2. Materials and Methods
2.1. Recruitment and Screening
3.1. Theme 1: Facilitating Beliefs
3.1.1. Subtheme 1.1: Understanding the Relative Safety Compared to Tobacco Smoking
“I just feel that because there’s, obviously there’s nicotine but because there’s not all the other harmful chemicals in it, I feel it’s a lot better for yourself and the baby than smoking, so I guess nothing is better, but it’s better than still craving the cigarettes and wanting it, like, smoking them than it is to have something that’s got a lot less bad stuff in it.”Exclusive user (ID, 2)
3.1.2. Subtheme 1.2: Economic Sense
“You can get sort of like a cheaper device that’s sort of like 20, 30 quid. But when you think about that, if you think about the cost of a packet of cigarettes and how long you’re going to be using it for, the cost of the vape and the juice and coils and everything, the cost compared to smoking is minimal.”Exclusive user (ID, 7)
“Perhaps look for your cheaper supermarket versions of the pens and not go for—if you—there’s, like, stores and stuff in, like, our shopping centre and you’re looking on about, sort of, £30 to £40 for very similar, but because it’s sort of the—whatever company they’re from, because it’s their brand and then you’re paying sort of about £6 for the liquids as well. And I think, you know, it is pretty much the same but because you’ve got someone there demonstrating it for you and it’s their brand, they charge you a lot more.”Exclusive user (ID, 2)
“But it is cheaper than cigarettes and it’s obviously investing for your health long term isn’t it?”Exclusive user (ID, 13)
3.1.3. Subtheme 1.3: Pregnancy as a Motivator
“And I think if you’re strong enough to follow through and pursue with it and set your mind to it and think ‘hang on this is a healthier option for me and my baby’, then you can actually conquer the cravings.”Exclusive user (ID, 15)
“I just knew that I had to, I just knew that…and I knew that even when I wasn’t pregnant, when I’ve got a young baby, smoking around them isn’t the right thing to do and even though, you know, vaping around them isn’t the best thing to do either, at least they’re not breathing in the chemicals, you know, they’re not passive smoking”Dual user (ID, 6)
3.2. Theme 2: Gaining Confidence as a Vaper
3.2.1. Subtheme 2.1: Experimentation
“To be honest my husband, if anything goes wrong with it [e-cigarette) he tends to fiddle with it and fix it any way, he’s pretty good. He uses his far more than I use mine. So yeah, he knows what he’s doing with it, I just hand it over.”Exclusive vaper (ID, 13)
“It’s a completely experience to smoking, you do sort of have to learn how to use them I think because it’s not the same as smoking.”Dual user (ID, 6)
“It has changed over time but to begin with I’d use it a lot, so I’d sit at home and I’d be like using it constantly, but I sort of don’t use it as much anymore.”Exclusive User (ID, 11)
3.2.2. Subtheme 2.2: Seeking or Experiencing Social Support
“Everyone was really supportive. They said it was great that I was managing to quit because quite a lot of my family use e-cigarettes so they’ve had experience with it.”Exclusive user (ID, 7)
“I was quite worried about using one but then also I felt it was better than cigarettes and my midwife actually praised me for it because she said you know, all my readings come up as the carbon monoxide and everything was all zeros, so she said to me ‘obviously that shows that it’s better to use one of them than it is to smoke cigarettes.”Exclusive user (ID, 2)
3.2.3. Subtheme 2.3: Actively Seeking Confirmation about E-cigarette Safety
“If it’s a choice between cigarettes and a vape, I’d take a vape every day of the week, it’s got to be better compared to what’s in a cigarette and there’s not a massive amount of research done on vaping so far. I mean I know a doctor, not in a university and he makes it when I said to him ‘what do you think about this?’ he said ‘I’d rather you do that any day of the week than stick a cigarette in your mouth’ and this was before I was pregnant he was like ‘that’s got to be 10 times better.”Exclusive user (ID, 12)
3.2.4. Subtheme 2.4: Employing Strategies to Deal with Social Stigma
“I’ve stayed away from vaping in front of the like complete strangers and then when people did say ‘oh well, this is bad for you, is it not bad for the baby?’ I would explain to them ‘well actually no, I’ve spoken to the midwife, this is 10 times better.”Exclusive user (ID, 12)
“I will sometimes sneak off……depending on where I am, if I can sort of sneak off or have some in the car before or whatever, then I will. But yeah no, it is difficult if I’m going to be out especially, because my parents don’t know so if I’m out with my parents all day then that’s particularly difficult, so I might just leave [child’s name] with them and just say ‘oh, I’m just going to go and have a look over here.”Exclusive user (ID, 13)
3.3. Themes within the Theoretical Domain Framework (TDF)
Conflicts of Interest
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|Theme and Subtheme||Number of Participants Contributing to Theme. Total n = 15|
|Understanding the relative safety of vaping compared with tobacco smoking||11/15|
|Believing vaping made economic sense||12/15|
|Pregnancy as a motivator||7/15|
|Gaining confidence as a vaper|
|Seeking or experiencing social support||13/15|
|Actively seeking confirmation about e-cigarette safety||12/15|
|Employing strategies to address social stigma||11/15|
|Theme||Theoretical Domain Framework (TDF)||Recommendations for Interventions|
|Understanding the relative safety compared to tobacco smoking||Beliefs about consequences: believing that vaping was safer than smoking minimised women’s concerns about the harmfulness of vaping. Increased determination and confidence to vape.||Women require information about the safety and costs (economic and health) of vaping in comparison to smoking. Intervention delivery could include leaflets, websites, text messaging support and HP discussions.|
|Economic sense||Environmental context and resources: women need to be able to afford the upfront costs associated with vaping; remembering they will be better off financially in the long run was important.|
Beliefs about consequences: immeasurable gains as vaping is beneficial for health and wellbeing in the long term.
|Actively seeking confirmation about the safety of e-cigarettes.||Knowledge: the process of seeking and accumulating knowledge was important for women to validate their reasons for vaping.|
Social influences: HPs’ endorsement of the safety of vaping in comparison to smoking was important for continued use.
|Employing strategies to deal with social stigma||Social influences: women felt social pressure not to vape during pregnancy.|
Knowledge: being able to defend their decision to vape was empowering.
Behavioural regulation: to fit in with social norms, women often hid their vaping or took actions to only vape in situations they felt comfortable with.
|Women require support to develop self-confidence/belief in their decision to vape as method to help them stop smoking. Interventions could include HP encouragement and showing the benefits of stopping smoking such as regular carbon monoxide readings.|
|Pregnancy as a motivator||Beliefs about capabilities: determination and self-belief that they have the ability to change their smoking behaviour was crucial.|
Beliefs about consequences: women felt guilty about smoking; they worried about the effects on their baby and this was a motivator to vape rather than smoke.
|Experimentation||Skills: through practice women acquired the skills to vape. This required time and persistence.|
Environmental context and resources: access to vape shops was a source of advice.
Social influences: family and friends who were vapers were able to assist with choosing, experimenting and maintaining e-cigarettes.
|Women need to develop practical skills to successfully vape. Intervention delivery could include peer support and HPs disseminating practical advice.|
|Seeking or experiencing social support||Social influences: supportive friends, family and HPs increased motivation. Peer support from other vapers was regarded highly.||Women who cannot quit via other methods require support to vape in order to quit smoking. Interventions could involve peer support groups and involving family members in discussions with HPs about vaping. |
Support is also required for vapers who have stopped smoking but also want to stop vaping too.
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