"In My Social Circle, We Don't Discuss Health risks": A Qualitative Study of the Role of Uncertainty in Adolescent...

Nicotine vaping products (NVPs) remain prevalent among Australian adolescents and young adults (AYAs), despite increasing evidence of associated health risks and evolving regulatory restrictions. While some youth acknowledge potential harms, many continue vaping, raising questions about the role of uncertainty tolerance in sustaining use. This study aimed to examine how AYAs perceive vaping-related health risks, experience uncertainty, and tolerate known and perceived harms.

Seven online semi-structured focus groups were conducted with 27 AYAs aged 16-26 in South Australia. Participants included people who vaped, who smoked tobacco, those who did both, and those who neither vaped nor smoked. Discussions examined perceptions of vaping-related health risks, exposure to public health messaging, and tolerance of uncertainty and views on health risks. Transcript data were analyzed using descriptive content analysis.

Participants rarely considered health risks unless prompted and described vaping as normalized and socially embedded, with high product accessibility a concern. Participants discounted prevention messaging, citing low personal relevance and limited credibility. Many framed health harms as distant or hypothetical, enabling continued use. Uncertainty about long-term consequences was not only tolerated but often used to justify risk-taking.

Australian AYAs navigate vaping by rationalizing and deferring engagement with risk. Uncertainty tolerance played a role in continued vaping, particularly in the absence of visible harms. Prevention strategies should address this tolerance directly and leverage social and peer-based messaging to counteract normalization. Findings highlighted the need for tailored messaging interventions designed to disrupt vaping risk minimization.