Initiation, continuation of use and cessation of alternative tobacco products among young adults: A qualitative study

Milkie Vu, Betelihem Getachew, Jackelyn B. Payne, Thomas R. Kirchner, Carla J. Berg

Research output: Contribution to journalArticlepeer-review


INTRODUCTION Diverse non-cigarette alternative tobacco products are increasingly popular in the United States. This study investigates the reasons why young adults initiate and continue the use of these products, as well as potential motivations and approaches for quitting. Products assessed include cigarettes, little cigars/cigarillos (LCCs), smokeless tobacco, e-cigarettes, and hookahs. METHODS We conducted 60 telephone interviews, of 30-minute duration, with tobacco users enrolled in colleges in Georgia. Qualitative analysis was used to identify themes emerging from the data. RESULTS Reasons for initiation, continued use, and (potential) cessation showed similarities and differences across products. Most commonly cited reasons for initiation included: peer influence (all products), flavors/tastes (all products except cigarettes), and easy environmental access and/or low costs (LCCs, smokeless tobacco, and e-cigarettes). Participants discussed several influences on continued use, such as peer influence (cigarettes, LCCs, and hookahs), stress management (all products except hookahs), and use with other substances (cigarettes, LCCs, and hookahs). Primary motivations for cessation mentioned by participants were family responsibilities (cigarettes, e-cigarettes, and hookahs) and health concerns (all products except e-cigarettes). Frequently used cessation strategies included avoidance of other tobacco users (cigarettes, LCCs, and hookahs) and a reduction of nicotine intake (cigarettes and e-cigarettes). CONCLUSIONS Our findings suggest that researchers should consider the differences in reasons for use and discontinued use of tobacco products in order to develop targeted messaging strategies, particularly noting the differential impact of interpersonal influences and health concerns.

Original languageEnglish (US)
Article number8
JournalTobacco Prevention and Cessation
Issue numberFebruary
StatePublished - 2018


  • Alternative tobacco products
  • College students
  • Qualitative research
  • Tobacco use
  • Young adults

ASJC Scopus subject areas

  • Epidemiology
  • Health(social science)
  • Health Professions (miscellaneous)
  • Public Health, Environmental and Occupational Health


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