Vaping Cessation During Pregnancy Among Smoke-Free HOPE Participants: A Qualitative Thematic Analysis

Pregnancy is a time when the body and mind undergo profound changes, often prompting a re-evaluation of daily habits. For many, this period brings a heightened awareness of how personal choices affect a developing life. Among the substances that can complicate this journey are electronic nicotine delivery systems, commonly known as e-cigarettes or vapes. Unlike traditional tobacco, these devices heat a liquid to create an aerosol that is inhaled, often containing nicotine, which is highly addictive and can interfere with fetal development. While public health guidelines have long focused on helping pregnant people quit smoking combustible cigarettes, the rapid rise of vaping has created a new challenge. The devices are often perceived as safer alternatives, yet they deliver nicotine and other chemicals that pose risks. Understanding how pregnant individuals navigate quitting these products is crucial, not just for their own health, but for the well-being of their children, as the decision to stop is rarely a simple switch but a complex struggle woven into daily life, emotions, and social relationships.

A team of researchers set out to understand this struggle by listening directly to the women living through it. They conducted a qualitative study, a type of research that focuses on gathering detailed stories and personal experiences rather than counting numbers or running statistical tests. The team worked with participants in a program called Smoke-Free HOPE, a support initiative in California led by community health workers. These workers, who are trained to provide guidance and connect people with resources, helped pregnant women who were using tobacco or nicotine products, including vapes, to try to quit. The researchers interviewed nine women who had completed the program and held two online group discussions with six of them. Instead of asking simple yes-or-no questions, the researchers invited the women to share their full stories: how they felt about vaping, what made it hard to stop, what helped them, and what it was like to try to quit while carrying a child.

The women who shared their stories revealed that quitting vaping during pregnancy is not just about breaking a nicotine habit; it is about rebuilding a sense of self. For many, pregnancy acted as a turning point that forced them to see their vaping not as a private choice, but as an action with direct consequences for their baby. One woman described the moment she realized she could not bring the device to her lips because she knew the vapor would go straight to her child. This shift in perspective turned the act of quitting into a moral duty tied to being a "good mother." However, this motivation was not always enough to sustain the change. Some women felt they were quitting only for the baby, not for themselves, and this external pressure sometimes made the process feel like a burden rather than a personal transformation. The desire to protect the child was a powerful force, but it did not always replace the deep-seated need to use vaping as a coping mechanism.

That need was often rooted in the way vaping helped women manage their emotions and daily routines. The researchers found that for these participants, vaping was a tool for emotional regulation, a way to calm anxiety, relieve stress, or simply feel a sense of control during a time of physical and emotional upheaval. One participant described it as the only way she could cope with overwhelming feelings, while another noted that it took away her pain during periods of depression. Beyond the emotional relief, vaping was deeply embedded in the rhythm of their day. It was a habit tied to waking up, going to sleep, or taking a break, often accompanied by the sensory pleasure of a sweet flavor or the visual mesmerizing effect of the vapor. For some, the device had even become a substitute for human connection, acting as a "friend" in moments of isolation. When a woman tried to quit, she was not just stopping a habit; she was trying to find a new way to handle stress and fill a void that the vape had previously occupied.

The social world in which these women lived also played a massive role in their ability to quit. Vaping was often normalized within their families and friend groups, making it difficult to resist. In some homes, everyone was vaping, and devices were easily accessible, with relatives offering them freely. This constant exposure created an environment where quitting felt like swimming against a current. Some women found that their social circles actively undermined their efforts, with friends or partners encouraging them to take another hit or try a new flavor. To succeed, many had to make difficult changes to their social lives. They set boundaries, asked people not to vape around them, or in some cases, distanced themselves from friends who continued to use. This restructuring of their social world was often painful, involving a sense of loss, but it was necessary to create a space where quitting could happen.

The support they received from institutions, such as healthcare providers and the program staff, was a double-edged sword. The community health workers who led the program were often seen as trusted allies. The women described feeling safe talking to them, noting that these workers listened without judgment and acted more like family than just service providers. This trust was essential for opening up about struggles and fears. In contrast, interactions with other parts of the medical system sometimes generated fear and hesitation. Some women worried that admitting to vaping would lead to them being labeled as bad mothers or reported to child protective services. This fear of surveillance made them hesitant to be honest with doctors or to seek help. When advice to quit was given without practical support or clear guidance, it left women feeling confused and unsupported. The difference between a supportive, nonjudgmental relationship and a fearful, bureaucratic one often determined whether a woman felt she could continue her journey toward quitting.

Throughout their stories, a pattern of uncertainty and non-linear progress emerged. The women did not describe quitting as a straight line from using to not using. Instead, they spoke of a cycle of trying, failing, and trying again. They often felt torn, knowing that vaping was harmful but also feeling that it was the only thing that could help them in a moment of stress. This internal conflict, or ambivalence, was a constant companion. They would quit for a few days, only to relapse when a difficult situation arose, then try again. The process was fragile, and the women were often unsure if their cravings were due to nicotine withdrawal or the normal discomforts of pregnancy. This ambiguity made it hard to know how to manage their symptoms. Furthermore, for some, quitting vaping led to a shift in what they used instead. They might stop vaping but start smoking cigarettes or using marijuana to manage nausea or stress, showing that the urge to use a substance often remained, even if the specific product changed.

The study suggests that helping pregnant women quit vaping requires more than just telling them it is dangerous. It requires understanding that vaping is often a way they manage stress, fill a routine, or cope with isolation. The research indicates that successful support must address these emotional and social needs, not just the nicotine addiction. It highlights the importance of building trust and creating a safe, nonjudgmental space where women can be honest about their struggles without fear of punishment. The findings also point to the need for support that helps women navigate their social environments, perhaps by teaching them how to set boundaries with friends and family. Ultimately, the journey to quit is a complex, ongoing process of identity change, where a woman learns to see herself not just as a user of a product, but as a mother protecting her child and a person finding new ways to care for herself. The path is rarely smooth, and the support needed must be as flexible and human as the women themselves.