This qualitative study is an essential exploration of youth nicotine and cannabis vaping behaviors during the first year of the COVID-19 pandemic, and the extent to which these practices were modified to adapt to new contexts. Vaping remains a common mode of nicotine and cannabis use yet pandemic-related studies on polysubstance use with cannabis has been limited [13, 29]. Our research offers a nuanced perspective to the novel vaping environment for youth who vape nicotine and use cannabis. Results revealed that profound changes to daily life resulting from the pandemic shaped nicotine and cannabis vaping practices through the following: (1) pandemic-driven changes in vaping frequency and access, (2) reduced social interactions shaping product-specific use, and (3) motivations for and outcomes of concurrent use of nicotine and cannabis.
Consistent with previous studies of young adult substance use behaviors in the first year of the pandemic [10, 13, 30,31,32,33,34], our study showed that youth vaping behaviors varied during the shutdown, with some youth reporting increases in use and others reporting decreases or no significant changes. Regardless of the direction of change, youth identified the uprooting of normal social activities and relationships due to social distancing, closures of non-essential businesses and schools, and quarantining as key factors underlying their use behaviors. In contrast to a recent study linking reduced e-cigarette use to limited access to retail outlets among surveyed young adults , our findings paint a more nuanced picture of youth vaping. Indeed, interruptions to nicotine access were encountered, but youth found this to be a temporary challenge that was resolved once their usual store reopened or once they found new retail sites to purchase from, which is consistent with a prior study on vape shops . In contrast to nicotine access, participants’ access to cannabis was not as affected since the informal market, a primary source in Kentucky where laws prohibit the sale of cannabis, remained uninterrupted. In general, youth considered ease of access across substances to be roughly the same as pre-pandemic levels.
Amid assumptions that the pandemic could offer unintended benefits through restricted access and thereby, lower substance use in younger populations , our qualitative data expands the narrative on reasons for reduced ENDS use during the pandemic to consider that the lack of in-person socialization and peer interactions, coupled with perceived health risks of sharing ENDS stemming from the pandemic, also resulted in decreased use. The irregular amount of time spent away from friends, school, and social gatherings offered a chance for several participants to implement desired decreases in their nicotine use. Strikingly, the loosening of health precautions (e.g., distanced socialization) included fears that returning to their “normal” lives could prompt a resurgence of social and shared use that would undo their nicotine cessation and quit attempts.
Furthermore, health guidelines encouraging self-isolation dramatically shifted former contexts of use. As with prior studies, youth in our study frequently characterized nicotine vaping as a social activity . Since they were not hanging out with their friends during the pandemic, it was much harder for youth who lacked a personal ENDS to vape. Among them, some also stated concerns about contracting COVID-19 from others and were newly unwilling to engage in this kind of shared use, which corresponds to findings observed in another qualitative study, although its sample consisted of young adults and focused on cannabis vaping .
In contrast to nicotine, social isolation contributed to increases in vaping and smoking cannabis among participants. Intrapersonal factors were cited, such as managing fatigue and boredom, wanting to detach from their current reality, and needing to alleviate stress or anxiety, all of which overlap with the extant literature on the therapeutic appeal of cannabis [13, 37,38,39]. Spending more time at home during the early stages of the pandemic being closely associated with more cannabis use may then suggest that cannabis provides a powerful sensation of relief or enjoyment as youth attempt to make sense of the unknown and their life within the context of the pandemic. Concurrent vaping of nicotine and cannabis were similarly linked to pleasure-seeking, yet this framing of use by participants distinguishes it from cannabis-only use during this period. Elevated feelings of euphoria and escape via simultaneous use may indicate that a special yet temporary state of being provides release and relief from pandemic-related stress and anxiety.
Overall, it was evident that differences in motives and rationale for use were identified between and among nicotine and cannabis, and further research is warranted to explore sense-making unique to young populations whose vaping behaviors are strongly connected to social contexts. The complexities of risk embedded in social contexts were prominently illustrated with participants who were afraid that going back to college or seeing friends more regularly again would provoke use and negatively impact their cessation practices and goals. Attention to similar characteristics of the social environment salient to sensemaking can leverage new insights beyond the pandemic for supporting youth wishing to reduce and quit vaping.
Moreover, our work demonstrated that device type played an important role in these health-risk conscious circumstances. Possession of ENDS used for cannabis (i.e., THC) was not unusual, and the availability of cannabis was noted to be more consistent than nicotine. As mentioned, participants that had access to cannabis before the onset of the pandemic had access to cannabis during the pandemic and were, thus, able to continue vaping and smoking with relatively fewer access problems. These findings complement and build upon a qualitative study on nicotine use that reported a host of modifications (i.e., buying less flavored products) that were adopted by young adults to sustain or increase their frequency of tobacco use . Investigating personal ENDS and other modes of cannabis use may help to contextualize observed rises in cannabis-vaping among youth in the early phases of the pandemic [13, 33].
Limitations and strengths
Despite the exploratory nature of the study, the identified variations in vaping practices highlight how youth are responding in different ways to the seemingly objective presence of a pandemic. Our Kentucky-based sample is not representative of all youth who vape but may call attention to regional characteristics of a tobacco-growing state with high rates of youth vaping. Further, interviews took place in August 2020; hence, the participant experiences and themes that emerged from this study reflect the earlier stages of the COVID-19 pandemic, which are subject to change over time. Also, participants were regularly vaping two years prior to the pandemic yet their experiences and behaviors diverged during the early stages of COVID-19, indicating that, even with such likenesses, sensemaking is multifaceted. The differing narratives may, thereby, be better understood through this theoretical lens that underscores how individuals construct meaning during serious and unpredictable times . We also acknowledge that the interviews captured what participants were willing to divulge, which may be subject to bias and potentially overlook other perceptions and behaviors central to youth who vaped nicotine and/or cannabis during the first year of the pandemic. Finally, youth in our sample tended to use the term “smoke” to refer to vaping and smoking cannabis. Steps were taken to minimize such ambiguities by repeatedly asking youth follow-up questions that specified both the substance of interest and the mode of delivery. Still, the interchangeable use of “vape” and “smoke” to refer to vaping cannabis were not always confirmed. In these few instances, we reference cannabis use generally.