Five main themes were identified that explain why e-cigarettes appear, at least anecdotally, to be efficacious in helping tobacco users quit smoking. Table 1 provides an outline of the themes identified and some examples of narratives expressed by focus group participants illustrating those themes. Additionally, focus group members discussed the perceived efficacy of e-cigarettes compared with conventional NRTs (e.g., nicotine patch, nicotine gum).

Table 1 Identified themes and examples of narratives expressed by focus group participants Full size table

Theme: bio-behavioral feedback

Participants in both focus groups felt that e-cigarette vaping mimicked smoking a real cigarette. The e-cigarette addressed participants’ oral fixation as well as the experience of inhaling, feeling the smoke hit the back of the throat (“throat hit”), and seeing the vapor cloud when exhaling. Participants emphasized the significance of the throat hit and vapor cloud, “That feeling when it comes down and hits your throat and you inhale it, that’s, like, a big deal for us all.” Additionally, the e-cigarette users followed their regular cigarette routine when vaping: “[…] When I quit cigarettes, my fixation with, you know, vaping, is very similar. So I like to vape while I’m in the car, I like to vape after I have a meal, or when I have a coffee, or when I’m drinking, and so on; so it mirrors that, almost.” Participants explained that they were able to swap e-cigarettes into their normal everyday smoking routine.

Theme: social benefits

The notion of a vaping community was continually reiterated among participants. They pointed out the significance of having the online community forums where they could ask questions and find support and encouragement from fellow users. One participant shared, “Going to the website, you start hearing people’s stories […] you research until you find something, and I kept coming back to this and really liked it. There’s a big support community ethic, which is part of it.” Another participant shared, “Having the support [from other e-cigarette users] was instrumental.” In addition to the large support network in the vaping community, enjoying the social aspect of e-cigarettes was noted. There are vaping clubs where e-cigarette users can vape together and hold discussions. As one participant mentioned, “You don’t hear about two people on the patch talking about their patches or what brand their trying or what not.” Participants enjoyed the sense of community and support from other vapers.

Theme: hobby elements

The participants repeatedly discussed vaping as a hobby. Most of them didn’t necessarily see e-cigarettes as a means to quit nicotine altogether but liked the experience in addition to mixing and matching different types of e-cigarette parts and “juice” flavors. One participant described it as a hobby: “I learned about […] the different bases and juices. There’s so much knowledge out there, and I became a nerd. And it became a hobby.” Another person shared, “I like all the flavors, I like the devices. You know, it’s my new hobby, my new collection. I don’t collect lighters now, I’m collecting juice and devices.” Participants enjoyed the autonomy of playing with the different components of e-cigarette to find their “sweet spot” or “perfect vape.”

Theme: personal identity

The majority of participants identified themselves as “vapers.” Previously they had defined themselves as “smokers,” and the e-cigarette allowed them to redefine their identity. According to one former smoker, “You know, for years, I loved being able to carry around my pack of cigarettes and my Red Sox lighter. I miss carrying my Red Sox lighter […] it becomes who you are. It becomes, you don’t do anything without a cigarette in your hand. Now, I can still do that and still get the nicotine without disgusting somebody else because I am smoking, and it does stink.” Instead of identifying as smokers and their brand of cigarettes, they now discuss and identify themselves by the type of e-cigarette they use and flavors they like.

Theme: difference between smoking cessation and nicotine cessation

As mentioned in the hobby elements theme, many of the participants did not necessarily see e-cigarettes as a means to transition to quitting nicotine altogether. Participants emphasized the difference between smoking cessation and nicotine cessation. E-cigarettes allowed them to quit smoking, but some participants did not want to quit nicotine, because they enjoy the e-cigarette experience and viewed it as going from a dangerous form of nicotine intake in cigarettes to a safer form in e-cigarettes. When asked about lowering the nicotine levels to the possibility of zero, one participant responded, “When I first started, that was the plan. But I enjoy it now. I don’t see anything wrong with it.” For those intending to eventually quit using e-cigarettes, the sense of urgency of needing to quit is not the same as with regular cigarettes. One participant shared, “My goal is to be nicotine-free at some point, but I’m not in a hurry, either.” Participants also discussed how the NRTs they were familiar with (patch, gum, etc.) were meant to be temporary and to eventually wean people off of nicotine all together, whereas reducing nicotine dependence is optional with e-cigarettes.

Perceived efficacy of e-cigarettes versus conventional nicotine replacement therapies

In the first focus group, three of six participants had tried varenicline, four of six had tried nicotine gum, and five of six had tried the nicotine patch. In the second focus group, participants expressed little confidence in the perceived efficacy of conventional NRTs, claiming that they still found themselves craving cigarettes while using these methods. They also reported undesirable side-effects and many quit attempts using NRTs that resulted in relapse to cigarette use. One participant reported that, while on the patch, “If you’re asking what do we mean when we say the patches didn’t work, at a certain point in time I was having a cigarette after; so whether it was a failure of the patch, or psychological, or with me or us, it does seem at the end of the day or end of the month you’re back on the cigarettes.” Another participant reported that the patch satiated the physiological craving for nicotine but not the psychological: “[…] The patch was able to satisfy the physical craving for me. It’s the psychological craving.”

Negative side-effects were reported during the use of NRTs. Some claimed to experience negative side-effects with the gum and the patch, with one participant suffering from hiccups during the use of the gum: “You get the hiccups. You feel your heart going like crazy.” Others reported extremely disturbing dreams while taking varenicline. One participant even claimed to smoke cigarettes while using varenicline: “I smoked through the whole thing. I was just smoking and taking varenicline.” When asked how e-cigarettes compare with traditional NRTs, one participant stated, “It’s the only thing that ever worked. I think it’s part the act. I think its part the way it’s delivered.” And another, speaking about NRTs, stated, “The delivery doesn’t work, that’s what I learned. Plain and simple.”