] really is a means to an end [nicotine/smoking cessation].” Ella, substitute [ 41 ]

“It’s just a revolving circle”: stigma

Although many acknowledged the stigma they had endured as a smoker in Western Australia, some vapers holding the ‘substitute’ identity now projected these same negative feelings to fellow vapers associated with the ‘cloud chasers’ subculture, perpetuating the circle of stigma.

“People think that people smoking vapes think they’re ‘cool’. Sitting in their car and they've got big clouds coming out of the car. Even I do it. When I see clouds like that I think, ‘You d***head. You think you’re cool vaping like that?’ … Like I’ve seen the way people blow out their clouds I’m like, ‘You’re one of these d***heads who’s overclocking the battery’ … .” Milo, substitute [ 36 ]

“It is not stealthy”: managing vaping in public

Vaping is notorious for producing large vapour clouds (although some products such as JUUL are very discrete), and as such some ‘substitute’ vapers spoke of how they disliked the attention vaping brought them from bystanders, and spent energy devising strategies to manage their e-cigarette use in discreet ways, such as vaping alone. This was especially pertinent for some young women:

“It is a bit showy because like there's a lot more vapour. I guess the only place in public that I do it and feel kind of safe is like just at the park when I'm taking a walk or something.” Karina, substitute [ 24 ]

The cloud chasers

“i’ve gone full enthusiast”: the vaper subculture.

This group of respondents shared the view that e-cigarettes are a healthier alternative to smoking, however, more importantly, vaping also offered social and symbolic functions not provided by “analogue cigarettes” .

Vaping was differentiated from smoking, with some describing it as a hobby, which at times could be all-consuming and expensive. Nevertheless, many genuinely enjoyed customising their experience through the collection of various flavoured liquids and coloured devices, experimenting with the creation of their own juices, engaging in the technological aspects of vaping and building accessories, such as coils.

“I play around with them [making coils], I do all my own, I build all the things, I use all the rebuildable stuff. So yeah, it has become a bit of a hobby, which is why I think it appeals to certain people, because it has that sort of community aspect where it becomes like a hobby … they all sort of get together…” Wade, cloud chaser [ 28 ]

A minority of vapers reported attending “build days” and “vape meets” where users got together to learn about Ohm’s law and battery safety, how to build coils, and to meet new people and socialise, as the Western Australian vape community was reportedly not as established as others in the Eastern States of Australia.

Participants commented on the various ‘types’ of vapers (i.e. hobbyist, flavourist) and ‘levels’ (i.e. novice, advanced user, expert, veteran) one could progress to. Participants categorised themselves by comparing their preferences and level of experience with others, which was influenced by various factors including vaping duration, type of device they were capable of safely using (regulated vs unregulated (no circuit board and runs directly off a battery)), possessing an online profile or presence, and experience in the retail industry.

“[I’m] close to the expert stage. An advanced user, I'd say. When you start using mechanical mods, that's when you're an advanced user.” Zadie, cloud chaser [ 27 ]

“I've gone full enthusiast … I want to have the experience. I'm also hoping to get a job in one of the vape shops in Perth because I'm really enthusiastic about health or being able to help people.” Quade, cloud chaser [ 24 ]

A small proportion of ‘cloud chasers’ were highly immersed in the vaping subculture and were actively involved in, or managed specialised vape groups, provided product reviews to YouTube, Instagram and Facebook, and some were even ‘sponsored’ by local or international e-cigarette brands to promote their products on social media. Relationships between these vapers and their sponsors were established by one of them contacting the other, usually through social media.

“I'm part of this group called Cloud Kings Australia. Cloud Kings are basically all over the world. There's a group of them in Sweden, Mexico, Germany, France, Amsterdam, mostly in Europe. We get sponsored by companies, get free product from those companies, and then we rep[resent] those companies.” Zadie, cloud chaser [ 27 ]

Few were also deeply entrenched in the vape trick culture:

“Absolutely, there's an absolute technique [to vape tricks]. We've got it down to a really fine art. There's names of [tor]nados that you can do like specialised ones and stuff like the DNA, the double, oh it’s crazy. So we go all out. Like you've got to wet the table, make it stick, and you've got to layer it. So we do layer upon layer upon layer of smoke. No one’s allowed to breathe. If you breathe, you're dead.” Clara, cloud chaser [ 33 ]

“Vaping brings people together”: for the cause and the community

The vape community, especially the online community, was described as “free of judgement” and provided for many a sense of connection and belonging. Participants described how their communication with like-minded vapers gave them the forum and permission to “nerd out” and voice their struggles and triumphs with a group who they felt would listen and be responsive, which some users did not feel they were able to do with their non-vaping friends and family. For those who were more experienced vapers, they felt it was important to give back to the community and chose to mentor new vapers through the initiation process.

“I'm in a lot of Australia-wide groups ... and it’s community-minded. … It's a way to quit smoking, sure, it's a health choice, but it's also a hobby for a lot of people, so I think these groups are both support networks and hobbyists. … I think it is important because there's nowhere else to get that support to quit smoking. For me that's what vaping is all about, it's about quitting smoking and staying off the cigarettes. … For people like myself who have tried everything … It is important for me to give back, so I give a lot of advice to people that say ‘Hey I don't know what to do.’ I try and give people the advice that I didn't get but also just making friends Australia-wide, getting to know people. It's awesome. It's a pretty cool community, yeah.” Ursula, cloud chaser [ 43 ]

Further, some participants had turned vaping into a business; were currently working, or aspiring to work in the retail industry; or were creating a social media presence (i.e. reviewing products, seeking sponsorship) for themselves. Some of these participants who were heavily involved in the online community and/or retail industry expressed frustration with the “childish” and “bitchy” behaviour displayed by some of the vape community online, especially among local and inter-state retailers. Instances of online users “dobbing” on people to the authorities who were selling nicotine and/or devices were described, as well as general unsocial behaviour as illustrated by one local business owner:

“They're [vape retailers] just very childish, … and because it's still quite a small community, everything's a personal attack against someone else. Like, if so and so were to have a sale and then he'd think that it was a direct attack on him. It is very clicky and very immature a lot of the time, I don't know why. I don't really bother doing much with Facebook groups because that’s just where it all is. When it's in-store and stuff and it's all very professional, everyone's very eager to help, it’s just everyone seems to become a keyboard warrior online.” Wade, cloud chaser [ 28 ]

Users who heavily invested in the culture or hobbyist ethos were inclined to perceive their device as an accessory, or a status symbol which was dependent on having the very latest and greatest device. For these vapers, vaping not only encompassed their passion and desire to help others quit smoking but their livelihood, which now strongly aligned with their core values.

“All my life I've had trouble [working] in retail because I have an ethical code where I can't sell something that I don't believe in and I believe 100% in the industry of vaping and what their motives are. I think it's good. It is entirely good and all the people that I've met who also promote it and stand behind it have good intentions, and their sole drive is to see people get well and stop smoking. We want to make smoking history just as much as the non-smokers. That's the thing … almost all vapers are reformed smokers…” Quade, cloud chaser [ 24 ]

The Australian NDSHS has been regularly conducted since 1985, and first provided limited data about e-cigarette use in 2013. Data from the most NDSHS [ 24 ] reports the most prevalent e-cigarette users are male current and former smokers, which is reflective of our sample population. Data does not distinguish whether users use nicotine in their vapourisers, nor what type of device they use. Enhanced surveillance and reporting of e-cigarette use within Australia would contribute to a deeper understanding of the population using e-cigarettes, the reasons for using and devices used among this cohort, and would assist policymakers to determine where public health efforts should be focussed.

Thirty-two vapers in this sample were committed smokers for several years and five participants were dual users of tobacco and e-cigarettes. The primary reason for initiating vaping was to quit smoking, citing less than optimal successes with other TGA (Therapeutics Goods Administration Footnote 1 ) approved smoking cessations aids, as also described by a sample of American vapers [ 44 ]. Vaping was considered more satisfying and therefore more supportive of successfully quitting smoking compared to other methods due to its similarity with conventional smoking, namely the inhale and exhale of vapour, nicotine hit, and the hand-to-mouth action, as also documented in other international research [ 16 , 18 , 43 ]. Furthermore, vaping does not expect one to relinquish the rituals and habits connected to smoking [ 45 ]. The conclusions surrounding the effectiveness of e-cigarettes as a smoking cessation aid and their harm reduction potential, however, are varied and depend on several factors, such as whether the smoker switches completely to e-cigarettes, becomes a dual user with cigarettes, and whether the user becomes a sustained and persistent vaper [ 42 ].

The majority of vapers in this sample were former smokers, however, several respondents had taken up the practice despite having never smoked. Understanding how vapers ‘make sense’ of their health practices [ 46 ] is required to understand the processes by which vapers make health behaviour choices, such as choosing to vape, so that appropriate tailored communication on the risks and benefits of e-cigarette use can be developed [ 47 ]. Limiting vaping uptake by non-smokers is essential and the supportive role Australia’s strict regulation plays in limiting this uptake and exposure to marketing is discernibly apparent when compared with vaping prevalence within countries with more liberal regulation (i.e. United States (US) [ 48 , 49 ] and UK [ 50 , 51 ]).

Participants within this study generally exhibited limited knowledge of the potential health effects of e-cigarettes. However, as reported by vapers abroad [ 52 , 53 ], they expressed many positive attitudes towards e-cigarettes, held very strong opinions that vaping offered them an alternative means to consume nicotine, and based their decision to use e-cigarettes on perceived harm reduction compared to cigarettes. For them, the individual health benefits experienced and the tangible sense of satisfaction since ceasing smoking outweighed the potential health risks of maintaining vaping. Furthermore, continued nicotine addiction was largely perceived as unproblematic so long as it helped maintain a cigarette-free lifestyle, also documented by others [ 43 , 54 ]. This concept has been studied by Oakes and Chapman [ 55 ] who explored the rationalisations smokers use to explain their justification of continued smoking and suggest a series of self-exempting beliefs may provide smokers with a false sense of security and ultimately block them from exploring the importance of quitting. Given the complexity of nicotine and addiction, and the assortment of information presented on e-cigarettes, it is not unexpected that users in this study and overseas [ 56 ] rely on their own experiences, and that of others, to inform their behaviour and decision-making processes [ 18 ]. This highlights the need for accessible, clear and impartial information about e-cigarette use which communicates the benefits, risks and current uncertainties to health professionals and the public about e-cigarettes [ 43 ] and continued support for nicotine cessation through approved cessation methods.

Participants mostly described positive reactions from friends and family to their e-cigarette use, particularly when their goal was to abstain from smoking. In this sample of vapers, few had close friends who vaped and therefore sought camaraderie through online fora and vape retail stores. As found in other qualitative inquires [ 16 ], the notion of a vaping community was recurrent. However, participating in a community that accepts the practice may make it difficult for individuals to quit and therefore contribute to sustained use [ 57 ]. These findings suggest that social norms surrounding e-cigarette use have a potentially powerful influence on initiation and maintenance and that understanding social networks is integral to prevention efforts.

Although tobacco smoking is legal in Australia, the decline in prevalence combined with the denormalisation of smoking and societal aversion has fated the behaviour to be predominantly relocated to the fringes of society and viewed as a deviant and marginalised behaviour [ 58 ]. For some smokers in this study, feeling stigmatised for being a tobacco smoker was the catalyst for them to redefine themselves as ‘vapers’, as supported by findings from Barbeau and Burda [ 16 ], making the language used (i.e. not referring to vaporises as e-cigarettes) incredibly important in an attempt to escape the stigma attached to cigarette smoking [ 44 ]. This redefinition and transition from smoker to non-smoker has been argued to play a key role in supporting successful smoking cessation [ 59 ]. However, through the quest to obtain the socially desirable non-smoker status, smokers have adopted another behaviour that maintains addiction and deviates from current societal norms, an unapproved and unconventional means to quit smoking.

Two approaches to vaping emerged from our data, that of the ‘cloud chaser’ and the ‘substitute’. Vapers within this sample displayed similar subcultural elements and practices to those reported in the international literature examining the motivations of e-cigarette users, identity formation and involvement in the vaping subculture [ 14 , 15 ] which could be diffused via global structures such as social media. However, some subcultural elements are localised to Australian vapers due to the unique social conditions under which the behaviour has evolved. For example, the vaping subculture which has emerged in the US is more encompassing than in Australia, which may be attributed to differences in the countries regulatory contexts [ 60 ], access to nicotine products, and exposure to mass marketing [ 61 ] and subcultural practices (e.g. vaping conventions [ 62 ] and abundant vape stores [ 63 ]).

Supported by Farrimond [ 14 ] and McQueen and Tower [ 64 ], ‘cloud chasers’ perceived their affiliation and connection with the vape community in the online and offline milieu as a positive source of support and reinforcement. Moreover, vaping was regarded as an integral part of their social identity, influencing how they behaved and the social and political activities they engaged in. Given the loss of identity and social engagement reported by individuals who quit smoking, the social opportunities, and group and community experience of vaping may be a particularly appealing aspect of the endeavour [ 6 , 16 , 53 ]. Furthermore, vaping was explicitly differentiated from cigarette smoking and referred to by many ‘cloud chasers’ as a hobby. Several dimensions of ‘pleasure’ were identified, including the sensory experience (i.e. flavours) and electronic and technological aspects of vaping [ 6 , 65 ]. Such descriptions of enjoyment are not usual in the substance-use discourse [ 66 ] due to the dominance of the ‘pathology paradigm’ which marginalises the idea of pleasure concerning drug use [ 67 ].

The assessment that e-cigarettes are a tool to manage nicotine addiction among ‘substitute’ vapers may explain why these users did not strongly identify with, or actively rejected connection with the social identity of vaping, and enjoyment did not play a substantive role in their use and maintenance [ 14 ]. Research suggests that cessation goal-oriented vapers may be less likely to become persistent e-cigarette users compared with vapers who do not stipulate future intentions to quit [ 68 , 69 ]. The nuanced differences in experiences of ‘cloud chasers’ and ‘substitute’ vapers may, therefore, contribute important insights for health communication. Australia has implemented a suite of effective strategies [ 23 ] to combat tobacco smoking that could be applied to e-cigarettes, such as supplementing health communications with legislation (e.g. health warnings, plain packaging, smoke-free laws that include e-cigarette use), until there is scientific evidence regarding their safety and efficacy as a tobacco cessation therapy [ 70 ].

E-cigarettes are both technically complex devices, which novice users may find difficult to spontaneously start, and a non-medical consumer product, which has resulted in the need for many aspiring users to look to other vapers as their experts, building a vast and international social network of shared knowledge and identity [ 14 ]. A common experience among this cohort of vapers was their use of e-cigarette forums and social media groups to discuss personal experiences, exchange information, and obtain new knowledge, similarily reported by vapers in New Zealand [ 18 ]. Seasoned vapers and newcomers disclosed periods of both active and passive engagement (also known as ‘lurking’ [ 71 ]). Lurking served newcomers with an opportunity to observe the community and its rules [ 72 ], whilst it provided more established vapers with the opportunity to monitor changes in the industry and the development of new products. Conversely, active contribution to these fora provided opportunities for learning among ‘newbies’ and mentorship for more experienced vapers. Some research suggests that joining and actively participating in e-cigarette-related social media communities [ 13 , 73 , 74 ] may play an important role in the development of ones vaping identity [ 14 , 18 ] and can exert a significant influence on attitudes and behavioural intentions toward e-cigarettes [ 75 ]. The investigation of dedicated vaping fora, therefore, may be valuable to study interactions among users and how these interactions shape e-cigarette knowledge, attitudes and behaviours.

These findings were gathered from a small purposive sample within a specific geographical context and time, and therefore may not be generalisable to the broader vaping community or e-cigarette users abroad due to Australia’s regulatory environment, absence of mass media advertising and lack of Government endorsement as a smoking cessation aid [ 76 ]. However, the consistency with other research suggests our findings are not atypical. All participants in this study were adults, therefore these results may not be generalisable to younger vapers.

Few studies have explored vapers motivations for use, reinforcing influences, and association with the vaper subculture, especially within the unique regulatory context of Australia. We found that our sample of vapers largely started vaping to quit smoking and underwent common experiences during their initiation phase. Subsequently, vapers tended to adopt one of two vaper identities, that of the ‘cloud chaser’ or the ‘substitute’, which some users moved between during different stages of their vaping career. The social and symbolic meaning of e-cigarettes and vaping were diverse. ‘Cloud chasers’ connected with the vaper subculture in varying degrees and involved concepts of pleasure, community and performance. However, the aesthetic and performance part of the subculture, in particular, had little appeal to ‘substitute’ vapers who largely viewed their use of e-cigarettes as a means to quit smoking, and enjoyment did not play a substantive role in their use. Understanding the complexities of vaping, and the nuanced differences of ‘cloud chasers’ and ‘substitute’ vapers may have important implications for health communication, research and policy. Our findings add to the understanding of the varying motives for use and provide new insights into the socialisation process and subsequent identity adoption of Western Australian vapers.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

The Therapeutic Goods Administration is the regulatory body for therapeutic goods in Australia and is responsible for conducting assessment and monitoring activities to ensure that therapeutic goods available in Australia are of an acceptable standard and that access to therapeutic advances is in a timely manner.

Abbreviations

Electronic cigarette

Electronic Nicotine Delivery Device

COnsolidated criteria for REporting Qualitative research

Greater Capital City Statistical Area

Index of Relative Socio-Economic Advantage and Disadvantage

National Drug Strategy Household Survey

Therapeutic Goods Administration

United States

United Kingdom

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Acknowledgements

We wish to thank the people who participated in this study and willingly provided their time and insights.

This research was supported by a Healthway Exploratory Research Grant [grant number 32803] and an Australian Government Research Training Program Scholarship. The Scholarship is provided by the Commonwealth of Australia to support the general living costs for students undertaking Doctoral Research studies. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

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Kahlia McCausland, Jonine Jancey & Bruce Maycock

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Tama Leaver

School of Marketing, Curtin University, Bentley, Western Australia, Australia

Katharina Wolf

School of Public Health, University of Sydney, Sydney, New South Wales, Australia

Becky Freeman

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Contributions

Conception and design of the work: JJ, BM, KM, TL, KW; Data acquisition and analysis: KM; Data interpretation: KM, BM; Writing – original draft: KM; Writing - review and editing: JJ, BM, BF, KW, TL. All authors read and approved the final manuscript.

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Participants gave written (at the time of the interview, or via email), and in one case verbal consent before participating in a face-to-face ( n  = 35) or telephone ( n  = 2) interview. All procedures were performed in compliance with relevant laws and institutional guidelines and the study protocol was approved by the Human Research Ethics Committee of Curtin University (HRE2017–0144).

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Competing interests

BF is a member of the NHMRC Electronic Cigarettes Working Committee (May 2020). She has received consulting payment for e-cigarette policy review for the NSW National Heart Foundation (December 2019). She had travel expenses (flight and registration) reimbursed to attend Oceania Tobacco Control Conference 2017 to present on e-cigarette and cessation. She provided her opinion (unpaid) at Australian Parliament’s Standing Committee on Health, Aged Care and Sport public hearing into the Use and Marketing of Electronic Cigarettes and Personal Vaporisers (September 8, 2017). She led a contract on e-cigarette regulation in Australia for the Commonwealth Department of Health (2016). She had travel expenses reimbursed by National Taiwan University for presenting on e-cigarette regulation (2016). The other authors have no conflicts to declare.

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Supplementary information

Additional file 1..

Data collection guide. The data collection guide includes the information recorded about the interview, participant’s demographic and behavioural information and the interview guide.

Additional file 2.

COREQ checklist. A checklist of items that should be included in reports of qualitative research.

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McCausland, K., Jancey, J., Leaver, T. et al. Motivations for use, identity and the vaper subculture: a qualitative study of the experiences of Western Australian vapers. BMC Public Health 20 , 1552 (2020). https://doi.org/10.1186/s12889-020-09651-z

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Home — Essay Samples — Nursing & Health — Smoking — Vaping: All You Need to Know about this Trend

Vaping: All You Need to Know About This Trend

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Published: Dec 18, 2018

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Table of contents

Vaping a fashion, vaping business, what’s the final point.

• House of Vapes
• Prohibition Vapes
• Vape & Juice
• The Wheatsheaf
• Prospect of Whitby

Hook Examples for Vaping Essay

• The Rise of Vapor: Step into the world of vaping and explore how this modern trend has taken the world by storm, reshaping the way people consume nicotine.
• Invisible Dangers: Uncover the hidden health risks lurking behind the enticing flavors and billowing clouds of vapor, as we delve into the alarming consequences of vaping.
• The Marketing Maze: Discover the strategies employed by vaping companies to target a new generation of users, and how the industry’s advertising tactics have raised ethical concerns.
• Teen Epidemic: Examine the startling rise in teenage vaping and the impact it has on adolescent health, education, and society as a whole.
• A Path to Quit: Explore the potential vaping holds as both a smoking cessation tool and a harm reduction method, considering the debates and challenges surrounding this approach.

Works Cited

• Cooper, R. (2018). Skipping a Beat: Assessing the state of gender equality in the Australian music industry. University of Sydney.
• Hibberd, J. (2020, March 8). How Women Are Changing the Indie Rock Scene. Rolling Stone.
• LISTEN. (n.d.). About. Retrieved from https://www.listenlistenlisten.org/about
• McMahon, K. (2019, April 29). The Triple J Gender Imbalance Is Being Highlighted Again By Industry Experts. Junkee.
• Merritt, S. (2019, October 3). Where are all the women in music production? Sydney Morning Herald.
• Music Industry Observer. (2021, January 25). How COVID-19 Has Impacted Women in the Music Industry. Music Industry Observer.
• O’Connor, R. (2018, March 8). International Women’s Day: Meet the women trying to change the face of the Australian music industry. ABC News.
• Rogers, K. (2018, November 21). An In-Depth Look at the State of Women in the Music Industry. Mixmag.
• Triscari, C. (2020, December 1). The music industry is finally waking up to its diversity problem. NME.
• UN Women. (2015). Gender Equality and the Music Industry. UN Women.

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235 Smoking Essay Topics & Examples

Looking for smoking essay topics? Being one of the most serious psychological and social issues, smoking is definitely worth writing about.

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🥇 good titles for smoking essay, 👍 best titles for research paper about smoking, ⭐ simple & easy health essay titles, 💡 interesting topics to write about health, ❓ essay questions about smoking.

In your essay about smoking, you might want to focus on its causes and effects or discuss why smoking is a dangerous habit. Other options are to talk about smoking prevention or to concentrate on the reasons why it is so difficult to stop smoking. Here we’ve gathered a range of catchy titles for research papers about smoking together with smoking essay examples. Get inspired with us!

Smoking is a well-known source of harm yet popular regardless, and so smoking essays should cover various aspects of the topic to identify the reasons behind the trend.

You will want to discuss the causes and effects of smoking and how they contributed to the persistent refusal of large parts of the population to abandon the habit, even if they are aware of the dangers of cigarettes. You should provide examples of how one may become addicted to tobacco and give the rationales for smokers.

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Reasons why one may begin smoking, are among the most prominent smoking essay topics. It is not easy to begin to enjoy the habit, as the act of smoke inhalation can be difficult to control due to a lack of experience and unfamiliarity with the concept.

As such, people have to be convinced that the habit deserves consideration by various ideas or influences. The notion that “smoking is cool” among teenagers can contribute to the adoption of the trait, as can peer pressure.

If you can find polls and statistics on the primary factors that lead people to tweet, they will be helpful to your point. Factual data will identify the importance of each cause clearly, although you should be careful about bias.

The harmful effects of tobacco have been researched considerably more, with a large body of medical studies investigating the issue available to anyone.

Lung cancer is the foremost issue in the public mind because of the general worry associated with the condition and its often incurable nature, but smoking can lead to other severe illnesses.

Heart conditions remain a prominent consideration due to their lethal effects, and strokes or asthma deserve significant consideration, as well. Overall, smoking has few to no beneficial health effects but puts the user at risk of a variety of concerns.

As such, people should eventually quit once their health declines, but their refusal to do so deserves a separate investigation and can provide many interesting smoking essay titles.

One of the most prominent reasons why a person would continue smoking despite all the evidence of its dangers and the informational campaigns carried out to inform consumers is nicotine addiction.

The substance is capable of causing dependency, a trait that has led to numerous discussions of the lawfulness of the current state of cigarettes.

It is also among the most dangerous aspects of smoking, a fact you should mention.

Lastly, you can discuss the topics of alternatives to smoking in your smoking essay bodies, such as e-cigarettes, hookahs, and vapes, all of which still contain nicotine and can, therefore, lead to considerable harm. You may also want to discuss safe cigarette avoidance options and their issues.

Here are some additional tips for your essay:

• Dependency is not the sole factor in cigarette consumption, and many make the choice that you should respect consciously.
• Cite the latest medical research titles, as some past claims have been debunked and are no longer valid.
• Mortality is not the sole indicator of the issues associated with smoking, and you should take chronic conditions into consideration.

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• Hazards of Smoking and Benefits of Cessation Prabhat Jha is the author of the article “The Hazards of Smoking and the Benefits of Cessation,” published in a not-for-profit scientific journal, eLife, in 2020.
• The Impact of Warning Labels on Cigarette Smoking The regulations requiring tobacco companies to include warning labels are founded on the need to reduce nicotine intake, limit cigarette dependence, and mitigate the adverse effects associated with addiction to smoking.
• Psilocybin as a Smoking Addiction Remedy Additionally, the biotech company hopes to seek approval from FDA for psilocybin-based therapy treatment as a cigarette smoking addiction long-term remedy.
• Investing Savings from Quitting Smoking: A Financial Analysis The progression of interest is approximately $50 per year, and if we assume n equal to 45 using the formula of the first n-terms of the arithmetic progression, then it comes out to about 105 […]
• Smoking as a Community Issue: The Influence of Smoking A review of the literature shows the use of tobacco declined between 1980 and 2012, but the number of people using tobacco in the world is increasing because of the rise in the global population.
• Smoking Public Education Campaign Assessment The major influence of the real cost campaign was to prevent the initiation of smoking among the youth and prevent the prevalence of lifelong smokers.
• Quitting Smoking and Related Health Benefits The regeneration of the lungs will begin: the process will touch the cells called acini, from which the mucous membrane is built. Therefore, quitting the habit of smoking a person can radically change his life […]
• Smoking and Stress Among Veterans The topic is significant to explore because of the misconception that smoking can alleviate the emotional burden of stress and anxiety when in reality, it has an exacerbating effect on emotional stress.
• Smoking as a Predictor of Underachievement By comparing two groups smoking and non-smoking adolescents through a parametric t-test, it is possible to examine this assumption and draw conclusions based on the resulting p-value.
• Smoking and the Pandemic in West Virginia In this case, the use of the income variable is an additional facet of the hypothesis described, allowing us to evaluate whether there is any divergence in trends between the rich and the poor.
• Anti-Smoking Policy in Australia and the US The anti-smoking policy is to discourage people from smoking through various means and promotion of a healthy lifestyle, as well as to prevent the spread of the desire to smoke.
• Smoking Prevalence in Bankstown, Australia The secondary objective of the project was to gather and analyze a sufficient amount of auxiliary scholarly sources on smoking cessation initiatives and smoking prevalence in Australia.
• Drug Addiction in Teenagers: Smoking and Other Lifestyles In the first part of this assignment, the health problem of drug addiction was considered among teens and the most vulnerable group was established.
• Aspects of Anti-Smoking Advertising Thus, it is safe to say that the authors’ main and intended audience is the creators of anti-smoking public health advertisements.
• Anti-Smoking Communication Campaign’s Analysis Defining the target audience for an anti-smoking campaign is complicated by the different layers of adherence to the issue of the general audience of young adults.
• Smoking Cessation Project Implementation In addition, the review will include the strengths and weaknesses of the evidence presented in the literature while identifying gaps and limitations.
• Smoking Cessation and Health Promotion Plan Patients addicted to tobacco are one of the major concerns of up-to-date medicine as constant nicotine intake leads to various disorders and worsens the health state and life quality of the users.
• Maternal and Infant Health: Smoking Prevention Strategies It is known that many women know the dangers of smoking when pregnant and they always try to quit smoking to protect the lives of themselves and the child.
• A Peer Intervention Program to Reduce Smoking Rates Among LGBTQ Therefore, the presumed results of the project are its introduction into the health care system, which will promote a healthy lifestyle and diminish the level of smoking among LGBTQ people in the SESLHD.
• Peer Pressure and Smoking Influence on Teenagers The study results indicate that teenagers understand the health and social implications of smoking, but peer pressure contributes to the activity’s uptake.
• Smoking Cessation Programs Through the Wheel of Community Organizing The first step of the wheel is to listen to the community’s members and trying to understand their needs. After the organizer and the person receiving treatment make the connection, they need to understand how […]
• Smoking: Benefits or Harms? Hundreds of smokers every day are looking for a way to get rid of the noose, which is a yoke around the neck, a cigarette.
• The Culture of Smoking Changed in Poland In the 1980-90s, Poland faced the challenge of being a country with the highest rates of smoking, associated lung cancer, and premature mortality in the world.
• The Stop Smoking Movement Analysis The paper discusses the ideology, objective, characteristics, context, special techniques, organization culture, target audience, media strategies, audience reaction, counter-propaganda and the effectiveness of the “Stop Smoking” Movement.”The Stop Smoking” campaign is a prevalent example of […]
• Smoking Health Problem Assessment The effects of smoking correlate starkly with the symptoms and diseases in the nursing practice, working as evidence of the smoking’s impact on human health.
• Integration of Smoking Cessation Into Daily Nursing Practice Generally, smoking cessation refers to a process structured to help a person to discontinue inhaling smoked substances. It can also be referred to as quitting smoking.
• E-Cigarettes and Smoking Cessation Many people argue that e-cigarettes do not produce secondhand smoke. They believe that the e-fluids contained in such cigarettes produce vapor and not smoke.
• Outdoor Smoking Ban in Public Areas of the Community These statistics have contributed to the widespread efforts to educate the public regarding the need to quit smoking. However, most of the chronic smokers ignore the ramifications of the habit despite the deterioration of their […]
• Nicotine Replacement Therapy for Adult Smokers With a Psychiatric Disorder The qualitative research methodology underlines the issue of the lack of relevant findings in the field of nicotine replacement therapy in people and the necessity of treatment, especially in the early stages of implementation.
• Smoking and Drinking: Age Factor in the US As smoking and drinking behavior were both strongly related to age, it could be the case that the observed relationship is due to the fact that older pupils were more likely to smoke and drink […]
• Smoking Cessation Clinic Analysis The main aim of this project is to establish a smoking cessation clinic that will guide smoker through the process of quitting smoking.
• Cigarette Smoking Among Teenagers in the Baltimore Community, Maryland The paper uses the Baltimore community in Maryland as the area to focus the event of creating awareness of cigarette smoking among the teens of this community.
• Advocating for Smoking Cessation: Health Professional Role Health professionals can contribute significantly to tobacco control in Australia and the health of the community by providing opportunities for smoking patients to quit smoking.
• Lifestyle Management While Quitting Smoking Realistically, not all of the set goals can be achieved; this is due to laxity in implementing them and the associated difficulty in letting go of the past lifestyle.
• Smoking in the Actuality The current use of aggressive marketing and advertising strategies has continued to support the smoking of e-cigarettes. The study has also indicated that “the use of such e-cigarettes may contribute to the normalization of smoking”.
• Analysis of the Family Smoking Prevention and Tobacco Control Act The law ensures that the FDA has the power to tackle issues of interest to the public such as the use of tobacco by minors.
• “50-Year Trends in Smoking-Related Mortality in the United States” by Thun et al. Thun is affiliated with the American Cancer Society, but his research interests cover several areas. Carter is affiliated with the American Cancer Society, Epidemiology Research Program.
• Pulmonology: Emphysema Caused by Smoking The further development of emphysema in CH can lead to such complications caused by described pathological processes as pneumothorax that is associated with the air surrounding the lungs.
• Smoking and Lung Cancer Among African Americans Primarily, the research paper provides insight on the significance of the issue to the African Americans and the community health nurses.
• Health Promotion and Smoking Cessation I will also complete a wide range of activities in an attempt to support the agency’s goals. As well, new studies will be conducted in order to support the proposed programs.
• Maternal Mental Health and Prenatal Smoking It was important to determine the variables that may lead to postpartum relapse or a relapse during the period of pregnancy. It is important to note that the findings are also consistent with the popular […]
• Nursing Interventions for Smoking Cessation For instance, the authors are able to recognize the need to classify the level of intensity in respect to the intervention that is employed by nurses towards smoking cessation.
• Smoking and Cancer in the United States In this research study, data on tobacco smoking and cancer prevalence in the United States was used to determine whether cancer in the United States is related to tobacco smoking tobacco.
• Marketing Plan: Creating a Smoking Cessation Program for Newton Healthcare Center The fourth objective is to integrate a smoking cessation program that covers the diagnosis of smoking, counseling of smokers, and patient care system to help the smokers quit their smoking habits. The comprehensive healthcare needs […]
• Risks of Smoking Cigarettes Among Preteens Despite the good news that the number of preteen smokers has been significantly reducing since the 1990s, there is still much to be done as the effects of smoking are increasingly building an unhealthy population […]
• Healthy People Program: Smoking Issue in Wisconsin That is why to respond to the program’s effective realization, it is important to discuss the particular features of the target population in the definite community of Wisconsin; to focus on the community-based response to […]
• Health Campaign: Smoking in the USA and How to Reduce It That is why, the government is oriented to complete such objectives associated with the tobacco use within the nation as the reduction of tobacco use by adults and adolescents, reduction of initiation of tobacco use […]
• Smoking Differentials Across Social Classes The author inferred her affirmations from the participant’s words and therefore came to the right conclusion; that low income workers had the least justification for smoking and therefore took on a passive approach to their […]
• Cigarette Smoking Side Effects Nicotine is a highly venomous and addictive substance absorbed through the mucous membrane in the mouth as well as alveoli in the lungs.
• Long-Term Effects of Smoking The difference between passive smoking and active smoking lies in the fact that, the former involves the exposure of people to environmental tobacco smoke while the latter involves people who smoke directly.
• Smoking Cessation Program Evaluation in Dubai The most important program of this campaign is the Quit and Win campaign, which is a unique idea, launched by the DHCC and is in the form of an open contest.
• Preterm Birth and Maternal Smoking in Pregnancy The major finding of the discussed research is that both preterm birth and maternal smoking during pregnancy contribute, although independently, to the aortic narrowing of adolescents.
• Enforcement of Michigan’s Non-Smoking Law This paper is aimed at identifying a plan and strategy for the enforcement of the Michigan non-smoking law that has recently been signed by the governor of this state.
• Smoking Cessation for Patients With Cardio Disorders It highlights the key role of nurses in the success of such programs and the importance of their awareness and initiative in determining prognosis.
• Legalizing Electronic Vaping as the Means of Curbing the Rates of Smoking However, due to significantly less harmful effects that vaping produces on health and physical development, I can be considered a legitimate solution to reducing the levels of smoking, which is why it needs to be […]
• Inequality and Discrimination: Impact on LGBTQ+ High School Students Consequently, the inequality and discrimination against LGBTQ + students in high school harm their mental, emotional, and physical health due to the high level of stress and abuse of various substances that it causes.
• Self-Efficacy and Smoking Urges in Homeless Individuals Pinsker et al.point out that the levels of self-efficacy and the severity of smoking urges change significantly during the smoking cessation treatment.
• “Cigarette Smoking: An Overview” by Ellen Bailey and Nancy Sprague The authors of the article mentioned above have presented a fair argument about the effects of cigarette smoking and debate on banning the production and use of tobacco in America.
• “The Smoking Plant” Project: Artist Statement It is the case when the art is used to pass the important message to the observer. The live cigarette may symbolize the smokers while the plant is used to denote those who do not […]
• Dangers of Smoking While Pregnant In this respect, T-test results show that mean birthweight of baby of the non-smoking mother is 3647 grams, while the birthweight of smoking mother is 3373 grams. Results show that gestation value and smoking habit […]
• The Cultural Differences of the Tobacco Smoking The Middle East culture is connected to the hookah, the Native American cultures use pipes, and the Canadian culture is linked to cigarettes.
• Ban on Smoking in Enclosed Public Places in Scotland The theory of externality explains the benefit or cost incurred by a third party who was not a party to the reasoning behind the benefit or cost. This will also lead to offer of a […]
• How Smoking Cigarettes Effects Your Health Cigarette smoking largely aggravates the condition of the heart and the lung. In addition, the presence of nicotine makes the blood to be sticky and thick leading to damage to the lining of the blood […]
• Alcohol and Smoking Abuse: Negative Physical and Mental Effects The following is a range of effects of heavy alcohol intake as shown by Lacoste, they include: Neuropsychiatric or neurological impairment, cardiovascular, disease, liver disease, and neoplasm that is malevolent.
• Smoking Prohibition: Local Issues, Personal Views This is due to the weakening of blood vessels in the penis. For example, death rate due to smoking is higher in Kentucky than in other parts of the country.
• Smoking During Pregnancy Issues Three things to be learned from the research are the impact of smoking on a woman, possible dangers and complications and the importance of smoking cessation interventions.
• The Smoking Problem: Mortality, Control, and Prevention The article presents smoking as one of the central problems for many countries throughout the world; the most shocking are the figures related to smoking rate among students. Summary: The article is dedicated to the […]
• Tobacco Smoking: Bootleggers and Baptists Legislation or Regulation The issue is based on the fact that tobacco smoking also reduces the quality of life and ruins the body in numerous ways.
• Ban Smoking in Cars Out of this need, several regulations have been put in place to ensure children’s safety in vehicles is guaranteed; thus, protection from second-hand smoke is an obvious measure that is directed towards the overall safety […]
• Smoking: Causes and Effects Considering the peculiarities of a habit and of a disease, smoking can be considered as a habit rather than a disease.
• Smoking Behavior Under Clinical Observation The physiological aspect that influences smokers and is perceived as the immediate effect of smoking can be summarized as follows: Within ten seconds of the first inhalation, nicotine, a potent alkaloid, passes into the bloodstream, […]
• Smoking and Its Effect on the Brain Since the output of the brain is behavior and thoughts, dysfunction of the brain may result in highly complex behavioral symptoms. The work of neurons is to transmit information and coordinate messengers in the brain […]
• Smoking Causes and Plausible Arguments In writing on the cause and effect of smoking we will examine the issue from the point of view of temporal precedence, covariation of the cause and effect and the explanations in regard to no […]
• Post Smoking Cessation Weight Gain The aim of this paper is to present, in brief, the correlation between smoking cessation and weigh gain from biological and psychological viewpoints.
• Marketing a Smoking Cessation Program In the case of the smoking cessation program, the target group is made up of smokers who can be further subdivided into segments such as heavy, medium, and light smokers.
• Smoking Cessation for Ages 15-30 The Encyclopedia of Surgery defines the term “Smoking Cessation” as an effort to “quit smoking” or “withdrawal from smoking”. I aim to discuss the importance of the issue by highlighting the most recent statistics as […]
• Smoking Qualitative Research: Critical Analysis Qualitative research allows researchers to explore a wide array of dimensions of the social world, including the texture and weave of everyday life, the understandings, experiences and imaginings of our research participants, the way that […]
• Motivational Interviewing as a Smoking Cessation Intervention for Patients With Cancer The dependent variable is the cessation of smoking in 3 months of the interventions. The study is based on the author’s belief that cessation of smoking influences cancer-treated patients by improving the efficacy of treatment.
• Factors Affecting the Success in Quitting Smoking of Smokers in West Perth, WA Australia Causing a wide array of diseases, health smoking is the second cause of death in the world. In Australia, the problem of smoking is extremely burning due to the high rates of diseases and deaths […]
• Media Effects on Teen Smoking But that is not how an adult human brain works, let alone the young and impressionable minds of teenagers, usually the ads targeted at the youth always play upon elements that are familiar and appealing […]
• “Passive Smoking Greater Health Hazard: Nimhans” by Stephen David The article focuses on analyzing the findings of the study and compares them to the reactions to the ban on public smoking.
• Partnership in Working About Smoking and Tobacco Use The study related to smoking and tobacco use, which is one of the problematic areas in terms of the health of the population.
• Cigar Smoking and Relation to Disease The article “Effect of cigar smoking on the risk of cardiovascular disease, chronic obstructive pulmonary disease and cancer in Men” by Iribarren et al.is a longitudinal study of cigar smokers and the impact of cigar […]
• Quitting Smoking: Motivation and Brain As these are some of the observed motivations for smoking, quitting smoking is actually very easy in the sense that you just have to set your mind on quitting smoking.
• Health Effects of Tobacco Smoking in Hispanic Men The Health Effects of Tobacco Smoking can be attributed to active tobacco smoking rather than inhalation of tobacco smoke from environment and passive smoking.
• Smoking in Adolescents: A New Threat to the Society Of the newer concerns about the risks of smoking and the increase in its prevalence, the most disturbing is the increase in the incidences of smoking among the adolescents around the world.
• The Importance of Nurses in Smoking-Cessation Programs When a patient is admitted to the hospital, the nursing staff has the best opportunity to assist them in quitting in part because of the inability to smoke in the hospital combined with the educational […]
• New Jersey Legislation on Smoking The advantages and disadvantages of the legislation were discussed in this case because of the complexity of the topic at hand as well as the potential effects of the solution on the sphere of public […]
• Environmental Health: Tabaco Smoking and an Increased Concentration of Carbon Monoxide The small size of the town, which is around 225000 people, is one of the reasons for high statistics in diseases of heart rate.
• Advanced Pharmacology: Birth Control for Smokers The rationale for IUD is the possibility to control birth without the partner’s participation and the necessity to visit a doctor just once for the device to be implanted.
• Legislation Reform of Public Smoking Therefore, the benefit of the bill is that the health hazard will be decreased using banning smoking in public parks and beaches.
• Female Smokers Study: Inferential Statistics Article The article “Differential Effects of a Body Image Exposure Session on Smoking Urge between Physically Active and Sedentary Female Smokers” deepens the behavioral mechanisms that correlate urge to smoke, body image, and physical activity among […]
• Smoking Bans: Protecting the Public and the Children of Smokers The purpose of the article is to show why smoking bans aim at protecting the public and the children of smokers.
• Clinical Effects of Cigarette Smoking Smoking is a practice that should be avoided or controlled rigorously since it is a risk factor for diseases such as cancer, affects the health outcomes of direct and passive cigarette users, children, and pregnant […]
• Public Health and Smoking Prevention Smoking among adults over 18 years old is a public health issue that requires intervention due to statistical evidence of its effects over the past decades.
• Smoking in the US: Statistics and Healthcare Costs According to the Centers for Disease Control and Prevention, tobacco smoking is the greatest preventable cause of death in the US.
• Smoking Should Be Banned Internationally The questions refer to the knowledge concerning the consequences of smoking and the opinions on smoking bans. 80 % of respondents agree that smoking is among the leading causes of death and 63, 3 % […]
• Microeconomics: Cigarette Taxes and Public Smoking Ban The problem of passive smoking will be minimized when the number of smokers decreases. It is agreeable that the meager incomes of such families will be used to purchase cigarettes.
• Alcohol and Smoking Impact on Cancer Risk The research question is to determine the quantity of the impact that different levels of alcohol ingestion combined with smoking behavioral patterns make on men and women in terms of the risks of cancer.
• Teenagers Motivated to Smoking While the rest of the factors also matter much in the process of shaping the habit of smoking, it is the necessity to mimic the company members, the leader, or any other authority that defines […]
• Indoor Smoking Restriction Effects at the Workplace Regrettably, they have neglected research on the effect of the legislation on the employees and employers. In this research, the target population will be the employees and employers of various companies.
• Hypnotherapy Session for Smoking Cessation When I reached the age of sixty, I realized that I no longer wanted to be a smoker who was unable to take control of one’s lifestyle.
• Stopping Tobacco Smoking: Lifestyle Management Plan In addition, to set objective goals, I have learned that undertaking my plan with reference to the modifying behaviour is essential for the achievement of the intended goals. The main intention of the plan is […]
• Smoking Epidemiology Among High School Students In this way, with the help of a cross-sectional study, professionals can minimalize the risk of students being afraid to reveal the fact that they smoke. In this way, the number of students who smoke […]
• Social Marketing: The Truth Anti-Smoking Campaign The agreement of November 1998 between 46 states, five territories of the United States, the District of Columbia, and representatives of the tobacco industry gave start to the introduction of the Truth campaign.
• Vancouver Coastal Health Smoking Cessation Program The present paper provides an evaluation of the Vancouver Coastal Health smoking cessation program from the viewpoint of the social cognitive theory and the theory of planned behavior.
• Smoking Experience and Hidden Dangers When my best college friend Jane started smoking, my eyes opened on the complex nature of the problem and on the multiple negative effects of smoking both on the smoker and on the surrounding society.
• South Illinois University’s Smoking Ban Benefits The purpose of this letter is to assess the possible benefits of the plan and provide an analysis of the costs and consequences of the smoking ban introduction.
• Smoking Cessation in Patients With COPD The strategy of assessing these papers to determine their usefulness in EBP should include these characteristics, the overall quality of the findings, and their applicability in a particular situation. The following article is a study […]
• Smoking Bans: Preventive Measures There have been several public smoking bans that have proved to be promising since the issue of smoking prohibits smoking in all public places. This means it is a way of reducing the exposure to […]
• Ban Smoking Near the Child: Issues of Morality The decision to ban smoking near the child on father’s request is one of the demonstrative examples. The father’s appeal to the Supreme Court of California with the requirement to prohibit his ex-wife from smoking […]
• The Smoking Ban: Arguments Comparison The first argument against banning smoking employs the idea that smoking in specially designated areas cannot do harm to the health of non-smokers as the latter are supposed to avoid these areas.
• Smoking Cessation and Patient Education in Nursing Pack-years are the concept that is used to determine the health risks of a smoking patient. The most important step in the management plan is to determine a date when the man should quit smoking.
• Philip Morris Company’s Smoking Prevention Activity Philip Morris admits the existence of scientific proof that smoking leads to lung cancer in addition to other severe illnesses even after years of disputing such findings from health professionals.
• Virginia Slims’ Impact on Female Smokers’ Number Considering this, through the investigation of Philip Morris’ mission which it pursued during the launch of the Virginia Slims campaign in 1968-1970 and the main regulatory actions undertaken by the Congress during this period, the […]
• Cigarette Smoking and Parkinson’s Disease Risk Therefore, given the knowledge that cigarette smoking protects against the disease, it is necessary to determine the validity of these observations by finding the precise relationship between nicotine and PD.
• Tuberculosis Statistics Among Cigarette Smokers The proposal outlines the statistical applications of one-way ANOVA, the study participants, the variables, study methods, expected results and biases, and the practical significance of the expected results.
• Smoking Ban and UK’s Beer Industry However, there is an intricate type of relationship between the UK beer sector, the smoking ban, and the authorities that one can only understand by going through the study in detail The history of smoking […]
• Status of Smoking around the World Economic factors and level of education have contributed a lot to the shift of balance in the status of smoking in the world.
• Redwood Associates Company’s Smoking Ethical Issues Although employees are expected to know what morally they are supposed to undertake at their work place, it is the responsibility of the management and generally the Redwood’s hiring authority to give direction to its […]
• Smokers’ Campaign: Finding a Home for Ciggy Butts When carrying out the campaign, it is important to know what the situation on the ground is to be able to address the root cause of the problem facing the population.
• Mobile Applications to Quit Smoking A critical insight that can be gleaned from the said report is that one of the major factors linked to failure is the fact that smokers were unable to quit the habit on their own […]
• Behavior Modification Technique: Smoking Cessation Some of its advantages include: its mode of application is in a way similar to the act of smoking and it has very few side effects.
• Effects of Thought Suppression on Smoking Behavior In the article under analysis called I suppress, Therefore I smoke: Effects of Thought Suppression on Smoking Behavior, the authors dedicate their study to the evaluation of human behavior as well as the influence of […]
• Suppressing Smoking Behavior and Its Effects The researchers observed that during the first and the second weeks of the suppressed behavior, the participants successfully managed to reduce their intake of cigarettes.
• Smoking Cessation Methods These methods are a part of NRT or nicotine replacement therapy, they work according to the principle of providing the smoker with small portions of nicotine to minimize the addiction gradually and at the same […]
• Understanding Advertising: Second-Hand Smoking The image of the boy caught by the smoke is in the center of the picture, and it is in contrast with the deep black background.
• People Should Quit Smoking Other counseling strategies such as telephone calls and social support also serves the ultimate goal of providing a modern approach in which counseling can be tailored to suit the counseling needs of an individual smoker. […]
• Importance of Quitting Smoking As such, quitting smoking is important since it helps relief the worry and the fear associated with possibility of developing cancer among other smoking-related illnesses. It is therefore important to quit smoking if the problems […]
• Cigarette Smoking in Public Places Those who argue against the idea of banning the smoking are of the opinion that some of them opt to smoke due to the stress that they acquire at their work places.
• “Thank You For Smoking” by Jason Reitman Film Analysis Despite the fact that by the end of the film the character changes his job, his nature remains the same: he believes himself to be born to talk and convince people.
• Ban of Tobacco Smoking in Jamaica The first part of the paper will address effects of tobacco smoking on personal health and the economy. Cognizant of its international obligation and the aforementioned health effects of tobacco smoke, Jamaica enacted a law […]
• Anti-Smoking Campaign in Canada
• Electronic Cigarettes: Could They Help University Students Give Smoking Up?
• The Change of my Smoking Behavior
• Psychosocial Smoking Rehabilitation
• The Program on Smoking Cessation for Employees
• Tips From Former Smokers (Campaign)
• Combating Smoking: Taxation Policies vs. Education Policies
• The Program to Quit Smoking
• Smoking Culture in Society
• Possible Smoking Policies in Florida
• Smoking Ban in the State of Florida
• Core Functions of Public Health in the Context of Smoking and Heart Disease
• Smoking: Pathophysiological Effects
• Putting Out the Fires: Will Higher Taxes Reduce the Onset of Youth Smoking?
• Smoking Bans in US
• Smoking as Activity Enhancer: Schizophrenia and Gender
• Health Care Costs for Smokers
• Medical Coverage for Smoking Related Diseases
• Exposure to mass media proliferate smoking
• The Realm of reality: Smoking
• Ethical Problem of Smoking
• The Rate of Smoking Among HIV Positive Cases.
• Studying the Government’s Anti-Smoking Measures
• Smoking Should Be Banned In the United States
• Effectiveness of Cognitive Behavioral Theory on Smoking Cessation
• Effectiveness of the Cognitive Behavioral Therapy for Smoking Cessation
• Wayco Company’s Non-smoking Policy
• Adverse Aspects of Smoking
• Negative Impacts of Smoking on Individuals and Society
• Dealing With the Increase in the Number of Smokers Between Ages 17 and 45
• Cannabis Smoking in Canada
• Smoking Ban in the United States of America
• Dangers of Smoking Campaign
• Smoking Ban in New York
• Smoking and Adolescents
• Trends in Smoking Prevalence by Race/Ethnicity
• Business Ethics: Smoking Issue
• Where Does the Path to Smoking Addiction Start?
• Public Health Communication: Quit Smoking
• Are Estimated Peer Effects on Smoking Robust?
• Are There Safe Smoking and Tobacco Options?
• What Are the Health Risks of Smoking?
• Does Cigarette Smoking Affect Body Weight?
• Does Cigarette Smuggling Prop Up Smoking Rates?
• What Foods Help You Quit Smoking?
• How Can People Relax Without Smoking?
• Does Education Affect Smoking Behaviors?
• Is Vaping Worse Than Smoking?
• Do Movies Affect Teen Smoking?
• What Is Worse: Drinking or Smoking?
• Does Smoking Affect Breathing Capacity?
• Does Smoking Cause Lung Cancer?
• Does Having More Children Increase the Likelihood of Parental Smoking?
• Does Smoking Cigarettes Relieve Stress?
• Does Time Preference Affect Smoking Behavior?
• How Does Smoking Affect Cardiovascular Endurance?
• How Hypnosis Can Help You Quit Smoking?
• How Does Smoking Affect Brain?
• How Nicotine Affects Your Quit Smoking Victory?
• How Does Secondhand Smoking Affect Us?
• Why Is Smoking Addictive?
• How Smoking Bans Are Bad for Business?
• Why Smoking Should Not Be Permitted in Restaurants?
• Why Public Smoking Should Be Banned?
• Why Has Cigarette Smoking Become So Prominent Within the American Culture?
• What Makes Smoking and Computers Similar?
• Does Smoking Affect Schooling?
• What Effects Can Cigarette Smoking Have on the Respiratory System?
• What Are the Most Prevalent Dangers of Smoking and Drinking?
• Social Security Paper Topics
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Statement from the Minister of Health and the Minister of Mental Health and Addictions and Associate Minister of Health on World No Tobacco Day

From: Health Canada

Today marks World No Tobacco Day, a day to raise awareness of the harmful and deadly effects of tobacco use.

May 31, 2024 │Ottawa, ON │Health Canada

Tobacco use continues to be the leading preventable cause of illness and premature death in Canada, killing approximately 46,000 Canadians each year. And, every year in Canada, exposure to second-hand smoke causes nearly 1000 deaths from lung cancer and heart disease in people who do not smoke. Second-hand smoke contains the same chemicals that are inhaled by the person smoking and is especially dangerous for babies and children.

This year's theme – Protecting children from tobacco industry interference – highlights the life saving importance of protecting young people from the harmful effects of tobacco and preventing dependency. We will continue to work alongside our partners in Canada and internationally to keep people safe and healthy. The federal government acknowledges that traditional tobacco has long been sacred and important to many First Nations and Métis People, whose uses differ from those of commercial tobacco. Today, we are raising awareness of the harms of commercial tobacco use and the benefits of quitting smoking.

Our government has strengthened the packaging and labelling requirements of tobacco products, becoming the first country in the world to require health warnings directly on individual cigarettes. This increases the reach of health warnings, especially among youth who often use individual cigarettes in social situations and may not see the health hazards information printed on the package.

Today, we announced $9,548,880 through the Healthy Canadians and Communities Fund for three organizations, including the Canadian Cancer Society, the University of Toronto and McMaster University. The funding will help create supportive social environments for tobacco prevention and cessation for at-risk populations.

The Government of Canada has resources available to help people quit smoking. The " I Quit for Me " guide equips youth with practical information to help them quit smoking or vaping. Additionally, the Tools for a Smoke-Free Life campaign encourages individuals who smoke to learn more about the array of tools and supports that can help them quit.

Quitting smoking is possible. Building a quit plan around your needs is the first step to success. Canadians can contact the pan-Canadian toll-free quitline where trained specialists can help them develop a plan, provide support, answer questions and provide referrals to programs and services in their community. The quitline can be reached at 1-866-366-3667 or online at Gosmokefree.gc.ca/quit . For more information and resources to help quit smoking, visit Canada.ca/quit-smoking .

The Honourable Mark Holland, P.C., M.P. The Honourable Ya'ara Saks, P.C., M.P.

Christopher Aoun Press Secretary Office of the Honourable Mark Holland Minister of Health 613-291-4176

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The Process for Developing Thesis Statements for History : Home

Process for developing thesis statements for history, developing a thesis statement for history .

More than most other academic disciplines, History is focused on clear, organized, and developed writing. And the key fundamental to writing in History is to focus on developing the proper thesis from start to finish.  

You can be much more efficient in your searches for research by narrowing down a topic from the very beginning with a working thesis.

For example: Your history teacher assigns a Portfolio Project about how the US ended up fighting for the Allies in World War I. The teacher prompts you by writing that the US could have fought for either the Allies or the Central power in World War I, but they ended up fighting for just the one. Why not the other? Or how remaining neutral in the war would have affected the eventual outcome. Take a position and argue which one was the better choice and why. Defend a strong position.

So, if you develop a working thesis out of this prompt you can immediately focus in on your position. 

The essential elements of a proper History working thesis:

• Asserts an historical argument - not a fact, but an ARGUMENT
• Therefore, you are asserting a position that you have to defend .
• Is historically focused and precise,
• and ALWAYS answers the question, "so what?" Why should we care, TODAY?
• Finally, your thesis should identify the main points that you are using to defend your position and will form the basis of every topic sentence in your body paragraphs. This part of the working thesis will take more time to develop. 

The thesis statement can be up to three to four sentences and is expected to be at the end or your introduction.

The Finish:

Your working thesis stays with the writing project until you revise it for the VERY last time - right before submitting your whole paper. You want to make sure that is closely reflects your conclusion, which was written after you developed the body of the paper. 

Remember: the very first thing that your reader will read is your introduction. First impressions are critically important. So, you will want to go back and update your thesis, which will be the end of your writing process. 

Using the prompt above, here is a successful thesis:

Although the US entered World War I on the Allied side against Germany and the Central Power on April 6, 1917, the war had already been raging in Europe for three years. The largest ethnic group in the US were German, equating to 10% of the population; yet while a majority of the nation favored England, France and the other Allies--both groups highly favored US neutrality as the best approach. Therefore, had Germany not continue responding to the Allied blockade by indiscriminately sinking all ships, regardless of citizenship and cargo, the US would have stayed neutral, and the eventual tide of the war would have gone the other way - for the Central Powers. 

These helpful tips were provided by James Meredith - 

• Last Updated: Jun 3, 2024 2:03 PM
• URL: https://csuglobal.libguides.com/thesis_statement