Motivation and emotion/Book/2024/E-cigarette use motivation

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

Overview

Figure 1. Disposable nicotine e-cigarette devices Case study A previously healthy 16-year-old male presented with progressive shortness of breath, cough, and hypoxemia in the setting of several months of daily nicotine and THC-containing e-cigarette use. He had been suffering from a chronic cough and intermittent nausea since he started vaping several months before presentation. His cough worsened 1 week before admission to the hospital, accompanied by post-tussive emesis and non-bloody diarrhea. He subsequently developed a fever and was evaluated in an emergency department. A chest radiograph showed a right lower lobe pneumonia prompting outpatient treatment with levofloxacin (Shah et al., 2020).

Electronic cigarettes are electronic devices that use a battery powered heating element to disperse liquid, typically a glycerin and/or propylene glycol solution, into an inhalable aerosol (Wadsworth et al., 2016). This aerosolized liquid contains flavorings, solvents, and the addictive, dependence-producing drug nicotine (Breland et al., 2017). Vaping and smoking prevalence in Australia has been trending upward since 2020, with the Australian population aged 14 and over containing 3.5 million smokers and/or vapers, with current smokers (11.8% of the population) outnumbering current vapers (8.9% of the population) (Wakefield et al., 2023).

Focus questions
What motivates people to vape?
What are the physical and mental health implications of e-cigarette use?
What psychological theories may be applied to e-cigarette use?

What motivates people to vape?

Reasons for initiating e-cigarette use

The most common reason for initiating e-cigarette use or vaping is to stop or reduce tobacco smoking behaviour (Kinouani et al., 2017). However, current evidence regarding the effectiveness of e-cigarette use in smoking cessation is inconclusive, and several longitudinal studies have reported that e-cigarette use is associated with a greater risk of initiation of tobacco smoking among adolescents and young adults (Kinouani et al., 2017). Smokers who initiate e-cigarette use for cessation rather than recreation or enjoyment purposes are more likely to have greater nicotine dependence, cigarette consumption, and e-cigarette consumption, however motivations and use differ and are related to both consumption and dependence (Temourian et al., 2022). A qualitative interview-based study of e-cigarette use motivation in smokers and non-smokers revealed that non-smokers cited social reasons for e-cigarette use, such as peer influence and social norms, whereas smokers or ex-smokers often cited health reasons for initiating e-cigarette use (Amin et al., 2021).

Socioeconomic status, adverse childhood events and e-cigarette use

Smoking and e-cigarette use is unequally distributed between people of different socioeconomic status, with higher smoking prevalence in groups of lower socioeconomic status contributing to health inequities (Jahnel et al., 2020). A study from Williams et al. examining adverse childhood experiences and early initiation of e-cigarette use behaviour in middle school students in Nevada found a strong graded relationship between cumulative adverse childhood experience (ACE) exposure and early initiation of electronic vapor product use (Williams et al., 2020).

Attitudes and education around e-cigarettes

Understanding individuals' perceptions about the relative safety of a behaviour provides a basis for a predictive relationship between perception/attitude and engagement in the behaviour (Erku et al., 2019). There appears to be a direct relationship between smokers' perception of the relative harm of tobacco cigarettes and nicotine vaping products (NVPs) and the likelihood of switching from smoking to vaping (Erku et al., 2019). A longitudinal study showed that smokers and ex-smokers who perceived NVPs as less harmful were subsequently more likely to try them, however a considerable portion of interviewed smokers reported a lack of knowledge about the relative safety (Erku et al., 2019). Some of the reasons for the significant rise in adolescent vaping include misconceptions about the safety of e-cigarettes, lower prices than traditional tobacco cigarettes, a variety of flavours such as fruits and candy, and social or peer pressure (Javed et al., 2022).

What are the physical and mental health implications of e-cigarette use?

Physical health effects of e-cigarette use

Research on the long-term health effects of the orally-ingested toxicants delivered via aerosolized vapor in e-cigarettes is limited, however there is rising concern about the health impacts among youth who begin using e-cigarettes at an early age (Williams et al., 2020). Many of the volatile organic compounds found in the saliva and urine samples of e-cigarette users are carcinogenic (Rubinstein et al., 2018). From March 2019 to February 2020, The Centers for Disease Control and Prevention states that more than 2,807 cases of lung injury associated with e-cigarette use were reported (Rocheleau, 2020). Furthermore, as of 2020, there were 68 deaths associated with e-cigarette use across 29 states (Rocheleau, 2020).

Mental health effects of e-cigarette use

Nicotine, the addictive chemical component of e-cigarettes, has been shown to cause severe impairment to the growing brain leading to cognitive and psychiatric issues, such as depression, anxiety, violence, other substance abuse, and suicidality (Javed et al., 2022). In adolescents, depressive symptoms predict an increased likelihood of initiating e-cigarette use, but sustained e-cigarette use is associated with an increase in depressive symptoms, and higher frequency of e-cigarette use is associated with higher rates of depressive symptoms (Lechner et al., 2017).

What psychological theories may be applied to e-cigarette use?

Theory of Planned Behaviour

Ajzen's theory of planned behaviour posits that attitudes, subjective norms, and perceived behavioural control all contribute to intentions to perform behaviours (Ajzen, 1991). In this context, the performed behaviour is e-cigarette use, and the TPB components (attitude, subjective norms, perceived behavioural control) all contribute to the performance of this behaviour. A study from the British Journal of Addiction found that for adult smokers in the general population, perceived behavioural control, attitudes and subjective norms were explaining intention regarding cigarette-smoking behaviour (Godin et al., 1992). The theory of planned behaviour can be applied the same way to e-cigarette use behaviour.

Social Learning Theory

Social learning theory, originally proposed by Albert Bandura, primarily focuses on the importance of interactions one has with others in their peer group (Akers & Jennings, 2015), and posits that people learn through observing, imitating, and modelling others' behaviour (Nabavi, 2012). Findings from a study utilising a social learning approach to e-cigarette use found that higher levels of peer e-cigarette use contribute to higher odds of personal e-cigarette use (Rocheleau et al., 2020).

See also

Nicotine and Emotion: what is the effect of nicotine on emotion?

Vaping - Society and Culture

References

Ajzen, I. (1991). The theory of planned behavior. Organizational behavior and human decision processes, 50(2), 179-211.

Akers, R. L., & Jennings, W. G. (2015). Social learning theory. The handbook of criminological theory, 230-240.

Amin, S., Dunn, A. G., & Laranjo, L. (2021). Why do people start or stop using e‐cigarettes in Australia? A qualitative interview‐based study. Health Promotion Journal of Australia, 32, 358-366.

Breland, A., Soule, E., Lopez, A., Ramôa, C., El‐Hellani, A., & Eissenberg, T. (2017). Electronic cigarettes: what are they and what do they do?. Annals of the New York Academy of Sciences, 1394(1), 5-30.

Erku, D. A., Gartner, C. E., Tengphakwaen, U., Morphett, K., & Steadman, K. J. (2019). Nicotine vaping product use, harm perception and policy support among pharmacy customers in Brisbane, Australia. Drug and Alcohol Review, 38(6), 703-711.

Jahnel, T., Ferguson, S. G., Partos, T., & Brose, L. S. (2020). Socioeconomic differences in the motivation to stop using e-cigarettes and attempts to do so. Addictive Behaviors Reports, 11, 100247.

Javed, S., Usmani, S., Sarfraz, Z., Sarfraz, A., Hanif, A., Firoz, A., ... & Ahmed, S. (2022). A scoping review of vaping, e-cigarettes and mental health impact: depression and suicidality. Journal of community hospital internal medicine perspectives, 12(3), 33.

Kinouani, S., Leflot, C., Vanderkam, P., Auriacombe, M., Langlois, E., & Tzourio, C. (2020). Motivations for using electronic cigarettes in young adults: A systematic review. Substance abuse, 41(3), 315-322.

Lechner, W. V., Janssen, T., Kahler, C. W., Audrain-McGovern, J., & Leventhal, A. M. (2017). Bi-directional associations of electronic and combustible cigarette use onset patterns with depressive symptoms in adolescents. Preventive medicine, 96, 73-78.

Nabavi, R. T. (2012). Bandura’s social learning theory & social cognitive learning theory. Theory of Developmental Psychology, 1(1), 1-24.

Rocheleau, G. C., Vito, A. G., & Intravia, J. (2020). Peers, perceptions, and e-cigarettes: A social learning approach to explaining e-cigarette use among youth. Journal of drug issues, 50(4), 472-489.

Rubinstein, M. L., Delucchi, K., Benowitz, N. L., & Ramo, D. E. (2018). Adolescent exposure to toxic volatile organic chemicals from e-cigarettes. Pediatrics, 141(4).

Shah, J., Mullen, M., & Lu, M. (2020). E-cigarette or vaping product use–associated lung injury: a case study and review of the literature. Journal of Radiology Nursing, 39(4), 305-308.

Temourian, A. A., Song, A. V., Halliday, D. M., Gonzalez, M., & Epperson, A. E. (2022). Why do smokers use e-cigarettes? A study on reasons among dual users. Preventive Medicine Reports, 29, 101924.

Wadsworth, E., Neale, J., McNeill, A., & Hitchman, S. C. (2016). How and why do smokers start using e-cigarettes? Qualitative study of vapers in London, UK. International Journal of Environmental Research and Public Health, 13(7), 661.

Wakefield, M., Haynes, A., Tabbakh, T., Scollo, M., & Durkin, S. (2023). Current vaping and current smoking in the Australian population aged 14+ years: February 2018-March 2023. Melbourne: Centre for Behavioural Research in Cancer, Cancer Council Victoria.

Williams, L., Clements-Nolle, K., Lensch, T., & Yang, W. (2020). Exposure to adverse childhood experiences and early initiation of electronic vapor product use among middle school students in Nevada. Addictive Behaviors Reports, 11, 100266.