Adolescent's perspective on the initiation of electronic cigarette use: a qualitative study

The initiation of electronic cigarette use is increasingly occurring at younger ages, raising concerns about its long-term health impacts on adolescents. Therefore, prevention and reduction efforts must be strategically designed by incorporating adolescents' perspectives on this behavior. This study aims to explore adolescents' perspectives on the initiation of electronic cigarette use in Yogyakarta, Indonesia.

This study employed a qualitative descriptive approach using focus group discussions (FGDs) involving eight adolescent electronic cigarette users from two public and private schools in Yogyakarta. Participants were purposively selected to explore their experiences and perceptions related to electronic cigarette initiation. Data were analyzed using Braun and Clarke's six-phase thematic analysis approach.

Thematic analysis revealed five themes: (1) first encounters occurred predominantly through peer exposure in social settings; (2) curiosity, flavor variety, and perceived reduced harm motivated use; (3) peers facilitated initial access through sharing devices; (4) unsupervised social gatherings provided opportunities for experimentation; and (5) initial experiences ranged from pleasurable to aversive, with positive experiences promoting continued use.

Electronic cigarette initiation results from the interaction between internal factors and environmental influences. These perspectives mutually reinforce one another, shaping experiences that contribute to adolescents'continued electronic cigarette use. Consequently, prevention efforts should incorporate adolescents' viewpoints to identify root causes of initiation and design more effective strategies to prevent adolescent engagement in electronic cigarette use in the future.