To Vape or Not to Vape

The decision to vape turns out to be a result of careful consideration.

By Marina A. Murphy

A study has shown that a combustible cigarette smoker’s decision to switch to vaping is a deliberate one and not something that happens by chance.

Smokers of combustible cigarettes who successfully switch to vaping go through a very specific deliberation process that contrasts with the rather passive process by which smokers are thought to initiate cigarette smoking.

The authors of the study say that we could use what we learn about this decision-making process to develop communication strategies that might stimulate more smokers who would otherwise not have considered using e-cigarettes to give them a try. These communication strategies could, for example, provide would-be vapers with information on the risks of smoking and the health benefits of switching to e-cigarettes.

“There is significant evidence that e-cigarettes are one of the most effective quitting aids for smokers, yet this information is not always getting to the people who need it or indeed to the health professionals who should be advising them,” says Pooja Patwardhan, a general practitioner and the medical director of the Centre for Health Research and Education (CHRE) in the U.K. “Understanding the decision-making process used by those who have successfully made the switch to e-cigarettes would certainly go some way towards changing this,” she says.

This study is thought to be the first to examine the decision-making process of vapers. It explored if and how vapers, smokers, and nonusers differ in their knowledge and attitudes regarding e-cigarettes and whether they use what knowledge they do have to consider the pros and cons of vaping. The results were published in The International Journal of Environmental Research and Public Health.1

The researchers from the National Institute for Public Health and the Environment as well as Maastricht University, both located in the Netherlands, conducted several focus group interviews with vapers, smokers and nonusers. The results reveal differences between vapers and smokers in the knowledge they have about e-cigarettes, their attitudes toward e-cigarettes and their views on the harmfulness of continuing smoking.


In general, vapers were more knowledgeable about e-cigarettes than smokers or nonusers. Smokers and nonusers did have information about e-cigarettes, but when asked, vapers could provide far more detailed information. Vapers reported seeking out information on e-cigarettes in order to make the decision to take up vaping in the first place. Typically, they sought information on product characteristics, ingredients of e-liquids and legislation regarding e-cigarettes. When asked how informed they felt about e-cigarettes, smokers and nonusers stated that they did not search for information about e-cigarettes and that they didn’t know much about them. By contrast, vapers felt very informed.


Another important difference between vapers, smokers and nonusers is in their attitude toward e-cigarettes. Successful switchers (vapers) are generally very positively predisposed toward e-cigarettes, emphasizing positive aspects like the varieties of flavors available and the adjustability of nicotine levels. Vapers tended to be negative about smoking. By contrast, smokers tended to be negatively predisposed toward e-cigarettes, in general mentioning that vaping was “weird,” but were positive about cigarette smoking. Regardless of the negative health effects associated with smoking, smokers said that they really enjoy smoking.


Another important difference between vapers and smokers was in their perception of the health risks. Vapers perceived smoking to be harmful to health but did not perceive any health risks with vaping. Smokers’ on the other hand, while acknowledging that smoking is harmful, did not understand how smoking causes smoking-related diseases and perceived that these diseases were only something that they needed to worry about in the distant future. Nonusers perceived both smoking and vaping to be addictive behaviors, so they indulged in neither.


This study showed that vapers make a conscious decision to seek out and deliberate information with which to make the decision to vape. Smokers and nonusers, by contrast do not consciously deliberate information to make the decision not to vape.

The authors suggest that insights into the conscious decision-making process of vapers who switched from smoking combustible cigarettes could be used to stimulate smokers to consciously deliberate vaping, despite the fact that, initially at least, they might consider it to be “weird.”

“Surely one of the most important steps in stimulating a smoker to consider switching to vaping is to ensure that their health practitioners have all the information they need to help them in the first place,” says Patwardhan. “That is why we at CHRE are developing an education and outreach program designed to bring doctors in the U.K. up-to-date on the latest policy recommendations so that they can clearly communicate with smokers on the range of services and devices available to help them in their attempts to stop smoking.”

Marina A. Murphy

Marina A. Murphy

Marina A. Murphy is a scientific communications and engagement expert with more than 20 years of experience, including 10 years in the tobacco sector.

  1. 2019 Feb 20;16(4). pii: E624. doi: 10.3390/ijerph16040624. []