Knowledge, perceptions, and experiences of e-cigarettes among young adults in Cape Town, South Africa: Insights from focus groups to inform regulations and prevention strategies.

Introduction: E-cigarettes have rapidly gained a market share in South Africa and globally. Concerns have been raised over the growing popularity of e-cigarettes among young people, who are frequently drawn to these novel products and are especially targeted by marketers. Using a qualitative method, this study aimed to gain insight into young adults' knowledge, experiences, and perceptions of e-cigarette use in Cape Town, South Africa.

Methods: We conducted five focus groups (FGs) among students of the University of Cape Town (n=48; 46% females; 54% males; aged 18-25 years). These FGs, which included both e-cigarette users and non-users, were audio-taped, transcribed verbatim, and analyzed thematically using Nvivo 12 software.

Results: Despite their lack of information about the chemical constituents of e-cigarettes and their harm, participants perceived them as healthier than combustible cigarettes. Participants equated the pleasant smell and environmental friendliness of e-cigarettes with safety. The absence of e-cigarette regulation was interpreted as evidence of their safety. Participants indicated that the lack of anti-e-cigarette indoor policies, the deceptive marketing regarding their safety, and their low price compared to combustible cigarettes, had key roles in increasing young people's use of e-cigarettes.

Conclusions: Findings highlight factors at multiple levels contributing to e-cigarette use among young people in South Africa. Comprehensive strategies for e-cigarette regulation and prevention are needed. Potential strategies include increasing knowledge of e-cigarette harms through evidence-based communication campaigns and strengthening e-cigarette regulations by limiting e-cigarette advertisements, banning vaping in public places, and reducing the flavors used in e-cigarettes.