Abstract
BACKGROUND: Despite legal restrictions, e-cigarette use is rapidly expanding in Chile, driven by informal sales and weak enforcement. Classified as pharmaceutical products, e-cigarettes are technically prohibited for commercial sale without health authority approval. However, widespread access and appealing product features have contributed to their social normalization (e.g., perceived as a common or an acceptable practice). This study aims to explore e-cigarette related behaviors and perceptions in the absence of clear institutional guidelines and oversight. METHODS: This qualitative study draws on 18 in-depth, semi-structured interviews conducted between May 2024 and May 2025 with adult users and adult informal sellers of e-cigarettes in the Metropolitan Region of Chile. Participants were recruited through snowball sampling. Data were transcribed, anonymized, and analyzed thematically using an inductive approach to capture participants’ motivations, perceptions of harm, and experiences navigating a largely unregulated vaping landscape. RESULTS: Three major themes emerged among adult users: (1) E-cigarettes were often introduced through peer influence and framed as a playful, socially embedded practice rather than a cessation tool; (2) Participants described high levels of normalization and visibility of e-cigarettes across public and private settings, even as they expressed ambivalence about health risks; (3) Most participants reported navigating a state of uncertainty fueled by inconsistent e-cigarette regulations, limited product labeling, and reliance on informal sources such as social media. The lack of clear legal guidance or public health communication contributed to both confusion and normalization of use in our sample. CONCLUSIONS: Participants described a legal and informational ambiguity that enables normalization and downplays perceived harms. As the first qualitative study on adult e-cigarette–related behaviors in Chile, these findings provide timely insights that may be valuable for other Latin American contexts facing similar regulatory gaps. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-025-24936-x.