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

4 Young adults' awareness of and attitudes towards e-cigarettes

4.1 This section presents findings in relation to young adults' awareness of e-cigarettes. Further details about the specific knowledge that young adults had about e-cigarettes will be presented in Chapter 10.

Vocabulary

4.2 At the beginning of each focus group, the young adults were asked what words they use to refer to: (a) an e-cigarette and (b) the action of using an e-cigarette. While the term 'e-cigarette' was recognised and understood by everyone, other words were often used. Those mentioned most often, across all groups, were:

• Vapour
• Vape
• Vapouriser
• E-cig

4.3 Some groups also identified a wider range of terms, including:

• Fake fag (or electric fag or fake cigarette)
• A pen (or e-pen or smoking pen)
• A crack pipe (or pipe)
• A sonic screwdriver

4.4 Participants also sometimes referred to 'box mods', 'shishas' or specific brand names in later discussions, although no one offered these terms when asked at the beginning of the discussion. One group of vapers pointed out that the shops they buy e-cigarettes from seem to make a distinction between 'vapes' and 'e-cigarettes', which they suggested was related to the branding of the devices.

4.5 Words used by young adults to refer to the action of using an e-cigarette included:

• Vaping (having a vape)
• Smoking (having a smoke)
• Blowing (or smoking) some air
• Blowing 'O's / doing smoke tricks ^[14]

Recognition of different types of e-cigarettes

4.6 Participants were asked about their awareness of e-cigarettes. They were shown pictures of different devices as a prompt to discussion.

4.7 In general, the participants had a high level of awareness of the different types of e-cigarettes commercially available. Individuals across all groups were able to discuss the differences between types of e-cigarettes, understood that some were disposable and others were refillable and rechargeable; and that different e-cigarettes produced variable amounts of 'smoke' (or vapour). Participants also were aware that there is a very wide range of flavoured liquids available and that some liquids were intended to mimic the taste of a cigarette, while others tasted nothing at all like a cigarette ( e.g. strawberry, watermelon, bubble gum, etc.), and that the liquids contained varying levels of nicotine. Individuals in the groups often commented that the pen-style e-cigarettes were the most popular.

4.8 There appeared to be slightly less awareness of e-cigarettes among individuals in the non-smoking groups. For example, one non-smoker said that she recognised what a box mod was, but was not sure that she had ever seen someone using one. Another said that he had seen people using box mods, but was uncertain of how they were different from pen-style e-cigarettes. Others said they were unaware that different liquids contained different levels of nicotine.

4.9 With few exceptions, when participants were shown a photograph of the device that is not commercially available, they commented that they had never seen an e-cigarette like it before. ^[15] Those (few) who thought they had seen this device simply believed it was a variation of a pen-style e-cigarette.

The use of e-cigarettes in young adults' networks

4.10 The use of e-cigarettes was common in the family and social networks of the young adults who took part in this research. All the participants knew someone who currently (or had previously) used an e-cigarette - including parents, grandparents, aunts / uncles, brothers / sisters, partners, friends or colleagues. This may partly be a reflection of smoking rates in the socio-economic groups these young people were from. When asked why these individuals had taken up vaping, focus group participants nearly always said: 'to stop smoking'.

4.11 Many could describe the types of devices used by individuals in their family and social networks, and were aware that some people had successfully used e-cigarettes to stop smoking, some had not entirely quit but had managed to reduce their smoking, and still others 'went back to fags' because the e-cigarette 'didn't work', or because e-cigarettes 'just weren't the same'.

Young adults' attitudes to e-cigarettes

4.12 Focus group participants were not explicitly asked to talk about their attitudes to e-cigarettes. Rather their attitudes were explored as part of wider discussions regarding their awareness of and knowledge about e-cigarettes. The most common attitudes expressed by young adults are discussed below. These issues generally arose spontaneously, rather than because they were specifically asked about.

E-cigarettes are cool / some people think e-cigarettes are cool

4.13 There were differing views about the extent to which e-cigarettes were considered to be 'cool', and some young adults voiced the opinion that, while some people their age might think they were cool, they themselves did not think that. All three of the non-smoker groups spontaneously raised the issue of the perceived 'coolness' of e-cigarettes as an explanation for why some people their age (and younger) were trying them. However, these non-smokers, themselves, did not see e-cigarettes as cool.

'Because they think they're cool, when they're really not! They need to grow up! Either smoke or just quit. I don't see the difference, just because they've got like strawberry flavours, it's not any better.' ( FG1, Female, non-smoker, aged 16-19, unemployed)

'I think there's a bit of it that… some of them will be addicted and it'll be a better way of getting nicotine or whatever for them, and then there's the fashionable aspect of it, where people are doing it because it's trendy, and that's why there's all these shops everywhere, and they're making it trendy and the adverts are making it trendy, so it'll be a little bit of, like, the people who are facilitating their nicotine, they're maybe wanting to try and go about it in a more healthy way, but then there are people that are just like, "Oh that's pure cool".' ( FG12, Female, non-smoking group, aged 19-25, in employment)

4.14 The smoking groups also often raised the issue of 'coolness'. Some had the impression that 'wee kids think that vaping is cool', and some stated that they had initially tried an e-cigarette because 'it looked cool'.

4.15 The vaping groups, on the other hand, did not generally talk about the 'coolness' of e-cigarettes. Only one individual - an unemployed young man, aged 16-19 - reported being motivated to take up vaping (after he had already successfully quit smoking) 'because it's cool', and this young man had gone on to become a vaping enthusiast (see Chapter 5 for a discussion of 'vaping enthusiasts'). Another young man commented that he was aware of non-smoking friends buying e-cigarettes; but his view was that this was 'a dumb thing for people to do.'

They're like a hobby - not seriously used for quitting

4.16 The view that e-cigarette use is like a hobby and that e-cigarettes are not seriously used for quitting smoking often arose in discussions with non-smokers and smokers, but not with vapers. Those who had this view commented that some vapers were using liquids that had no nicotine content at all, and they pointed to the predilection among vapers for using their devices to do 'smoke tricks'. (Experiences of using of e-cigarettes to do 'smoke tricks' is discussed in Chapter 5.)

'The flavoured ones are like a hobby. It's not really like trying to quit smoking, because if you were trying to quit smoking you'd want something as close to fags as possible. Some of the flavours, you get the ones with zero nicotine, and it's just like you're not getting any nicotine, all you're doing is just smoke rings.' ( FG2, Male, smoking group, under 21, in further education)

'I think people just do it now as more of a hobby than actually needing to do it. I don't think they're addicted to it at all. I don't think it's a habitual thing. I just think it's because they like having it and they like that people look at it and go, "Oh, look how much smoke I can blow. It's brilliant.''' ( FG12, Male, non-smoking group, aged 19-25, in employment)

They're rubbish / they don't work

4.17 The view that e-cigarettes are 'rubbish' or that they 'don't work' was expressed almost exclusively among groups of smokers, and all but one of the smokers' groups expressed this view. The perception that 'they don't work' was often related to an expectation that young adults had that e-cigarettes would help them to stop smoking, whereas the reality of their experience had been different. The view that e-cigarettes are 'rubbish' was partly related to this same expectation, but was also sometimes a comment about the taste or about the fact that the devices break easily. Participants listed a number of perceived failures or shortcomings with the devices in terms of the sensory experience they offer in comparison to smoking:

• They don't curb the cravings for cigarettes
• 'You don't get any good smoke out of them'
• They are not enjoyable
• They cause a feeling of 'fuzziness' on the tongue and / or 'make your nose feel weird'.

4.18 It is not clear whether the smokers who expressed these views were referring to a single device that they had tried to use, or to different types of devices.

4.19 Vapers sometimes also expressed similar views, but they tended to do it in relation to a specific device - the cigalike (or fake fag). Among vapers, there was a common view that 'only a half decent e-cigarette is effective in helping people to quit smoking'.

Switching to e-cigarettes is like swapping one addiction for another

4.20 The view that the use of e-cigarettes is like swapping one addiction for another was expressed mainly by smokers and vapers. One group of non-smokers had a similar view, but this was expressed more along the lines of, 'vaping is just the same as smoking'. This belief was given as the reason why non-smokers were not interested in trying e-cigarettes. Some non-smokers also raised this point, indirectly, in commenting on the behaviour of other non-smokers who had tried e-cigarettes:

'I think people who don't smoke think it [vaping] is not smoking - obviously because people say it's not harmful and there's different flavours. So they think they're not actually smoking, when they are.' ( FG1, Female, non-smoking group, aged 16-19, unemployed)

4.21 Among smokers and vapers, the view that using e-cigarettes is like swapping one addiction for another was given in some cases as a reason for people not to vape (or to stop vaping), as addiction itself was seen as undesirable. However, in other cases the swapping of one addiction for another was given as an explanation for how vaping helped people to stop smoking. ( Chapter 6 will discuss these issues in greater depth.)

Young adults' reasons for not trying vaping

4.22 Before going on to discuss young adults' experiences of using e-cigarettes in the next chapter, it is worth noting that most of the non-smokers and a small number of the smokers (10%) had never tried vaping. (See again Table 3.4 in Chapter 3.) In general, non-smokers tended to equate vaping with smoking - or associated it with stopping smoking - and therefore saw no reason to be interested in vaping themselves. A similar point was made by this small group of smokers: they saw vaping as a way of quitting smoking and, at this point in their lives, they were not interested in stopping smoking and so had no interest in vaping.