E-cigarette use among adults in southern Iran: a qualitative study

BACKGROUND: espite Iran's ban on e-cigarettes since 2012, their use continues among adults due to complex individual, social, and cultural factors. Qualitative evidence exploring these determinants in Iran remains limited. This study examined the motivations and experiences of adult e-cigarette users aged 19-52 years in southern Iran. METHODS: A qualitative study using thematic analysis, guided by Braun and Clarke's six-step framework, was conducted in 2024. Participants were recruited using a combination of purposive and snowball sampling techniques and Data were gathered through semi-structured interviews with 45 current (past 30 days) e-cigarette users residing in Bandar Abbas. Two researchers independently coded and analyzed the data, employing strategies to enhance trustworthiness, including investigator triangulation and member checking. RESULTS: In this study, 45 people (37 men and 8 women) with a mean age of 25.8 years and an age range of 19 to 52 years participated. Our analysis identified six key themes: (1) Sensory and experiential appeal (e.g., diverse flavors, pleasant sensations, modern design), (2) Emotional regulation and stress alleviation, (3) Social contexts and normalization (e.g., peer pressure, familial acceptance, influencer marketing), (4) Perceived practical benefits and misconceptions (e.g., perceived harm reduction, use as a smoking cessation aid), (5) The role of the tobacco industry (e.g., product design, marketing strategies, and availability), and (6) Physical and psychological dependence. In our analysis, social contexts and normalization were the most important contexts for e-cigarette use, given the target group population. CONCLUSIONS: E-cigarette use among adults aged 19-52 years in Bandar Abbas is driven by a complex interplay of sensory appeal, emotional regulation needs, social normalization, widespread safety misconceptions, and aggressive tobacco industry marketing. Despite Iran's ban, use persists and is reinforced by physical and psychological dependence, peer influence, and limited healthy recreational alternatives. Culturally tailored, multi-level interventions are urgently needed, including evidence-based public education to counter misconceptions, strict regulation of industry advertising and accessibility, and the development of alternative stress-coping resources, especially for younger users.