Contexts of cigarette and e-cigarette use among dual users: a qualitative study.
BACKGROUND
Not much is currently understood regarding the contexts of cigarette and e-cigarette use among dual users. Proper application of e-cigarettes to smoking cessation or tobacco harm reduction would require an understanding of when and why dual users use cigarettes versus e-cigarettes. This study sought to elucidate the contexts of cigarette versus e-cigarette use among dual users.


METHODS
Twelve focus group discussions were conducted with 62 young adult current daily e-cigarette users [63% men; mean age = 25.1 (Standard Deviation = 5.5)]. Almost all participants either concurrently smoked cigarettes or had been recent dual users. Data were analyzed following principles of inductive deduction.


RESULTS
Results indicated that dual users' use of cigarettes is influenced by particular activities (e.g., before/after eating), strong craving or need for stimulation (e.g., in response to stress), places/situations (e.g., when cigarette smokers are nearby; outdoors), use of other substances (alcohol, coffee), and unavailability of an e-cigarette when needed. In addition to particular activities and places/situations that are conducive to e-cigarette use, use of e-cigarette when cigarette is not available or where cigarette smoking is not permitted emerged as contexts specific to e-cigarette use.


CONCLUSIONS
For habitual cigarette smokers wanting to quit tobacco smoking, switching over completely to e-cigarettes may require skills of cognitive-behavioral management. Future research needs to ascertain the characteristics of dual users who use e-cigarettes as cessation aids versus as cigarette alternative when cigarette is unavailable or smoking is not permitted.
Cancer Prevention & Control Program, University of Hawaii Cancer Center, 701 Ilalo St, Honolulu, HI, 96822, USA. ppokhrel@cc.hawaii.edu.
Pallav
P
Pokhrel
Cancer Prevention & Control Program, University of Hawaii Cancer Center, 701 Ilalo St, Honolulu, HI, 96822, USA. therzog@cc.hawaii.edu.
Thaddeus A
TA
Herzog
Cancer Prevention & Control Program, University of Hawaii Cancer Center, 701 Ilalo St, Honolulu, HI, 96822, USA. nmuranaka@cc.hawaii.edu.
Nicholas
N
Muranaka
School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 North Pleasant Street, Amherst, MA, 01003, USA. regmi@umass.edu.
Sakshi
S
Regmi
Cancer Prevention & Control Program, University of Hawaii Cancer Center, 701 Ilalo St, Honolulu, HI, 96822, USA. pfagan@cc.hawaii.edu.
Pebbles
P
Fagan
D000328:Adult; D066300:Electronic Nicotine Delivery Systems / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D036301:Qualitative Research; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D062789:Tobacco Products / Q000706:statistics & numerical data*; D061485:Tobacco Use Cessation Devices; D014029:Tobacco Use Disorder; D055815:Young Adult