Beliefs About e-Cigarette Regulation Among a Cohort of Long-Term Adult Users: A Thematic Analysis

The United States Food and Drug Administration (FDA) is a regulatory authority with the ability to regulate tobacco products, including electronic cigarettes (e-cigarettes). Few studies have investigated the beliefs and attitudes about e-cigarette regulation, from the perspective of long-term users of e-cigarettes. The purpose of the current study was to understand the beliefs about e-cigarette regulation among former and current users of e-cigarettes using a qualitative approach.

We conducted a cross-sectional survey among a cohort of former and current users of e-cigarettes in 2022 which contained open-ended questions about perceptions of e-cigarette regulation. Participants were asked about their e-cigarette use, whether the FDA should regulate e-cigarettes (yes/no), and responded to an open-ended question about their opinions of FDA regulation/non-regulation of e-cigarettes. Means and frequencies were used to describe the sample, and all open-ended responses were imported into MAXQDA software. Open-ended responses were analyzed using thematic analysis.

Participants (n=172) were 93.0% White, 66.3% male, and 73.3% were people who currently use e-cigarettes. More than half (51.7%) of participants reported they do not believe the FDA should regulate e-cigarettes, while 48.3% of participants reported they believe that the FDA should regulate e-cigarettes. Opponents of e-cigarette regulation felt it would lead to over-regulation and politicization. On the other hand, those with supportive views felt that FDA regulation would ensure the safety of e-cigarette products.

Our findings suggest that this cohort of long -term users of e-cigarettes believe FDA regulation will affect the availability of e-cigarette products, making it harder to quit smoking or to avoid relapsing to traditional cigarettes. User perceptions highlighted that the FDA should assess the health impact of e-cigarette products and their influence on smoking cessation efforts among smokers who had otherwise been unable to quit.