Abstract
BackgroundGrowth of e-cigarette use among smokers has raised concerns over uptake by non-smokers, particularly young people. Legislative changes aimed in part at reducing youth exposure to e-cigarettes include the EU Tobacco Products Directive (TPD). A core justification for such measures is the belief that e-cigarettes can lead to tobacco smoking through mechanisms of renormalisation including: mimicking and normalizing the act of smoking; increasing product acceptability via marketing; nicotine exposure. These mechanisms are here explored in relation to findings from qualitative research. MethodsThis paper reports results from twenty-one group interviews with 14–15 year olds in Wales, England and Scotland, conducted as part of an ongoing evaluation of the impact of the TPD on youth smoking and e-cigarette use. Interviews were conducted around the end of the transitional period for TPD implementation, and explored perceptions of e-cigarettes and tobacco, as well as similarities and differences between them. ResultsYoung people differentiated between tobacco and e-cigarettes, rejecting the term e-cigarette in favour of alternatives such as ‘vapes’. Experimental or occasional use was common and generally approved of where occurring within social activity with peers. However, regular use outside of this context was widely disapproved of, unless for the purpose of stopping smoking. Increased prevalence of e-cigarettes did not challenge strongly negative views of smoking or reduce perceived harms caused by it, with disapproval of smoking remaining high. Nicotine use was variable, with flavour a stronger driver for choice of e-liquid, and interest more generally. ConclusionThe extent to which participants differentiated between vaping and smoking, including styles and reasons for use in adults and young people; absence of marketing awareness; and continued strong disapproval of smoking provides limited support for some of the potential mechanisms through which e-cigarettes may renormalise smoking. However caution over nicotine exposure is still necessary.
Highlights
Current UK legislation prohibits sale of vaping equipment to under 18′s and mandates registration of nicotine-based products, and full disclosure of ingredients, with the UK Medicines and Healthcare Regulatory Agency (MHRA) (Tobacco & Related Products Regulations, 2016)
While some have suggested mandated name change from e-cigarettes to vapourisers or nicotine control products (Royal Society for Public Health, 2015) to enhance the differentiation between smoking and vaping, changes to the appearance of devices and the ubiquity of the term ‘vaping’ in public discourse, marketing and policy, our research suggests that this differentiation is already occurring
The distinctions made between casual and regular vaping, as well as between vaping and tobacco smoking, do not suggest that the former is seen as similar enough to smoking to trigger uptake among those who would not otherwise have smoked
Summary
Current UK legislation prohibits sale of vaping equipment to under 18′s and mandates registration of nicotine-based products, and full disclosure of ingredients, with the UK Medicines and Healthcare Regulatory Agency (MHRA) (Tobacco & Related Products Regulations, 2016). Within the heavily regulated context, e-cigarettes continue to be accepted, and promoted, for smoking cessation by bodies such as Public Health England and NHS Health Scotland This is in stark contrast to other countries such as the US, where the Food and Drug Administration (FDA) have supported significant restrictions on e-cigarettes, including bans on certain flavoured liquids (FDA, 2019) and some regions have gone as far as voting to ban e-cigarette sales entirely (BBC News, 2019). A core justification for such measures is the belief that e-cigarettes can lead to tobacco smoking through mechanisms of renormalisation including: mimicking and normalizing the act of smoking; increasing product acceptability via marketing; nicotine exposure. These mechanisms are here explored in relation to findings from qualitative research.
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