BACKGROUND: The increasing prevalence of e-cigarette use among adolescents poses a significant public health challenge, despite the 2019 national ban under the Prohibition of Electronic Cigarettes Act (PECA) in India. E-cigarettes, often marketed as a safer alternative to traditional smoking, are gaining traction among schoolchildren, facilitated by covert networks and peer influences. This study aims to explore the prevalence, motivations, and patterns of e-cigarette use among school-going children in Mumbai, examining the social, economic, and psychological dynamics that sustain this hidden epidemic.
METHODS: Using a qualitative lens, focus group discussions (FGDs) were conducted with 72 students from diverse localities in Mumbai. Participants were selected to ensure representation across socioeconomic backgrounds. Discussions delved into awareness, access, usage patterns, peer influences, and perceptions of health risks associated with e-cigarette use. Data were analyzed thematically to uncover nuanced insights into the drivers of e-cigarette adoption and the mechanisms that enable its continued availability despite regulatory efforts.
RESULTS: The study unveiled a sophisticated network of access and affordability, with crowdfunding models and peer-driven ownership systems circumventing financial barriers. Despite a general awareness of e-cigarettes—commonly referred to as "pen hookah" or "vape"—knowledge of the health risks and legal implications remained fragmented and inconsistent. Availability persisted through shadow markets and discreet sales near schools. Peer influence and social validation emerged as dominant motivators for use. Misconceptions, such as e-cigarettes being harmless or safer, further fuelled adoption.
CONCLUSIONS: The findings highlight the need for multi-pronged interventions, including stricter enforcement of PECA, public awareness campaigns, and community engagement. Educating adolescents and families on the health risks and legal consequences, alongside dismantling shadow networks, is crucial. The study underscores the importance of proactive measures to curb the growing e-cigarette epidemic among youth and inform future policy and prevention programs.