Reasons for electronic cigarette initiation and perceived risks in Golestan Province, Iran: a qualitative study

The use of Electronic Nicotine Delivery Systems, including e-cigarettes, has become an important public health concern in Iran. Understanding the reasons for initiation and perceived risks is essential to inform effective interventions. This qualitative study aimed to explore the motivations for e-cigarette initiation and users’ perceived risks in Iran. Twenty-two e-cigarette users aged 15–42 years from Gorgan and Aqqala were recruited through purposive and snowball sampling. In-depth semi-structured interviews were conducted and analyzed using qualitative content analysis. Guba and Lincoln’s criteria were applied to ensure credibility, and investigator triangulation was used during data collection and analysis. Content analysis generated two main themes comprising seven main categories and 11 subcategories. The first theme concerned reasons for e-cigarette initiation, including accessibility and ease of use, aesthetic appeal and trendiness, substitution for cigarettes, and curiosity and peer pressure. The second theme concerned perceived risks of e-cigarette use, including perceptions of lower harm than traditional cigarettes, acknowledgment of health risks, and perceived addictiveness. Although most participants perceived e-cigarettes as less harmful than conventional cigarettes, all participants acknowledged potential health risks, while perceived addictiveness was reported by three participants. Among the e-cigarette users included in this study, e-cigarette use was influenced by convenience, social appeal, curiosity, and perceptions of reduced harm. Educational interventions and stronger regulation of social media marketing are needed to prevent uptake and address misconceptions about e-cigarette safety and addictiveness.