HSC 340 – Qualitative Methods Paper Instructions Synthesis of Public Health Evidence
Qualitative Methods Paper Instructions: Synthesis of Public Health Evidence
The use of electronic cigarettes, or “vaping,” has become a major public health issue in young adults and college students (Case et al., 2022). Vaping consists of inhaling aerosolized nicotine through electronic devices that are frequently marketed as safer alternatives to traditional cigarettes (Dubé et al., 2023). Though researchers continue to uncover growing amounts of evidence indicating serious health hazards associated with vaping, the prevalence of vaping remains very high among college populations because of the availability of these products, appealing flavors, and perceived lower levels of harm compared to traditional combustible tobacco products (Chen et al., 2024). This paper will outline the public health implications of vaping in colleges through a synthesis of the literature and presentation of qualitative findings related to user experience, motivations, and the documented effects of vaping.
Background
Vaping behavior among young adults is consistently found to be influenced by multiple factors (social, psychological, and environmental). Several qualitative studies have found that peer influence and social environments are key factors in both initiating and continuing the use of vaping products, with many people saying they first tried vaping in social settings with friends (Dubé et al., 2023; McKenzie et al., 2022; Yang et al., 2022). Others have found that many young adults use vaping as a coping strategy for stress, anxiety, and boredom, especially within college because students are often under a lot of pressure to perform (Case et al., 2022; Huma et al., 2021). These various influences continue to contribute to the normalization of vaping in college cultures and to the ongoing use of vaping among young adults.
While vaping is relatively new compared to smoking, there are serious concerns for consumers’ health based on current research. Fatigue, decreased lung function, and discomfort in the lungs are common physical symptoms reported by young people who vape, as well as psychological dependence on nicotine (Case et al., 2022; Dubé et al., 2023). Withdrawal from nicotine remains the greatest health risk to individuals, with many users citing symptoms such as irritability, cravings for nicotine, and mood swings when they try to stop using nicotine-containing products (Pbert et al., 2024; Huma et al., 2021). These findings demonstrate that vaping presents both an immediate and a long-term public health risk to the user.
Vaping is harmful to one’s health, and as a consequence of that, young adults may face numerous barriers to stopping vaping. Many individuals want to quit nicotine, but they may not be able to do so due to various reasons, such as social influences, habitual usage, and limited connection to cessation programs (Pbert et al., 2024; Yang et al., 2022). According to research, social support, tracking behaviors, and creating individualized quit plans can provide opportunities for success with regard to quitting vaping among young adults (Huma et al., 2021). Knowing what types of barriers exist and what may help to decrease these barriers will aid in creating effective public health policies to reduce the number of young adults who use vapes.
Methods
This study used a qualitative method of investigation in order to look at how college students vape, as well as their thoughts about vaping. A qualitative method was chosen for this research because it provides a very detailed opportunity to understand a person’s experience, how social issues affect their use of the product, and how they develop their habits, all of which can be quite complicated and require attention to contextual factors (Huma et al., 2021). For this research, three different types of data were collected through interviews, a focus group, and photovoice in order to get a complete and accurate description of the vaping habits and perceptions of college students.
Interviews
Researchers interviewed college students who had vaped in the past year to gather information about their use of such products. They were recruited for the study through convenience sampling. This included current users, former users, and those who had attempted to quit using vapes, allowing researchers to collect a wide variety of opinions (Pbert et al., 2024). The interview was structured using a semi-structured interview guide that covered vaping habits, motivations, risks associated with using vapes, and experience quitting, and all interviews were conducted in an open format so that students felt comfortable sharing their experiences. The sessions were audio-recorded and transcribed. All interviews were conducted with informed consent, voluntary participation, and confidentiality of verbal or written information (Dubé et al., 2023).
Focus Group
A focus group was formed with college sophomores who study for a degree in business, nursing, or political science to observe their group dynamics and common normative behavior toward vaping (Yang et al., 2022). This research asked questions about participants’ attitudes about vaping, as well as their reasons for using vapes, along with their social experiences (open-ended). Participants were encouraged to interact with each other and share their collective views about the normality and belief systems they have regarding using vapes. This session was recorded, transcribed, and analyzed through a comparison with the data collected via individual interviews so common themes could be identified (McKenzie et al., 2022).
Photovoice
Using Photovoice enabled the collection of photographs and written reflections from participants regarding their daily experiences with vaping. Their photos and reflections demonstrated how vaping has become part of their daily routines and provided a deeper understanding of their lived experiences (Huma et al., 2021). The resulting data illustrated the integration of vaping into everyday behaviors. As well, the reflections provided illustrations of habitual use and normalization that complemented the interview and focus group data findings. The information received will remain confidential; however, all participants consented to having their entries included in this research.
Results
Theme 1: Vaping as a Coping Mechanism for Stress and Emotions
Qualitative data analysis found a number of major themes about vaping practices and motivations. One dominant theme among participants was using vaping as a means of coping with stress and regulating emotions. For example, several participants stated that they engaged in vaping while finishing difficult assignments and taking exams, as well as while experiencing feelings of anxiety or otherwise being stressed. As one participant stated about their use of vaping for coping with stress, “I use it whenever I get stressed out, especially when taking an exam”; this speaks volumes about how other young adults use nicotine products for similar reasons (Huma et al., 2021).
Theme 2: Social Influence and Normalization
According to participants, the influence of social environments was a large factor for both starting and continuing to use vape products. Participants reported that the primary motivation for starting to vape was because their friends were vaping, with some stating, “It is something that everyone is doing.” Vaping was seen primarily as a social experience, as it was often used at gatherings and parties (which reinforced its acceptability). Being around others who vape also contributed to the participant’s continued use of vape products and difficulty quitting; this supports what is true regarding peer-influenced behaviors (Dubé et al., 2023).
Theme 3: Development of Dependence and Habit Formation
Vaping was often described by participants as a type of habitual activity that formed part of their everyday life. Some participants stated that they vaped “all day long, every day,” while others indicated they vaped automatically or without thinking when doing routine activities, such as driving or relaxing. Participants experienced signs of nicotine dependence resulting in withdrawal symptoms. In one case, a participant stated that they felt “very irritable and moody” when they did not have a vape, which shows strong nicotine dependence (Pbert et al., 2024).
Theme 4: Awareness of Negative Health Effects
Despite recognizing the adverse health impacts of vaping, some of the participants did not alter their behaviors. Every participant reported at least one symptom of vaping, including shortness of breath, tiredness, headaches, and reduced physical performance. For instance, one participant said that they are not able to run anymore without becoming winded, and there was evidence to support this from another participant who stated that they have frequent headaches too. Both types of experiences are related to the physical symptoms associated with vaping among young adults (Case et al., 2022).
Theme 5: Barriers and Motivations to Quitting
Withdrawal symptoms and cravings, as well as social influences, are commonly cited reasons for difficulties experienced by participants who tried to quit vaping, while many others found success and experienced increased physical health and greater energy as a result of not continuing. Common reasons for difficulties in quitting include reliance on vaping for stress relief, social pressures from friends who vape, and awareness of the negative health risks associated with vaping. Several participants reported that they were motivated to cease using e-cigarettes due to the financial expense of continued use, potential risk of disease, and negative physical effects of using these devices. These factors are well-documented motivators for individuals attempting to reduce or eliminate their e-cigarette vaping habits. (Pbert et al., 2024)
Theme 6: Integration of Vaping into Daily Life
The findings from Photovoice revealed that participants used their vapes daily in the course of completing various tasks. According to one participant, “It is just part of my daily routine.” This shows how much vaping has been integrated into their daily habits. This type of established routine creates dependence on vaping and makes it difficult to quit because it becomes a normal part of their everyday behavior (McKenzie et al., 2022).
Discussion
This qualitative research provides insights into the experiences of using, motivations for using, and struggles with using electronic cigarettes by college students. There was consistency with the previous research demonstrating that stress, peer pressure, and habit development are important contributors to their continued use. Participants in the study indicated that they were using electronic cigarettes as a way to cope with their experiences of stress and anxiety, consistent with prior research showing how young adults utilize the use of nicotine to cope with psychological and academic pressures (Huma et al., 2021; Case et al., 2022). This information would suggest that the use of electronic cigarettes is recreational and also has ties to mental health.
As per participants’ responses, social influences played an important role in the beginning and in continuing to vape. Participants indicated that friends were the reason they began vaping and having trouble stopping while being around others who used vape products. These findings support current literature discussing the influence of peers on the normalization of vaping behavior (Dubé et al., 2023; McKenzie et al., 2022). The normalization of vaping behavior amongst college campuses creates an environment where it is acceptable to use vape products and makes it difficult for individuals to resist or quit using vape products, regardless of their knowledge of the associated health risks.
Participants indicated that nicotine dependence and habitually using vapor products were also noted in the existing literature on these variables. Participants described vaping as an automatic part of their daily lives, and they experienced withdrawal symptoms in the form of irritability and cravings for vaping products. This supports research on how quickly people can develop nicotine addiction and the many barriers to stopping (Pbert et al., 2024). In addition to the physical dependence on the product, the inclusion of vaping in daily routines, such as driving and/or relaxing, further reinforces the user’s dependence on vapes, highlighting the behavioral aspect of addiction independent of just being chemically dependent (McKenzie et al., 2022).
Despite participants’ knowledge regarding negative effects on their health, the knowledge may not have led to a consistent change in behavior. The previous literature indicates that individuals would acknowledge they may be putting themselves at risk through continued use; however, they would continue to use it due to both the addiction aspect and perceived benefits of using (Chen et al. 2024; Brierley et al. 2024). Participants reported symptoms including breathlessness and fatigue while continuing to use the device, and thus indicated that the immediate benefits (like reduced stress) have a greater influence than the long-term health risks they are putting themselves at.
This research identified three barriers to quitting smoking: emotional withdrawal symptoms, social environment challenges, and a reliance on vaping as an emotional coping strategy. Participants who had previously been unable to quit identified fears of withdrawal aids, such as cravings and associated negative emotions with quitting, as the reason they were unable to stop smoking. These results mirror previous research indicating that social exposure and stressors are among the primary barriers to quitting (Pbert et al., 2024; Yang et al., 2022). However, several participants successfully quit using techniques such as distraction, physical exercise, and social support. This aligns with recommended behavioral interventions for quitting smoking (Huma et al., 2021).
These results indicate that both the psychological and social elements of vaping must be targeted through interventions from a public health standpoint. Participants have already been exposed to educational material concerning the possible dangers of vaping, so education may not be adequate to target these issues. Interventions should include access to cessation resources tailored specifically to college students, as well as developing programs for managing stress and building peer support (Chen et al., 2024). Finally, normalizing through policy implementation and creating social norm campaigns could potentially reduce the behavior of vaping (Yang et al., 2022).
When interpreting these findings, there are several limitations that must be taken into consideration. Due to the fact that this is convenience sampling, the generalizability of these results is limited, as all participants are taken from only one very similar college sample. The use of self-report data could also lead to bias from either recall or response. A small sample size, while typical of qualitative research, may not capture all of the experiences. However, multiple methods of data collection (such as interviews, focus groups, and photovoice) provide additional credibility due to triangulation of the data and provide a fuller picture of vaping behaviors (McKenzie et al., 2022).
Conclusion
This research has provided a greater understanding of the factors that help sustain the use of vaping among college students. Stress, social influence, and addiction are found to play important roles in sustaining the use of vaping products. Vaping is incorporated into the daily routine of many college students as a way to cope or manage stress, along with being reinforced by peers. Even if students are aware of the numerous health effects of using vaping products, they will continue the behavior. Therefore, effective strategies to improve public health in this area should include cessation programs that fit the needs of the individual, peer support, and reducing the rates of normalization within college environments. Future studies need to further cite both the continuous changes in behaviors and more inclusive intervention approaches.
References
Brierley, M. E., Kirley, I., & Jongenelis, M. I. (2024). Exploring Perceptions of Anti-Vaping Message Themes: A Qualitative Study of Australian Adolescents and Adults. Nicotine & Tobacco Research, 27(2), 262–270. https://doi.org/10.1093/ntr/ntae198
Case, K. R., Clendennen, S. L., Shah, J., Tsevat, J., & Harrell, M. B. (2022). Changes in marijuana and nicotine vaping perceptions and use behaviors among young adults since the COVID-19 pandemic: A qualitative study. Addictive Behaviors Reports, 15, 100408. https://doi.org/10.1016/j.abrep.2022.100408
Chen, Y., Liu, S., Cai, Y., Gao, R., Liu, H., Jiang, X., Liu, X., Zhao, X., Wang, Z., Chen, Z., Han, J., & Xu, J. (2024). A qualitative exploration of e-cigarette prevention advertisements’ effectiveness among college students in China. Tobacco-Induced Diseases, 22(June), 1–12. https://doi.org/10.18332/tid/189300
Dubé, C. E., Pbert, L., Nagawa, C. S., Simone, D. P., Wijesundara, J. G., & Sadasivam, R. S. (2023). Adolescents who vape nicotine and their experiences vaping: a qualitative study. Substance Abuse Research and Treatment, 17, 11782218231183934. https://doi.org/10.1177/11782218231183934
Huma, Z. E., Struik, L., Bottorff, J. L., & Hasan, M. K. (2021). Preferences for Mobile-Supported E-Cigarette Cessation Interventions among Young Adults: A Qualitative Descriptive Study. JMIR Formative Research, 6(4), e33640. https://doi.org/10.2196/33640
McKenzie, N., Glassman, T. J., Dake, J. A., Maloney, S. M., & Na, L. (2022). Factors that influence cannabis vaping habits of college students: A qualitative study. Journal of American College Health, 72(8), 2856–2863. https://doi.org/10.1080/07448481.2022.2135375
Pbert, L., Dubé, C. E., Nagawa, C. S., Simone, D. P., Wijesundara, J. G., & Sadasivam, R. S. (2024). Vaping cessation support recommendations from adolescents who vape: a qualitative study. BMC Public Health, 24(1), 1615. https://doi.org/10.1186/s12889-024-19036-1
Yang, J., Faruqui, A., Sou, A., & Mackey, T. (2022). Non-compliance with university tobacco-free policies: A qualitative exploration. Tobacco Prevention & Cessation, 8(April), 1–8. https://doi.org/10.18332/tpc/146713
Appendix
Part I: Synthesis Matrix
| Author (Year) | Population | Purpose | Key Findings (Themes) | Relevance to Study |
| McKenzie et al. (2022) | College students (undergraduates) | Look at how participants feel and what they think about vaping habits. | Vaping is affected by accessibility, privacy, mood improvement, and social acceptance; many people use it for more than one reason. | Backs up themes of social use, ease of use, and normalizing behavior among students |
| Pbert et al. (2024) | Adolescents who vape | Look into the reasons for stopping and ways to stop vaping. | Barriers include worry, peer pressure, and lack of access. Health, cost, and dependence are the main reasons people want to quit, and social support is very important. | Describes the difficulties of stopping and how important social and environmental factors are |
| Dubé et al. (2023) | Adolescents who vape | Learn about vaping habits and experiences. | Starts with friends; used for stress or anxiety; habits form; worries about addiction and health risks | Backs up themes of peer pressure, dealing with stress, and making habits |
| Case et al. (2022) | Young adult vapers | Look into how vaping habits changed during COVID-19. | People who were bored vaped more, and negative views did not stop them. They kept vaping even though they were worried about their health. | Makes the gap between knowing about risks and continuing to act bigger |
| Chen et al. (2024) | College students | Check how well warnings against vaping are working. | Effective messages show hurt in real life, make people feel something, and make health risks clear. Ineffective messages do not have any of these elements. | Helps with public health messages and methods for preventing illness |
| Brierley et al. (2024) | Adolescents and young adults | Find good themes for messages that discourage vaping. | Themes include damage to health, addiction, social effects, and how important it is to send messages that people can relate to. | Backs up the need for methods for targeted communication. |
| Huma et al. (2021) | Young adult e-cigarette users | Find out what people want from programs to help them quit. | Personalization, social support, progress tracking, and inspirational messages are desired features. | Describes effective tools for quitting and how to plan an intervention |
| Yang et al. (2022) | University students and staff | Examine tobacco policy compliance. | Stress, a lack of regulation, and social factors can make people not follow the rules, leading to rationalization of use. | It shows that institutions and the environment can affect vaping habits. |