Media influences on university students’ e-cigarette risk perceptions and use in Chengdu, China: A qualitative study

INTRODUCTION Media exposure may influence young adults' risk perceptions and vaping behaviors.This study explores how media exposure is associated with university students' perceptions of electronic cigarette risks and use behavior.METHODS Between January and February 2024, 20 purposively sampled full-time Chinese university students aged 18-25 years with lifetime e-cigarette use participated in semi-structured online interviews of 40-60 minutes, in Chengdu, China.Interviews continued until data saturation was reached.All interviews were conducted by one trained bilingual female researcher.Transcripts were analyzed using inductive qualitative content analysis in NVivo 14, and intercoder agreement was assessed using Cohen's kappa.The study followed Consolidated Criteria for Reporting Qualitative Research guidelines and was reported with reference to the Standards for Reporting Qualitative Research checklist.RESULTS Four main themes and twelve subthemes were identified: 1) everyday media exposure to e-cigarette-related information (information volume, source credibility, and visible representations of vaping); 2) e-cigarette-related media content (health consequences, aesthetic appeal and behavior-oriented content, and repeated exposure); 3) interpretations of official health information (risk messages, personal relevance, message frequency, and attitudes towards official information); and 4) peer-mediated information and behaviors (peer-reported health consequences of e-cigarette use and peer-shared experiences on social media).Peer narratives and algorithm-driven social media content were perceived as more influential than official messages in shaping risk perceptions and usage.CONCLUSIONS Participants perceived repeated exposure and peer-driven social media content as contributing to message fatigue, reduced risk salience, and the normalization of e-cigarette use.Official health messages were generally viewed as credible but abstract, repetitive, and less personally relevant than peer narratives.