58. E-cigarettes as a Gateway to Smoking: What do Adolescents Themselves Think?

Abstract

PurposeTo determine whether electronic cigarettes (EC) can act as a gateway to smoking traditional cigarettes (TC) among adolescents.MethodsAs part of a larger qualitative study on EC use including 42 adolescents/young adults (16-26y.o., 19 females) in 8 focus groups (FG) (4 FGs with EC users, 2 with TC users, 1 with non-users, 1 with mixed consumption types), participants were asked if they believed that ECs could act as a gateway to smoking. FGs were audio-recorded and transcribed verbatim. Transcripts were analyzed according to a thematic analysis procedure.ResultsParticipants expressed significant threat of EC acting as a gateway to TC use among adolescents. Several factors encouraging this passage were reported: (1) EC was a smooth way of starting for those who found TC too brutal at first; (2) EC users got used to the smoking gestures, tastes, nicotine (if present), inhalation, and feel in the throat, all of which acted as an efficient preparation for real smoking; (3) EC did not bring much satisfaction in terms of effect, inducing a great risk to move on to TC; (4) groups of youths always included those who want to take their consumption further and pull their peers along, in this case from EC to TC; and (5) TCs were considered easier to use compared to ECs requiring a lot of preparation. Worries were accentuated by the powerful attractiveness of EC inciting many adolescents to try or use it due to: its fashion and popularity; the perception of EC as harmless, not seeing the potential underlying addiction, while enjoying the same socializing characteristics as smoking; the possibility of using EC in smoke-free areas; the lack of available information on EC and notably on its harmfulness; its ease to hide from parents; its ease to obtain; its sweet taste; and its high-tech/modern aspect. Participants considered an even greater gateway threat regarding very young adolescents given their naïve perception of EC as harmless. Some participants reported that EC had acted as a gateway to TC for themselves either by starting their overall cigarette consumption with an EC or by starting EC after having stopped smoking for a while leading them to start smoking again. Only a small minority of participants did not perceive EC as a risk for a gateway to TC for two reasons: (1) EC could have the reverse effect of keeping adolescents away from TC; (2) because of the belief that no one would want to start ECs if not smoking TCs in the first place. Finally, some participants believed that the gateway threat existed only (for some) or specially (for others) if ECs contained nicotine.ConclusionsECs are considered by adolescents themselves as having a great potential of acting as a gateway to smoking although perceived as a harmless substance. Health professionals should screen for EC use and inform consumers of the potential gateway effect. From a public health perspective, there is an urge for better preventive policies directed at protecting adolescents.Sources of SupportSwiss Tobacco Prevention Program. PurposeTo determine whether electronic cigarettes (EC) can act as a gateway to smoking traditional cigarettes (TC) among adolescents. To determine whether electronic cigarettes (EC) can act as a gateway to smoking traditional cigarettes (TC) among adolescents. MethodsAs part of a larger qualitative study on EC use including 42 adolescents/young adults (16-26y.o., 19 females) in 8 focus groups (FG) (4 FGs with EC users, 2 with TC users, 1 with non-users, 1 with mixed consumption types), participants were asked if they believed that ECs could act as a gateway to smoking. FGs were audio-recorded and transcribed verbatim. Transcripts were analyzed according to a thematic analysis procedure. As part of a larger qualitative study on EC use including 42 adolescents/young adults (16-26y.o., 19 females) in 8 focus groups (FG) (4 FGs with EC users, 2 with TC users, 1 with non-users, 1 with mixed consumption types), participants were asked if they believed that ECs could act as a gateway to smoking. FGs were audio-recorded and transcribed verbatim. Transcripts were analyzed according to a thematic analysis procedure. ResultsParticipants expressed significant threat of EC acting as a gateway to TC use among adolescents. Several factors encouraging this passage were reported: (1) EC was a smooth way of starting for those who found TC too brutal at first; (2) EC users got used to the smoking gestures, tastes, nicotine (if present), inhalation, and feel in the throat, all of which acted as an efficient preparation for real smoking; (3) EC did not bring much satisfaction in terms of effect, inducing a great risk to move on to TC; (4) groups of youths always included those who want to take their consumption further and pull their peers along, in this case from EC to TC; and (5) TCs were considered easier to use compared to ECs requiring a lot of preparation. Worries were accentuated by the powerful attractiveness of EC inciting many adolescents to try or use it due to: its fashion and popularity; the perception of EC as harmless, not seeing the potential underlying addiction, while enjoying the same socializing characteristics as smoking; the possibility of using EC in smoke-free areas; the lack of available information on EC and notably on its harmfulness; its ease to hide from parents; its ease to obtain; its sweet taste; and its high-tech/modern aspect. Participants considered an even greater gateway threat regarding very young adolescents given their naïve perception of EC as harmless. Some participants reported that EC had acted as a gateway to TC for themselves either by starting their overall cigarette consumption with an EC or by starting EC after having stopped smoking for a while leading them to start smoking again. Only a small minority of participants did not perceive EC as a risk for a gateway to TC for two reasons: (1) EC could have the reverse effect of keeping adolescents away from TC; (2) because of the belief that no one would want to start ECs if not smoking TCs in the first place. Finally, some participants believed that the gateway threat existed only (for some) or specially (for others) if ECs contained nicotine. Participants expressed significant threat of EC acting as a gateway to TC use among adolescents. Several factors encouraging this passage were reported: (1) EC was a smooth way of starting for those who found TC too brutal at first; (2) EC users got used to the smoking gestures, tastes, nicotine (if present), inhalation, and feel in the throat, all of which acted as an efficient preparation for real smoking; (3) EC did not bring much satisfaction in terms of effect, inducing a great risk to move on to TC; (4) groups of youths always included those who want to take their consumption further and pull their peers along, in this case from EC to TC; and (5) TCs were considered easier to use compared to ECs requiring a lot of preparation. Worries were accentuated by the powerful attractiveness of EC inciting many adolescents to try or use it due to: its fashion and popularity; the perception of EC as harmless, not seeing the potential underlying addiction, while enjoying the same socializing characteristics as smoking; the possibility of using EC in smoke-free areas; the lack of available information on EC and notably on its harmfulness; its ease to hide from parents; its ease to obtain; its sweet taste; and its high-tech/modern aspect. Participants considered an even greater gateway threat regarding very young adolescents given their naïve perception of EC as harmless. Some participants reported that EC had acted as a gateway to TC for themselves either by starting their overall cigarette consumption with an EC or by starting EC after having stopped smoking for a while leading them to start smoking again. Only a small minority of participants did not perceive EC as a risk for a gateway to TC for two reasons: (1) EC could have the reverse effect of keeping adolescents away from TC; (2) because of the belief that no one would want to start ECs if not smoking TCs in the first place. Finally, some participants believed that the gateway threat existed only (for some) or specially (for others) if ECs contained nicotine. ConclusionsECs are considered by adolescents themselves as having a great potential of acting as a gateway to smoking although perceived as a harmless substance. Health professionals should screen for EC use and inform consumers of the potential gateway effect. From a public health perspective, there is an urge for better preventive policies directed at protecting adolescents. ECs are considered by adolescents themselves as having a great potential of acting as a gateway to smoking although perceived as a harmless substance. Health professionals should screen for EC use and inform consumers of the potential gateway effect. From a public health perspective, there is an urge for better preventive policies directed at protecting adolescents.