First-Use of Cigarettes, E-Cigarettes, and Cannabis: Qualitative Assessment of Subjective Reactions and Social Contexts Among Emerging Adults.

Dickinson H.; Kulak J.; Kamper-DeMarco K.; Felicione N. · Journal of studies on alcohol and drugs · 2026

**Background & Methods** This qualitative study analyzed retrospective narratives from 293 undergraduate participants (mean age 21.3 years) regarding their first-use experiences with cigarettes, e-cigarettes, and cannabis. Participants completed surveys assessing emotional valence and contextual factors surrounding substance initiation, with thematic coding applied to identify patterns in motivations, settings, and social influences. **Key Findings** - Mean age of first use was 16.1 years for cigarettes, 17.0 years for e-cigarettes, and 16.7 years for cannabis, with e-cigarettes representing the most common nicotine initiation route (54%) and joints the predominant cannabis form (48.7%). - Subjective reactions differed markedly by substance: cigarette users predominantly reported negative reactions, while e-cigarette and cannabis users described heterogeneous responses including enjoyment, discomfort, or no perceptible effect. - Social and emotional contexts significantly influenced initiation experiences, with peer influence, party settings, and curiosity identified as primary motivational factors across all three substance types. **Dosage & Administration** Not reported. The study characterized routes of administration (joints for cannabis, e-cigarettes as nicotine delivery) but did not quantify specific doses or frequency at initiation. **Safety & Adverse Effects** The study did not systematically assess adverse effects. Qualitative reports indicate some users experienced discomfort with first use, but detailed characterization of specific adverse reactions was not provided beyond general valence coding (positive, negative, neutral). **Evidence Quality** This is a qualitative review with significant limitations. The sample is predominantly female (84.3%), limiting generalizability to broader adolescent and emerging adult populations. Retrospective narrative collection introduces recall bias, as participants provided accounts years after initiation. The cross-sectional design precludes causal inference regarding social contexts and substance use trajectories. While the diverse racial/ethnic composition strengthens some aspects, the urban Northeastern university setting may not represent rural or geographically diverse populations. The study's primary strength lies in characterizing subjective experiences often absent from epidemiological surveys, providing contextual insight for prevention efforts. However, the qualitative methodology and retrospective design classify this as lower-level evidence suitable for hypothesis generation rather than definitive clinical or public health conclusions.

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