A qualitative analysis of free-text responses exploring smokers’ arguments against vaping: implications for e-cigarette messaging

Background: Despite considerable evidence that vaping is a safer alternative to smoking, there is a common misperception among smokers that electronic cigarettes are as or more harmful than cigarettes. Messaging which highlights the benefits of e-cigarettes to current smokers, while also discouraging use among non-smokers may be effective at changing these beliefs. Method: In this online survey, 452 UK smokers who do not vape responded to messages about quitting smoking. We used thematic analysis to qualitatively analyse their free-text responses to the messages about vaping. Findings: There were 102 qualitative responses, from 87 participants to the e-cigarette messages and the sentiment of these was largely negative. We developed three themes which encapsulate key arguments smokers made against using e-cigarettes: 1) The science isn’t convincing, 2) Vaping is harmful and 3) Vapes aren’t helpful with quitting. Participants were worried about the lack of scientific evidence and the conflicting evidence they had received. They were concerned about the long-term risks of vaping and nicotine. Conclusions: While some of the arguments we identified are based on personal preferences, others were based on uncertain risk perceptions (e.g., the harm caused by nicotine or the long-term risks of vaping). Here we examine these risk perceptions in the context of existing theory and evidence on risk and provide recommendations for future communications to smokers who are skeptical of e-cigarettes. Together, this research builds a deeper understanding of smokers’ key anti-vaping arguments and provides a framework for developing e-cigarette messages which can address these fundamental concerns.