Health Implications on the Rise of the E-Cigarette Subculture in the Asian American Population: A Qualitative Study

Background and Purpose: The use of Electronic Nicotine Delivery Systems (ENDS) such as e-cigarettes, vape pens, and e-hookahs has gained traction within the past couple of years in the US since its introduction to the US market in 2007 (Regan, Promoff, Dube, & Arrazola, 2011). The CDC reported an increase of ENDS use among US youth from 4.5% in 2013 to 13.4% in 2014 with the highest use among Caucasians (15%) and Latinos (15%) (Arrazola, et al., 2015). However, little is known of ENDS use among Asian Americans. A study in 2014 found that among high school youth in Hawaii, e-cigarette trial and daily use were higher than conventional cigarette trial (9% vs 6% for 1-2 times use; 2% vs. <1% daily use) with the highest use among Filipinos (23%) and Native Hawaiians (22%) (Wills, Knight, Williams, Pagano, & Sargent, 2014).

The purpose of this paper is to understand the health motivations, decisions, and behaviors why Asian Americans initiate and retain ENDS use.

Methods: Twelve semi-structured interviews were conducted. Respondents were recruited using social media and snowball sampling. Inclusion criteria includes: 18 years old and above, identifies as Asian American, California resident, and a current ENDS user. Eight of the participants identified as male while four identified as female. The age of the participants ranged from 19 to 34 years old. Asian American ethnicities represented in the sample are: Chinese, Filipino, Thai, Vietnamese, & Mixed Race. Interviews were audio-recorded, transcribed, and analyzed using Grounded Theory.

Findings: The average ENDS use of participants is 2.5 years. The average amount of nicotine in their ENDS device is 10.3 (mg). 50% of the respondents identified as dual users where they still smoke conventional cigarettes and/or marijuana along with their ENDS use but much less than when they were not ENDS users. The other 50% did not identify as dual users. Some of the primary themes that were prominent from the respondents is peer influence. Many of the participants shared that they were influenced by their peers to become e-cigarette or vape users. Respondents also reported perceived health benefits since switching to ENDS use. Participants shared that they were no longer out of breath or winded compared to when they were regular conventional cigarette smokers. Familiarity to flavors is also another aspect that entice Asian American ENDS users to maintain their ENDS use because of the growing 7,000 and more flavors that they could choose from to smoke in their device (Vagadori, 2015). Many of these flavors are flavors that are prominent in Asian and Asian American cuisine and palette found in Asian candies, boba/bubble tea shops, etc.

Conclusions and Implications: Asian American youth and young adults are a vulnerable population to the ENDS industry because of their familiarity to ENDS flavors and the social influence of ENDS use. Through this understanding, social workers and health educators can better create interventions and campaigns in addressing ENDS use in the Asian American population.

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