A survey of 355 smokers with mental health conditions, conducted by Action on Smoking and Health (ASH) in the UK found that 28% of participants had used an e-cigarette to make a quit attempt. Use of e-cigarettes, known as vaping, is growing among people with mental illnesses. Considering the difficulties people with mental illnesses experience in quitting smoking due to their higher nicotine dependence, inadequate smoking cessation support and greater exposure to pro-smoking environments, tobacco harm reduction approaches, such as switching from cigarettes to e-cigarettes, have been proposed to reduce smoking related harm in this priority population. A review of the evidence on e-cigarettes by the Royal College of Physicians concluded that while likely to be more harmful than nicotine replacement therapy, the risks of vaping are substantially lower than smoking. E-cigarettes are battery operated devices that heat a solution of propylene glycol and/or vegetable glycerol, typically containing nicotine and flavorings to produce an aerosol which can be inhaled into the lungs. There is growing interest in e-cigarettes, also known as nicotine vaporizers, as a tobacco harm reduction approach for those who are unable to quit smoking with conventional quit smoking methods.
However, smoking cessation rates among people with mental illness remain low and only limited evidence supporting the effectiveness of traditional smoking cessation treatments such as nicotine replacement therapy, varenicline and bupropion among people with severe mental illnesses exists.
Encouraging smoking cessation is central to improving the physical health and life expectancy of people with mental illness. Higher rates of smoking combined with lower access to health care and socio-economic disadvantage contributes to the 10–15-year lower life expectancy of people with severe mental illnesses compared to the general population. Smoking prevalence among people with mental illnesses such as schizophrenia, bipolar disorder, depression and anxiety disorder, is much higher than among those without mental illness. These findings have implications for policy and practice concerning assisting smokers with mental illness to reduce their health risk through switching to e-cigarettes. Media platforms like Reddit may shape the opinions of stakeholders and generate lay expertise about contentious health topics such as e-cigarettes. People with mental illness and their carers use online discussion boards like Reddit to discuss the benefits and limitations of e-cigarettes for people with mental illness. The limitations of vaping included: Unsatisfactory substitute for cigarettes and psychiatric medicines Drug interactions Nicotine addiction Risks of e-liquid Practical difficulties and Cost. Six themes were classified as motivations to vape for people with mental illness: Self-medication Quitting smoking Freedom and control Hobby Social connectedness and Motivation from caregivers and online communities. The thematic analysis included 3263 comments from 133 discussion threads. We coded relevant posts into themes under the framework of motivations for and limitations of vaping for people with mental illness. We systematically searched the website using keywords related to e-cigarettes and mental illness. This study aims to understand the nature and significance of online lay discussions about e-cigarettes and mental illness.