First-Use of Cigarettes, E-Cigarettes, and Cannabis: Qualitative Assessment of Subjective Reactions and Social Contexts Among Emerging Adults.

Abstract

Objective: Increases in nicotine/tobacco and cannabis use among adolescents and emerging adults highlight the importance of understanding the circumstances surrounding substance initiation. While prior research has focused on prevalence and risk factors, fewer studies have explored subjective accounts of first use. This study used qualitative analyses of retrospective narratives to characterize emotional and contextual factors of adolescents' and emerging adults' first-use experiences.

Method: Participants included 293 undergraduates (M_age = 21.3 years, SD = 2.9) from a midsized, urban Northeastern university. The sample was predominantly female (84.3%) and racially/ethnically diverse (43.9% White, 42.4% Black, 16% Latinx). Participants completed a retrospective survey assessing first use of cigarettes, e-cigarettes, and cannabis. Qualitative narratives were thematically coded for valence (positive, negative, neutral), and contextual factors (setting, social, influences, and motives).

Results: Mean age of first use was 16.1 years (SD = 3.4) for cigarettes, 17.0 (SD = 2.6) for e-cigarettes, and 16.7 (SD = 2.2) for cannabis. E-cigarettes were the most common nicotine initiation method (54%), while joints (48.7%) were most common for cannabis. Valences of first use were mixed: most cigarette users reported negative reactions, while e-cigarettes and cannabis users reported a wider range of responses, including enjoyment, discomfort, or no effect. Social and emotional contexts, such as peer influence, parties, and curiosity were common motives.

Conclusions: Qualitative accounts of first-use experiences provide insight into how adolescents and emerging adults interpret substance initiation. These findings emphasize the importance of social and emotional contexts surrounding substance initiation which may inform prevention efforts.