Transitions Between Electronic and Combustible Cigarettes: A Mixed Methods Analysis of Peer Interactions in an Online Community for Tobacco Cessation.

The growing popularity of e-cigarettes is a public health concern. There is an emerging need to understand the pathways between electronic and combustible modes due to the specialized nature of risks associated with each transition. Online social media has become the most dominant knowledge space for these evolving behaviors, and as such, can provide unique opportunities for modeling switching patterns. In this paper, we describe the utility of online peer interactions using qualitative inquiry and network visualizations using 500 messages to characterize (a) transition pathways and (b) psychosocial attributes as individuals contemplate and act on such transitions. Our results indicate that the E2A pathway is the most prevalent in e-cigarette-related transitions, where most of the individuals are in the "active e-cig use" stage. Perceived benefits and barriers are the most commonly held health beliefs, while counterconditioning and stimulus control behavior change processes are frequently manifested. Such insights can help in the design of personalized pathway-specific behavior change interventions.