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Pathways of Nicotine Product Use: A Qualitative Study of Youth and Young Adults in California

March 2019

Few studies have explored pathways of youth initiation of alternative nicotine delivery systems (ANDS), such as e-cigarettes.

To learn more about his topic, a study team led by scholars at the Prevention Research Center of the Pacific Institute for Research and Evaluation conducted in-depth qualitative interviews with 49 Californian youth between 15-25 years who had vaped nicotine. 

The interviews focused on youth’s experiences and reasons for ANDS initiation and use.

Categorizing participants into initiation pathways by self-reported use and age of initiation of ANDS and cigarettes, the study authors analyzed the meaning and role of vaping across 3 pathways of use:

1) smoking to vaping
2) vaping to smoking, and
3) vaping only

The most common pathway reported by the participants was smoking to vaping (74%) followed by vaping prior to smoking, and then vaping but never smoking.

The results suggest that, regardless of initiation pathway, youth were generally aware of the health consequences of smoking and engaged in use of nicotine products having considered the relative risks.  The use of ANDS is perceived as a transitional tool away from smoking. 

These findings challenge conventional public health discourses about ANDS as a threat to youth’s health. 

The study results highlight the need for public health professionals to acknowledge harm reduction strategies of youth users of ANDS as public health messages are constructed and as policies for smoking cessation are crafted.

Says lead study author, Dr. Tamar Antin “Though tobacco harm reduction is quite controversial within the public health community, our study suggests that it is being practiced by young smokers. Many are seeking out less harmful forms of nicotine to help them quit smoking. Listening to and integrating their perspectives into public health practice is crucial to benefit the health of all young people.”

Source:  Antin, T., Hess, C., Kaner, E., Annechino, R. and Hunt, G., 2019. Pathways of Nicotine Product Use: A Qualitative study of Youth and Young adults in California. Nicotine & Tobacco Research. DOI: 10.1093/ntr/ntz028.

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PIRE is an independent, nonprofit organization merging scientific knowledge and proven practice to create solutions that improve the health, safety and well-being of individuals, communities, and nations around the world.

The Prevention Research Center (PRC) of PIRE is one of 16 centers sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), of the National Institutes of Health, and is the only one that specializes in prevention. PRC's focus is on conducting research to better understand the social and physical environments that influence individual behavior that lead to alcohol and drug misuse.

The Resource Link for Community Action provides information and practical guidance to state and community agencies and organizations, policy makers, and members of the public who are interested in combating alcohol and other drug abuse and misuse.

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