Why adolescents choose to stop or never start vaping: evidence from South Africa

Abstract

Introduction: E-cigarette use among adolescents is increasing rapidly, raising serious concerns about nicotine addiction, health risks, and long-term developmental impacts. However, limited research has explored adolescents’ motives for never starting or quitting vaping, specifically in the global south. Therefore, this article aims to examine adolescent high school learners’ motives for quitting or never starting vaping. Methods: This study uses qualitative data from a large cross-sectional survey conducted among 25 149 South African high school learners aged 13–19 (grades 8–12), to examine motives for quitting or never starting vaping. Among learners who quit or never started vaping, a total of 11 401 (5162 and 6239 respectively) usable open-ended responses were thematically analyzed. Results: Health and addiction concerns emerged among the most frequently mentioned motives for both never starting vaping, mentioned by 46.0% of learners who never vaped, and quitting vaping (33.5%). Lack of appeal was also commonly cited among learners who quit vaping, especially among older learners (44% of grade 12 learners). Additionally, some learners, particularly boys, referred to athletic performance and fitness as reasons for never starting (13.5%) or quitting (14.4%). Other motives, such as access and economic barriers were only cited by a small minority as reasons for vaping abstinence (2.6%) and cessation (4.7%). Differences in motives by gender and grade level were observed. Conclusions: These findings can inform the development of context-specific prevention and cessation strategies. Our findings indicate that implementing educational campaigns on the consequences of vaping and restricting access, for example, through increasing taxes on vaping products, might aid adolescent vaping prevention and cessation efforts. Implications: As adolescent e-cigarette use rises, gaps in knowledge to fuel intervention and prevention strategies remain. The prominence of health and addiction concerns highlights the importance of implementing awareness campaigns on the negative effects of vaping on health. With vaping losing appeal over time, reinforcing negative perceptions through ongoing education and health reminders might effectively support cessation efforts. Because participants did not cite economic barriers for not starting to vape, this suggests missed opportunities for economic measures such as higher taxes.