Using an e-Cigarette is Like Eating Tofu When You Really Want Meat.

Objectives: Whereas controversy about the e-cigarette's effectiveness and safety as a smoking cessation tool continues, e-cigarette use prevalence continues rising. In this study, we sought to describe experiences of adult e-cigarette users and to examine their motivations, beliefs, and use patterns. Methods: This qualitative study included one-on-one semi-structured phone interviews with 20 current California e-cigarette users (mean age = 38 +/- 9.44 years). Interviews were transcribed and thematically analyzed using MAXQDA. Results: E-cigarettes initially addressed participants' problems related to smoking; they no longer smelled like cigarette smoke and could avoid smoke-free regulations. Participants highlighted the importance of e-cigarette flavors and of "receiving moral credit" for harm reduction by using e-cigarettes to quit smoking cigarettes. Many described eventual dissatisfaction with e-cigarettes, which resulted in relapse to cigarette smoking and/or dual use with cigarettes. The convenience of e-cigarettes coupled with the pattern of constant use left participants increasingly reliant on e-cigarettes. Conclusions: Ultimately, failed cessation and dual use exposes smokers to greater levels of nicotine, while still exposing them to cigarette smoke. Public health campaigns should promote awareness of the risks of using e-cigarettes, including failed cessation attempts, dual use, addiction, and other health consequences.