Lived experiences and cardiovascular perceptions of E-Cigarette users in Peshawar, Pakistan: A Phenomenological Exploration.

Abstract

Background: The rapid rise in electronic cigarette (e-cigarette) use in Pakistan, particularly in urban centers such as Peshawar, has generated increasing concern regarding potential cardiovascular risks. While e-cigarettes are promoted as a harm-reduction tool for smokers, their long-term cardioprotective or cardiotoxic effects remain unclear, especially within South Asian populations. Understanding how users interpret these risks is essential for guiding public health action. The aim was to explore the lived experiences, perceptions, and cardiovascular health concerns of adult e-cigarette users in Peshawar, Pakistan.

Methodology: A qualitative phenomenological design was employed. Twelve adult e-cigarette users were purposively selected and interviewed using semi-structured interviews conducted in the local language. Audio-recorded interviews were transcribed verbatim and analyzed using Braun and Clarke’s six-phase thematic analysis framework.

Results: Five key themes emerged: (1) perceived harm-reduction and control, (2) awareness and experiential physical changes, (3) ambivalence toward cardiovascular symptoms, (4) social acceptance and normalization of vaping, and (5) uncertainty and the need for credible information. Although many participants reported improved breathing or stamina, several simultaneously described symptoms such as palpitations or chest discomfort. A statistically significant association was found between cardiovascular symptoms and perceived physical improvement, indicating that users without symptoms were more likely to feel physically better.

Conclusion: Participants generally viewed vaping as a safer alternative to smoking but remained uncertain about its long-term cardiovascular effects. The coexistence of perceived benefits and emerging symptoms highlights the need for clearer clinical guidance and locally relevant health education.