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

5 Young adults' experiences of using e-cigarettes

5.1 This chapter will discuss young adults' experiences of using e-cigarettes - including their reasons for trying them, what they like and don't like about them, the contexts in which they use e-cigarettes, the impact of using e-cigarettes on their use of tobacco, and why some have continued to vape while others have stopped. This chapter will show that e-cigarettes are largely seen as smoking cessation aids by young adults, but that is not their only role.

5.2 Chapter 6 will look in more detail at young adults' experiences of smoking cessation, their understanding of their own addiction to, and dependence upon, smoking and their views on the addictiveness of e-cigarettes.

Young adults' first experience of e-cigarettes

Motivations for trying e-cigarettes

5.3 As shown in Chapter 3 ( Table 3.4), more than three-quarters (77%) of the young adults who took part in this research (including nearly a quarter of the non-smokers) had tried an e-cigarette at least once. ^[16] When asked about their reasons for trying one, focus group participants discussed a wide range of motivations.

5.4 The desire to quit, or cut down on smoking was the main reason given, and those who cited this as their motivation for trying an e-cigarette generally believed that they were less harmful than ordinary cigarettes. However, not everyone who tried an e-cigarette did so with the intention of giving up or reducing their smoking. In fact, there were some individuals who stated that they had already successfully stopped smoking for a period of time, and only took up vaping later, and of course, there were also some non-smokers who had tried an e-cigarette.

5.5 Other common reasons for trying e-cigarettes were:

• Curiosity: Some said they just wanted to see what it was like; that they were intrigued; that they wanted to know what the difference was between using an e-cigarette and smoking an ordinary cigarette; or because they 'wanted to see if they were as good as everybody was saying'.
• Flavour / smell: Linked to the motivation of curiosity was the desire to try the different flavours. Participants were aware of the wide range of flavours available and wanted to sample them. Some also thought that e-cigarettes 'smelled really nice', and this pleasant smell contrasted sharply with the smell of cigarette smoke, which some said they hated.
• Cost: Some participants were motivated by the desire to save money. There was a perception that e-cigarettes were ultimately cheaper than cigarettes - although as discussed in Chapter 9, the relatively large initial outlay for good-quality devices was seen to be a barrier for some young adults, both in starting and in continuing to vape.
• Convenience: Some pointed out that e-cigarettes give people a way of getting nicotine in places or circumstance where they could not otherwise have a cigarette - for example, in their own homes (where they would otherwise feel they needed to go outside), on the bus or in the pub. However, participants also noted that many places which had initially allowed vaping on their premises now no longer did so, and this led some to question the convenience of vaping over smoking.
• The need for secrecy: Others said they wanted to be able to use an e-cigarette in places where they might get in trouble if they were found smoking, such as on a school trip or a cadet camp, or at home where their parents did not permit them to smoke.
• Social reasons: Young adults in some groups had the perception that 'everyone', or at least 'lots of people', seem to be using e-cigarettes and seem to enjoy them. Thus some said they wanted to be part of what appeared to be a fun and pleasurable activity among their friends - i.e. 'to join in the banter'.
• Because it looked cool / they wanted to do smoke tricks: The perception that e-cigarettes looked 'cool' or 'funky' motivated some young adults to try them. Some discussed the appeal of doing 'smoke tricks' and said that this was a competitive, but fun activity among some vapers.

5.6 Other reasons for trying e-cigarettes, mentioned less often, were:

• Because they had run out of cigarettes and an e-cigarette was readily available at the time
• To annoy a teacher
• Out of boredom
• Because the individual was drunk at the time.

5.7 Regarding the last point, it was clear that, for some individuals, the decision to try an e-cigarette was taken on impulse and without a great deal of consideration - at a party or in a pub or club. Others said they made a snap decision when they were at a kiosk to buy cigarettes or they purchased their first e-cigarette because they had been offered a discount. One individual tried their first e-cigarette as a result of a promotion in which they were being given out for free.

Where they got their first e-cigarette

5.8 The most common sources from which young adults obtained their first e-cigarette were:

• They bought their own: Usually those who bought their own first e-cigarette bought it in a shop - i.e. a convenience store or garage, a shopping centre or market stall, a specialist vaping shop - or in a nightclub.
• Someone bought one for them or gave one to them: Young smokers sometimes said that their first e-cigarette came from a relative - usually a parent, a grandparent or an aunt - to encourage them to stop smoking. One individual said that the first one he tried was made for him by a friend.
• They tried one belonging to someone else: It was also common for young adults to sample e-cigarettes belonging to other people - friends, parents and other relatives, or colleagues.

Experience of first use

5.9 The participants in this study described a range of experiences of their first use of an e-cigarette - both positive and negative.

5.10 Those who said their first experience was positive generally highlighted the pleasant flavour or taste which they contrasted with the 'disgusting' taste of a cigarette. Some non-smokers said they also liked the flavour of the e-cigarette they tried, but were not interested in trying one again.

5.11 However, it was more common for young adults to say that their first experience of an e-cigarette was unpleasant in several respects: they disliked the taste; the smoke caused them to cough or choke; they felt a burning or other uncomfortable sensation at the back of their throat; or it made them feel sick or lightheaded. These unpleasant experiences were reported across a range of devices. One individual said that the first time he used an e-cigarette (a pen-style device), the top had not been screwed on properly and he got hot liquid on his face. He also said he felt pains in his lower abdomen when he began using e-cigarettes, but these disappeared over time.

5.12 Others said that they felt e-cigarettes simply did not give them the same satisfaction as a cigarette. The following quotes illustrate some of these issues:

'I was sitting there continuously smoking it and I was like "This isn't…". And the fag one [cigalike], I don't know what's used in that, but that seemed to dry your throat out, really dry your throat out.' ( FG5, Male, smoking group, aged 19-25, in employment)

'I really was not keen on it whatsoever. But I was, like, I'll try and stick at it to quit smoking, but no, I gave up with it because it was horrible.' ( FG2, Female, smoking group, under 21, in further education)

'It [a box mod] pure chokes you. Yeah, it's pure mental how much smoke comes out of that one. It was pure lethal. I smoked it and it was horrible.' ( FG9, Male, smoking group, aged 16-19, unemployed)

'Someone gave me one [a cigalike], I think it was actually my gran. She was, like, "Oh you should try this, this is so much better", and I literally was, like, as if I had just sucked talcum powder out of a straw. I was like, it was so rubbish. "Ok, that didn't curb any cravings, they're rubbish!" So then I got one of those ones [pen-style e-cigarettes] and I was like, "I'm really going to do this, I'm really going to try", but it was just rubbish as well. It doesn't do the same thing [as a cigarette].' ( FG6, Female, vaping group, under 21, in employment)

5.13 Those in the vaping groups often commented that when they first started vaping, they did not enjoy it and found the experience too different to smoking. However, by persevering, and trying different devices and flavours, they found something that suited them.

Regular use of e-cigarettes

5.14 Despite the unpleasant first experience that young adults often had, some nevertheless continued to use e-cigarettes. As noted in Chapter 3 ( Table 3.5), 40% of participants described themselves as current vapers ( i.e. at least once a week) and current vaping was highest among former smokers and occasional smokers.

5.15 Young adults' experiences of vaping, and their explanations of the relationship between vaping and smoking in their lives were varied, complex and highly individual. However, some recurring themes arose and several of these are discussed below. Other themes, related to the use of e-cigarettes as smoking cessation aids and the addictiveness of e-cigarettes, will be discussed in Chapter 6.

E-cigarettes can help people to quit or reduce their smoking, but the journey is not always straightforward

5.16 As reported above, not everyone who tried vaping did so with the aim of quitting smoking. However, it was common for those in the vaping groups to say that the use of e-cigarettes had helped them to reduce their smoking including, in some cases, when they had not actually set out with this aim. For example, some participants reported that, once they started vaping, they found they could not tolerate the smell and taste of cigarettes anymore and so decided to stop smoking as a result. It was also clear that some had managed to quit smoking altogether - although success was not attributable in every case to the use of e-cigarettes, as people sometimes began vaping only after they had already quit smoking.

5.17 However, dual use of e-cigarettes and tobacco cigarettes was common, and decisions about dual use appeared to be highly specific to each individual.

5.18 Some dual users said that they used e-cigarettes at certain times of the day and cigarettes at other times. For example, one person only smoked tobacco cigarettes at home, morning and evening, but vaped throughout the day; while another did the opposite, vaping at home, but smoking when away from home during the day. One young man said he vaped all week until Friday when he went out drinking with friends when he swapped to cigarettes. Another said he tended to use his e-cigarette 'towards the end of the month when he has no money'. Some reported that they used ordinary cigarettes when they forgot to charge their e-cigarette.

5.19 In addition, a recurring theme in the discussions about dual use was that an e-cigarette simply was not as satisfying as a cigarette in certain circumstances - namely, when drinking, when under stress, or first thing in the morning (discussed further in Chapter 6).

5.20 Just as dual use was common, so too was the movement back and forth between e-cigarettes and tobacco cigarettes. Those who regularly vaped reported that they sometimes went for long periods without a cigarette, but returned to tobacco when their e-cigarette was lost or broken, or simply because 'it was easier to go and buy fags than buy the replacement parts' for the e-cigarette. Others reported resorting to cigarettes at times of intense stress, and then returning to vaping again once the stress had reduced. (Again, see Chapter 6 for further discussion of this point.)

5.21 However, in general, those who vaped regularly reported that they were smoking less - in some cases much less - than before they started vaping.

'[For me, it has been an] on and off sort of process. Like, when I first got my new vape, I did it for about two months and then I just sort of forgot about it, so I just got back into smoking, but it didn't really last too long, because I wasn't used to it, you know, I was more used to the vape. So I still smoke quite a bit, but it's less than it was before, but it's just remembering I've got my vape and I should be using it instead.' ( FG6, Male, vaping group, under 21, in employment)

'I always said to myself that as soon as I start having 20 a day I would stop. The only time I smoke… there was an occasion a couple of weeks ago when my electric fag broke and I was on a night out, so I had to go and buy fags for that, but even then, I bought a pack of 20 fags, I smoked four and I gave the rest away because I can't smoke a normal fag anymore. I'm on that [e-cigarette] permanently now, yeah. But I don't look at it as a way of stopping smoking, it's just a cost-cutting measure for me, like.' ( FG3, Male, vaping group, aged 18-23, in further education)

'[I was smoking] 20 to 30 a day, but after that I started with that [the e-cigarette] and I was, like, one [cigarette] in the morning and I could do without all day.' ( FG7, Male, vaping group, aged 19-25, unemployed)

Switching from tobacco cigarettes to e-cigarettes led to improvements in health

5.22 Those who regularly vaped and no longer smoked said that their health had improved as a result. The main health-related benefits they reported were that they no longer coughed, had breathing problems or got regular chest infections. Some reported feeling fitter ( i.e. being able to run more than previously), others said they just generally felt healthier. Others referred to changes in their voices: one young woman described her voice as more 'girly' since she quit smoking and took up vaping, while one young man observed that vaping did not result in the 'voice deprivation type of thing' that he often got with cigarettes. One young woman listed several improvements to her health which had occurred since she started vaping:

'I've noticed huge changes in my health. I can sleep better. I don't get out of breath as quickly, because to be honest I was smoking since I was 16 and I stopped when I was 22, so that was a long time smoking. And to just stop and wean off to something that's basically steam based… the cough went away, the breathlessness went away, the sleeping got better. I didn't wake up in the middle of the night with coughing fits, and my kidneys got healthier as well, because I had kidney issues, and that just sort of went away.' ( FG3, Female, vaping group, aged 18-23, in further education)

5.23 In some cases, participants commented that the health of people they knew -parents or friends who had taken up vaping to quit smoking - had also improved.

People do not use e-cigarettes in the same way as cigarettes

5.24 It was common for young adults across all groups to observe that people used their e-cigarettes differently to the way they smoked tobacco. Several statements were repeatedly used to describe this aspect of vaping behaviour: 'It is never out of my hand', 'I use it constantly', 'I was smoking it all the time'.

'I was using it [e-cigarette] constantly, all the time because I had it in my hand. You find out you might cut down on fags, but you're just smoking that all the time.' ( FG4, Female, smoking group, under 21, unemployed).

5.25 Some participants were unconcerned about this, believing e-cigarettes to be less harmful than ordinary cigarettes. Others thought that their constant use of an e-cigarette possibly meant that it was worse for their health than tobacco cigarettes. Some people gave up vaping because of this concern, and some individuals no longer smoked or vaped. Other individuals found that when they returned to cigarette smoking, they smoked more than they had previously because they were now in a different routine. This issue is discussed in greater depth in Chapter 6.

E-cigarette enthusiasts

5.26 Among the five focus groups of vapers, there were one or two individuals (males and females) in each group who might be described as vaping 'enthusiasts' or 'experts'. For these individuals, the appeal of vaping was not only in relation to the perceived health and social benefits that the devices offered. Vaping appealed to them on an intellectual level too, and all of them had a detailed technical knowledge about how different devices worked (see Chapters 8 and 10). Some of these individuals participated in online forums for vapers which provide advice about vaping etiquette and to encourage a vaping 'lifestyle'. They also discussed vaping humour, ^[17] and all of them expressed great pleasure in doing smoke tricks or 'making big clouds'.

Smoke tricks

5.27 One of the appeals of vaping, for some young adults, was in being able to use the devices to do 'smoke tricks'. This activity was seen as fun by some individuals, and one young woman described it as 'a sport - the strongest cloud wins'. Some referred to online videos which demonstrate how to do smoke tricks. Three young adults in one group listed some of the tricks that they had done or seen:

Male 1: 'Blowing Os. French Inhale.'

Male 2: 'I can put vape in a glass and then pour it out.'

Female: 'Making circles and jellyfish things.'

Male 1: 'Blowing it onto the table and doing tornadoes.' ( FG10, vaping group, aged 16-19, unemployed)

5.28 Another young man shared his experience of filling a room with vapour:

'It's fun trying to fill your room up with vape when you have the massive big box mods because you can put the wattage right up and try and mess about with it, and there's quite a lot you can do with it. I remember once at a party I completely filled one of the bedrooms.' ( FG6, Male, vaping group, under 21, in employment)

5.29 Other vapers were less interested in this type of activity, and some non-smokers who had seen people doing smoke tricks considered it to be immature. At the same time, there was a view expressed by some participants that young children who start vaping often do so because they want to be able to do smoke tricks, and indeed one non-smoker said that this was what had appealed to him. One young woman echoed this sentiment, but said that she eventually lost interest:

'Well, I was only interested in it for the smoke tricks, and I lost interest in it, so, I still have it, it's just I don't use it at all.' ( FG2, Female, smoking group, under 21, in further education)

Reasons for giving up vaping

5.30 In this study, 90% of smokers had tried vaping, but only 39% said they were current vapers. This section explores the reasons that young adults gave for stopping vaping and returning to smoking. Many of these have already been mentioned above.

• E-cigarettes are felt to be an inadequate substitute for cigarettes: Smokers talked about the 'draw' or the 'kick at the back of the throat' which they get from a cigarette, but which they said they did not get from some e-cigarette devices. Others said that the e-cigarette simply did not satisfy their craving, or that it did not help them cope with stress in the same way as a tobacco cigarette.
• E-cigarettes taste unpleasant: Although young adults were aware that there was a wide range of flavoured liquids to choose from, not all were interested in exploring and sampling different liquids or could afford to do so. Therefore, if they had an unpleasant experience with the taste the first few times they tried one, they sometimes did not look further. One young man (a former smoker) said that he stopped using his e-cigarette (and now no longer smokes anything) when his preferred liquid began to be manufactured by a different company and the taste changed.
• The individual was concerned about their health: Some smokers said that they noticed they began coughing more once they stopped smoking and started vaping. Others were concerned that their constant use of the device was resulting in them getting too much nicotine.
• The individual was concerned about safety: Some were put off using e-cigarettes because of stories they had read (in the media or social media) about faulty and leaking devices causing injury or harm.
• E-cigarettes are too 'futtery (fiddly)': While some young adults (the enthusiasts) enjoyed the technical aspects of using e-cigarettes, others found that the ongoing requirement to charge the device, replace various components, and to clean and refill the reservoir at regular intervals, just turned them off.
• The individual 'forgot about it': Participants sometimes 'forgot' to charge their devices - and expressed frustration at being unable to use a vaping device with a flat battery. Others said they went on holiday and forgot to take their e-cigarette device, and so started smoking again while they were away.
• The device was broken or stolen: Participants talked about how easily the devices (particularly the pen devices) could break. Some had purchased several devices because each one had broken, but eventually gave up due to the expense and went back to smoking cigarettes. There were also occasional cases where an individual's device had been stolen.
• The individual lost interest: Some who started vaping because they wanted to do smoke tricks said they simply lost interest.