Young adults’ perceptions of e-cigarettes: a qualitative study

1. Young adults’ perceptions of e-cigarettes: a qualitative study Mark Lucherini (m.lucherini@ed.ac.uk) Amanda Amos Catriona Rooke

2. Outline • Background and aims • Participant characteristics • Findings • Possible implications

3. Study aims • To explore young adults' (16-24 year olds) understandings of and engagement with e-cigarettes, and whether and in what ways this may be influencing social norms around smoking tobacco.

4. Study background • Smoking prevalence increases among 16-24 year olds • Transition period where some move from being ‘social’ to ‘proper’ smokers • Young adults from more deprived areas most likely to be smokers and least likely to quit • Cigarettes and smoking are often ‘taken-for-granted’ normalities and fulfil important social and cultural roles • How are e-cigarettes understood in this context?

5. Participant characteristics • Methods – friendship groups and individual interviews • 72 participants • 33 interviews with 1 to 4 participants • Age range 16-25 (mean age 19.6) • 39 female and 33 male

6. Smoking status

7. Vaping status

8. Participants’smoking and vaping • Participants and smoking • Many smokers wished to quit. The most common reasons were to improve health, save money and for the benefit of their children. • Reasons for trying e-cigarettes (n=60) • To stop smoking, for the taste/flavour and to save money. • Reasons for not continuing with e-cigarettes (n= 46) • Not satisfying their ‘cravings’, not helping with stress, not used when drinking (instead tobacco was used), and, more generally, not helping with cessation attempts. • Reasons for continuing to vape (n=14) • Satisfying the ‘craving’, cutting down on combustible tobacco, helping them to quit smoking, saving money

9. Findings • Three main themes: • Smoking and vaping identity • The value of cigarettes • ‘A thing on their own’

10. Finding 1 – Smoking and vaping identity • Controllable smoking identity • E-cigarettes a threat to control • E-cigarettes offer no change to ‘smoking’ identity Addiction

11. Controllable smoking identity • Participants often felt their smoking is controllable and not an addiction • “I'm not addicted to cigarettes. Like, I can smoke for, say, like a year, like consistently, every day, have a fag, stuff like that … I don't get addicted” (Alice, 17, current smoker, ever vaped) • For some controllable smoking meant that their addiction was not that bad • “It's just in the morning [when I need a cigarette] … afternoon and then that's me to night, so I'm not that bad, I don't think I'm that bad anyway” (Jennifer, 23, current smoker, ever vaped) • Planning to quit when older • “So yeah, I'll worry when I'm 30! I suppose it's not kicked in the kinda health thing” (Ellen, 22, current smoker, ever vaped).

12. E-cigarettes a threat to control • Many participants noted seeing others using e-cigarettes more often than they would use cigarettes. • There was a wariness that this could lead to an ‘addiction’ to e-cigarettes. • “There's somebody up the stairs [at her work] and he's been off fags for coming up to two years now and he's been on that [e-cigarette] day in/day out … just can't get off them, so it's just replacing nicotine … and then you've got this addiction to that”. (Jane, 19, current smoker, ever vaped) • No end point to the practice of vaping • “If you go for a walk or you go to work or whatever you tend to have like a smoke on the way there. With the vapour you could just non-stop go for it on the way there and it just doesn’t help” (Gregory, 21, current smoker, ex vaper) • But still potential for e-cigarettes to enable more control

13. E-cigarettes offering no change to ‘smoking’ identity • Smoking identity based on nicotine dependency • Still looks like smoking • “It’s the same thing. It’s still smoke. It stinks”. (Malcolm, 17, current smoker, ever vaped) • Smoking identity based on stopping the behaviour of smoking • Hand-to-mouth motions, financial outlay, need to buy supplies • Improved health outcomes not enough on their own

14. Finding 2 - The value of cigarettes • Cigarettes and alcohol • Cigarettes and stress

15. Cigarettes and alcohol • For most participants drinking and smoking ‘just go together’. • E-cigarettes are less social than cigarettes • “It's not gonna be, ‘tap you for a fag’, it's not gonna be a social thing … It's gonna be, ‘this is mine's’ … everybody will have them. You should have enough liquid yourself” (Daniel, 16, ex smoker, ever vaped) • Lamenting the social change • “Well it was a big social thing, when you had a fag … that's how you made friends… And now, it's like, you just keep to yourself, you don't see people speaking”. (Julia, 21, current smoker, ever vaped) • Attempts at using e-cigarettes fall apart when drinking and socialising

16. Cigarettes and stress • General, everyday stress • Participants made reference to the areas that they lived and their social networks being stressful which led to smoking. • Unemployment • [Talking about being nervous before a job interview] “So I'll have a fag, and stand outside for ten minutes … but I try and not use the e-cig 'cause it doesn't help with the nerves, as such. A fag kind of helps you a wee bit there”. (Fred, 24, current smoker, current vaper) • Tragedy • “They did [help me cut down] but it was like more everybody stressing me and that and it was just the e-cigarette got chucked away in a drawer and the fags got pulled back out” (James, 17, current smoker, ex vaper) • Immediate comfort of cigarettes more important than long-term health concerns.

17. Finding 3 - ‘A thing on their own’ • Changing reasons for use of e-cigarettes • Non-smokers using e-cigarettes • Who are e-cigarettes for?

18. Changing reasons for use of e-cigarettes • Noting change from a cessation device to ‘lifestyle’ device • [Saying when he first became aware of e-cigarettes] “Probably when I got help to try and quit smoking … but I tried that a couple of times and just didn't like it … I think it's starting to become a population now, it's like everybody is doing it, even if they don't smoke they're just doing it” (Gavin, 17, ex smoker, ever vaped) • E-cigarettes no longer connected to cigarettes • Participants often mentioned their confusion at e-cigarettes seemingly no longer having a connection to cigarettes (through being a cessation aid). • Participants suspicious of any ‘smoking’ behaviour

19. Non-smokers using e-cigarettes • For the taste/flavour • To fit in with others • Fashion accessories • To ‘smoke healthy’ • “‘oh just I didn't want to smoke but I fancied something’” (Ellen, 22, current smoker, ever vaped) • Overall, e-cigarettes were only discussed as acceptable when they were being used as smoking cessation aids.

20. Who are e-cigarettes for? • Younger people using e-cigarettes to look ‘cool’ and older people using e-cigarettes to quit smoking • Older participants (20-25) more frequently expressed some interest in using e-cigarettes to quit or cut down smoking than younger (16-19) participants • Younger participants more frequently expressed an interest in trying e-cigarettes for reasons other than smoking cessation or cutting down than older participants • Although the general feeling among the participants was that • e-cigarettes were ‘not for them’

21. Possible implications • Finding 1 • Young adults must believe that they would be supported to cut down and eventually quit vaping. • Finding 2 • Greater appreciation of the social context of young people’s lives. • Finding 3 • More controlled image of e-cigarettes and vaping important to convince young smokers that vaping is a safer alternative to smoking and an activity that can be controlled.

22. Thank you for listening!m.lucherini@ed.ac.uk