‘I don’t think I'd feel good about myself if I was to give up smoking and go to one of these’: perceptions of e-cigarettes among South Australian young adult smokers and ex-smokers

Objective: To explore South Australian (SA) young adult smokers’ and ex-smokers’ perceptions of e-cigarettes as a possible tool for smoking cessation in a context where only e-cigarettes that do not contain nicotine are legally available. Design: Six focus groups: two groups of five participants each for daily smokers, occasional smokers (less than daily) and ex-smokers. Participants (N = 30, 57% male) were aged between 18 and 25 years; e-cigarette experience ranged from none (33%), experimental (47%) to using them as a cessation aid (20%). Topics discussed included smoking experiences, smoking cessation, and e-cigarette experiences, observations and perceptions. Transcripts of the discussions were analysed thematically. Results: Three overarching themes emerged: (1) E-cigarettes deemed unnecessary for quitting and lack appeal as a quitting aid; (2) Social unacceptability of e-cigarettes; and (3) Ambiguity in how e-cigarettes should be managed given the unknown risks and benefits. These views appeared to limit the desire to use e-cigarettes as a cessation aid. Nonetheless, participants preferred a ‘wait and see’ approach to regulation of e-cigarette availability, highlighting uncertainty about the evidence of harm. Conclusion: Perceptions of e-cigarettes may be shaped by the policy and social environment. Australia’s maintained ban on nicotine-containing e-cigarettes signals potential harm, but unlike other Australian states, SA is yet to implement proposed non-nicotine e-cigarette regulations, which may create confusion about the risks and benefits of use. Further research is needed to identify how to convey information about e-cigarettes that does not undermine existing commitments to protecting the community from potential harm.