Young adults and e-cigarettes: a qualitative exploration of awareness, experience and attitudes

2 Methods

2.1 This chapter sets out details of the research methodology used in this study. It includes information about the approach to sampling, the recruitment methods, details of the topic guide, and the conduct of the focus groups. At the end of this chapter, we also discuss our use of quotes in this report.

Research design and purposive sampling approach

2.2 A qualitative research design was used to conduct this study. Specifically, 13 focus groups were undertaken with young adults aged 16-25 in three Scottish cities. The rationale for using focus groups was that they allow participants to discuss topics in a spontaneous and naturalistic way, while also enabling them to interact with each other. It was thought that young people, in particular, would find this method less intimidating than one-to-one interviews and would feel less pressure to provide what they may think are 'socially acceptable' answers given that they would be among their peers. The use of focus groups also enabled the study to involve a relatively large number of young people within the time constraints available.

2.3 The aim of qualitative research is to obtain an in-depth understanding of a particular issue from the perspective of the people being studied. Statistical inference and the 'representativeness' of the findings are not the aim. Rather, the intention is to gather information which can be generalised to groups who have similar characteristics to those who took part in the research. In order to do this, care must be taken in creating the sample.

2.4 The approach to sampling in this study was intended to ensure that the young adults who took part in the research reflected a number of population characteristics that are key to understanding the issue of e-cigarette use in this group. In particular, the approach took into account what is known about: (i) the prevalence and nature of cigarette and e-cigarette use among young people; and (ii) the relationship between tobacco smoking and deprivation.

2.5 As set out in the previous section, recent survey findings have shown that a relatively high proportion of young people have experimented with e-cigarettes, although regular use is mainly restricted to current smokers. At the same time, smoking is strongly linked to deprivation, with the highest smoking rates among those living in the poorest communities.

2.6 Age was also an important factor. As stated above, the transition to smoking largely takes place within the 16-25 age group, and so, this study sought to include sufficient numbers of young adults from across this age group to cover potentially different views and experiences which may be associated with age and life stage.

2.7 Therefore, a purposive sample was constructed based on: (i) participants' employment status ( i.e. in education / employed / unemployed), (ii) their smoking / vaping status ( i.e. smoker / vaper / non-smoker), and (iii) their age.

2.8 Unemployed people were specifically included in the study as a way of capturing the views of people affected by deprivation. The overall sample was biased towards smokers and current vapers, as these groups were expected to have a more in-depth knowledge about and personal experience of using e-cigarettes.

2.9 Altogether, thirteen (13) focus groups were carried out, involving a total of 99 young adults. (Details of the achieved sample are in the next chapter.) There were five groups with vapers, five with smokers and three groups with non-smokers. Seven of the groups comprised young adults aged 16-21, and six comprised those aged 19-25. ^[13] Six of the groups were with young adults in employment, five were with unemployed young adults and two were with students in college (further education).

Recruitment methods

2.10 Young adults were recruited through a range of organisations in three Scottish cities: Glasgow, Edinburgh and Dundee. The aim was to recruit around eight individuals, and an equal number of males and females, in each focus group. Contacts with education and workplace organisations were facilitated by individuals in health promotion departments and Healthy Working Lives teams in NHS Boards.

2.11 There were some initial difficulties in recruiting groups of vapers - particularly among the younger age range (16-21s) and among those who were unemployed. A large number of young people's support services were contacted to request assistance with recruitment, but service managers reported that vaping among these groups was rare - mainly, they said, because young adults in these groups could not afford to buy e-cigarettes. (This is a finding in itself and the cost of e-cigarettes is discussed further in Chapter 9.)

2.12 Notwithstanding this, the focus groups were eventually recruited through:

• A third sector employability service for young people (two focus groups)
• A third sector health promotion service for young people (two focus groups)
• A further education college (two groups with students and one group with staff)
• Two large private sector organisations employing young adults in call centres or apprenticeships (four focus groups)

2.13 In addition, two focus groups (one with older unemployed vapers and one with older employed smokers) were arranged with assistance from a professional focus group recruiter.

2.14 Each recruiting organisation was given a short information sheet about the project to provide to potential participants, and a detailed set of inclusion criteria for focus group participation. For example: they were asked to gather a group of smokers, aged 16-21, in employment; or vapers, aged 19-25, who were unemployed. Each recruiting organisation was given £15 for each participant they recruited as an acknowledgement of the time and effort recruiters spent in assisting the research. Focus group participants were given £30 in cash to thank them for their time.

Topic guide

2.15 The topic guide was developed in consultation with the Scottish Government and the Research Advisory Group established for this project. Topics included:

• Knowledge about e-cigarettes
• Experience of using e-cigarettes and the reasons for doing so
• The types of e-cigarettes used and the contexts in which they are used
• General perceptions of e-cigarettes, including views about a possible 'gateway' effect
• Perceptions of the safety and quality of e-cigarettes
• Perceptions of price / affordability / accessibility of e-cigarettes
• Information and support needs

2.16 Each discussion was tailored to the group; so, for example, there was less detailed discussion with non-smokers about their experience of using e-cigarettes since the non-smokers all had little, if any, such experience.

Conduct of the focus groups

2.17 All focus group participants were asked to complete a one-page anonymous questionnaire (included in the Annex) at the start of the discussion. This included questions about their sex, age, employment status, vaping status ('Have you ever vaped?' and 'Do you currently vape - i.e. use an e-cigarette at least once a week?'), and smoking status. In relation to the last question, it was left open to the individual to define him/herself as a smoker, non-smoker, occasional smoker, or former smoker - no specific criteria were given to participants to distinguish between smoking and occasional smoking. Participants who identified themselves as smokers, occasional smokers or former smokers were asked how old they were when they started smoking.

2.18 Each focus group lasted between 40 and 60 minutes. Focus groups with non-smokers tended to be shorter than those with smokers or vapers.

2.19 Part of the discussion involved showing participants photographs of a range of e-cigarette devices and liquids and asking them whether they had ever seen these before. Included among the photographs was a disposable e-cigarette device which has been developed for use in prisons and was not commercially available, so it would probably never have been seen by most people. This photo was included to gauge the level of awareness among participants about specific types of devices.

Use of quotes in this report and the designation of participants

2.20 Quotes from focus group participants are used throughout this report. Each quote includes a reference which contains the following information:

• The focus group ID ( FG1, FG2, etc.)
• The sex of the speaker (male, female)
• Which target group the speaker was part of ( e.g. smoking group, under 21, in further education; or non-smoking group, aged 19-25, in employment)

2.21 As will be seen in the following chapter, many of the individuals who took part in the smoking and vaping focus groups were, in fact, dual users of cigarettes and e-cigarettes (smoker-vapers). Other participants moved back and forth between smoking and vaping.

2.22 Thus, although there are references throughout the report to 'smokers' or 'vapers', strictly speaking where these designations are used in Chapters 4- 11 (the discussion of the qualitative findings), they refer to 'participants in the smoking groups' and 'participants in the vaping groups', respectively. While some in the non-smoking groups also had previous experience of trying vaping, there were no current vapers in these groups. There were, however, some people in the vaping groups who defined themselves as non-smokers or former smokers. These individuals are simply referred to as vapers.