A qualitative analysis of electronic nicotine delivery systems (ENDS) uptake and use among young adult never-smokers in New Zealand

INTRODUCTION: Electronic nicotine delivery systems (ENDS) likely pose fewer health risks than smoking. Yet ENDS uptake has increased among never-smoking young adults, who likely face greater health risks relative to non-users of ENDS. To date, few qualitative studies have explored ENDS uptake and use by never-smokers. METHODS: We conducted in-depth, semi-structured interviews with 16 current ENDS users from New Zealand aged 18 to 24 years old who reported never having smoked cigarettes regularly. We explored participants’ experimentation with conventional tobacco products, trial, uptake and patterns of ENDS use, and their future intentions regarding both ENDS and conventional tobacco products. We managed the data using NVivo12 and used thematic analysis to interpret the transcripts. RESULTS: ENDS use enhanced connection and belonging by providing communal experiences and facilitating social interactions. Participants’ mastery of tricks generated social cachet within friendship groups and counteracted the ENDS-related stigma they experienced. Flavours, clouds and devices’ physical attributes provided stimulation and engagement, and some used ENDS for stress or appetite management. Lastly, participants rationalised ENDS uptake by referencing the far greater risks smoking posed. CONCLUSIONS: ENDS uptake by young adult never-smokers is driven by both psycho-social and functional factors. ENDS provided shared hedonic experiences and physical pleasures, and generated both bonding and bridging social capital, although many participants had also experienced judgement from others for using ENDS. Policies that denormalise ENDS as recreational devices could discourage uptake by never-smokers, though measures will require careful nuancing to avoid deterring smokers from switching to ENDS.