The relationship between sports performance, physical activity and e-cigarette use among Australian adolescents: A qualitative study

INTRODUCTION In 2022–2023, 30% of Australian adolescents aged 12–17 years had used electronic cigarettes (e-cigarettes). Adolescents are particularly vulnerable to the negative health impacts of e-cigarettes. Although sport and physical activity participation have been postulated as potential protective factors against e-cigarette use, evidence on their relationship is limited and no qualitative data are available. This study aims to qualitatively explore the relationship of e-cigarette use, sport participation and physical activity, among Australian adolescents aged 14–17 years. METHODS A total of 96 participants aged 14–17 years completed 78 online single or paired semi-structured qualitative interviews, as part of the Generation Vape project, during February–May 2023. All discussion was unprompted. Reflexive thematic analysis was applied and inductive coding undertaken. RESULTS Of the 96 participants, 52 (54%) volunteered data relating to this topic. Sport participation and athletic performance were perceived as key drivers of protective adolescent e-cigarette use behaviors including abstinence, cessation and ‘responsible use’. Most current and former users reported experiencing health harms attributed to e-cigarettes – predominantly shortness of breath – during day-to-day physical activity such as walking or climbing the stairs and during sporting activities. Some users reported no difference in fitness attributable to e-cigarette use and former users reported improvements after quitting. CONCLUSIONS Sport participation was considered important by adolescents and related it to e-cigarette patterns of use; and e-cigarette users described experiencing negative health effects in sport and fitness settings. E-cigarette use in adolescents may jeopardize the physical, mental and social benefits of engaging in sport and recreational physical activity. There is a need for greater regulation of e-cigarette industry sponsorship of sport to reduce adolescent exposure to e-cigarette marketing and promotion. E-cigarette prevention campaigns that highlight impacts on sport maybe an effective intervention to support overall adolescent wellbeing.