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Understanding Young Adult Poly-Tobacco Users’ Perceptions of “E-cigarette, or Vaping, Product Use-Associated Lung Injury” (EVALI) in California
Presented by: 
Alyssa Bercasio.jpeg
Alyssa Bercasio, MSc
Masters Student
Alyssa Bercasio, Stella Bialous, Shannon Watkins, Jeremiah Mock, Kimberly Koester, Minji Kim, Nhung Nguyen, Arit Harvanko, Hyunjin C. Kim, Sarah Rosen, and Pamela Ling

Institute for Global Health Sciences, UCSF

School of Nursing, Center for Tobacco Control Research and Education, UCSF

Department of Community and Behavioral Health, College of Public Health, University of Iowa

Center for Tobacco Control Research and Education, UCSF

Division of Prevention Science, Center for AIDS Prevention Studies, UCSF

Division of General Internal Medicine, Department of Medicine, UCSF

Department of Medicine, Center for Tobacco Control Research and Education, UCSF


E-cigarette use is on the rise in California, and with the hospitalizations and deaths caused by the outbreak of “e-cigarette, or vaping product-use associated lung injury” (EVALI), it is imperative to understand how e-cigarette consumers understand the information about EVALI in an evolving e-cigarette landscape. We performed a qualitative, thematic analysis of 25 semi-structured interviews of young adult (18 to 29 years), poly-tobacco users (defined as the regular use of cigarettes, e-cigarettes, and/or smokeless tobacco) in California conducted in the Fall of 2019. There were four emergent themes: perceived cause, perceived health impact, the intersection of youth vaping and EVALI, and the impact on e-cigarette use behaviors. Participants attributed the cause of EVALI to JUUL-use or cannabis vaping, and most participants understood the severity of EVALI’s health impact. Despite the participants’ broad understanding of the health impact, there were few participants who explicitly acknowledged EVALI as a respiratory illness, and many identified EVALI as an issue of youth vaping. With regard to the EVALI’s impact on participants’ nicotine or cannabis e-cigarette use behavior, responses ranged from decisions to quit e-cigarette use to unchanged behavior. Overall, this study captured poly-tobacco users’ responses to EVALI during a time of rapidly developing information. Participants’ understanding of the cause and health impact of EVALI was often limited and variable, but despite this, positive behavioral impacts on nicotine and cannabis e-cigarette consumption were made, indicating the need for an easily understandable EVALI and e-cigarette education to better inform consumers’ decisions for e-cigarette use.


Keywords: tobacco control; e-cigarette, or vaping, product-use associated lung injury (EVALI); poly-tobacco product use

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