E-Vaping Patterns of Use, Information Needs and Risk Perception in the Post Pandemic Era: An International Survey and Social Media Listening Study

Introduction: The rapid proliferation of Novel Psychoactive Substances
(NPSs) in e-cigarette products presents an urgent public health concern.
These include herbal compounds, synthetic cannabinoids, cathinones,
and other potent analogues, often used by young adults. Their unregulated
presence in vape liquids raises significant addiction and intoxication
risks. This study aimed to elucidate current trends in NPS vaping
and user perceptions to inform clinical and regulatory interventions.
Methods: This study employed a mixed-methods design that combined
an international survey with social media listening. The survey was
in English and Greek, distributed between April and December 2024
via online forums (e.g., Bluelight), social media, and university mailing
lists. Quantitative data were analysed using SPSS. Simultaneously,
a netnographic study analyzed 11,721 social media comments (Reddit,
YouTube) to extract motivations and perceptions. Data scraping tools
Apify and ExportComments were employed, followed by thematic categorization
and sentiment analysis.
Results: The survey received 1,045 responses where 210 respondents
(20%) were vapers {49% males; 40% aged 25–39; (66% heterosexuals,
21% bisexuals); (47% from Greece, 22% from the UK, 18% from the
US and Canada)}. The majority 52% were either high school or college
leavers. 86% trusted online resources for information regarding vaping
and only 32% referred to healthcare professionals. 81% stated that
reliable online resources would work best as the main source of information.
62% of participants were tobacco smokers, and only 21% were
ex-smokers. A total of 46% started e-vaping at 25 years or above; 60%
used vapes daily. 72% had frequent or occasional cravings to vape; 37%
tried to stop unsuccessfully. Meanwhile 31% complained about adverse
events after vaping such as coughing, weakness, dizziness, sore throat,
chest pain, palpitations, anxiety, COPD. Natural novel psychoactive substances,
synthetic cannabinoids and flavorings as well as nicotine were
mainly referred to as preferred in vaping liquids. 55% of participants
stated that vaping poses medium risk. 32% of the vapers were also users
of prescribed medications such as codeine, oxycodone, and 40% also
users of NPSs (mainly herbals and benzodiazepines) combined with vaping.
Netnographic findings revealed that the primary motivations for
vaping were smoking cessation (63%), perception that vaping was less
harmful (15%), and sensory appeal (8%). Youth often cited stress relief,
peer influence and social identity as vaping drivers. Posts also highlighted
widespread unawareness about NPS presence in vape products,
reflecting a dangerous information gap.
Conclusions: Vapes are increasingly exploited as vehicles for a range
of illicit drugs and NPSs, particularly among youth, with high addiction
and toxicity risks. Real-time monitoring, better education strategies, and
targeted policies are urgently needed. Understanding psychological motivators,
such as stress coping or social appeal, is crucial to inform prevention
strategies and regulatory responses.