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

7 Young adults' views about vaping as a gateway to smoking

7.1 The possible 'gateway' effect of e-cigarettes ( i.e. that e-cigarettes might be taken up by non-smokers and later result in a progression to cigarette smoking) has been the subject of much debate in the public health community and in the media. For this reason, e-cigarette use by children and adolescents has been a particular focus of concern. However, there is currently insufficient evidence to say whether the gateway effect will materialise to the extent that it poses a significant public health challenge. In order to make a contribution to this debate, participants in all the focus groups were asked their opinions on the question of whether people who do not smoke might be likely to take up vaping, and from there, to progress to smoking.

Non-smokers taking up vaping

7.2 As previously discussed, participants gave various reasons for why they started vaping - some of which had nothing to do with quitting smoking. Some said they initially wanted to try an e-cigarette out of curiosity, to taste a particular flavour, to do smoke tricks, or 'because it looked cool'. While some of the non-smokers in this research had tried vaping (usually out of curiosity), these participants were unanimous that they were not interested in vaping in the longer term. Those who had never tried vaping expressed a strong distrust about the safety and perceived 'healthiness' of e-cigarettes. Some had asthma and saw e-cigarettes in the same light as ordinary tobacco cigarettes.

7.3 At the same time, participants across all groups said that they had often seen young children and teenagers using e-cigarettes, or hanging around outside of shops that sell e-cigarettes. Some expressed 'shock' at seeing young teenagers vaping while walking down the street with their parents.

7.4 There was a recurring view expressed that e-cigarettes are made to seem particularly appealing to children - because of the flavours and colours.

'It's made very attractive… because there was a point where I was like, "Oh I wouldn't mind just trying it once." I probably won't because I would like to know what is in it. But you see everyone doing it and sometimes they smell really nice, like sometimes they smell awful, but sometimes you're like, "That smells nice." And people will be like, "Do you want to try it?" and you'd be like - with a cigarette you'd be like "No" - but with that, I think you're not maybe thinking, "Oh I'll get addicted to it", or "No, it'll taste harsh", you're thinking, "Oh it's just a cool flavour", do you know what I mean?'' ( FG12, Female, non-smoking group, aged 19-25, in employment)

7.5 Participants also commented that e-cigarettes were widely perceived not to be harmful, and since it was possible to use e-cigarettes without nicotine (thus avoiding nicotine addiction), this also encouraged young people to try them even if they had not previously smoked.

Views about the possible progression from vaping to smoking

7.6 There was some disagreement among young adults about whether non-smokers might be inclined to take up smoking after having tried an e-cigarette. The most common view was that it would be unlikely for the following reasons:

• Taste: 'But then somebody that's never smoked, they're just used to smoking the vape like, and then they go and get a real fag and they go "Yuck!''' ( FG11, Female, vaping group, aged 19-25, in employment)
• Cost: 'But if you start on an e-cig and you're paying less money and you get all these awesome flavours and whatnot, and then you try a cigarette and it tastes horrendous, you're probably not going to want to smoke, and for the price as well, like £10 a go.' ( FG7, Male, vaping group, aged 19-25, unemployed)
• People think vaping is 'better for them' than smoking: 'I don't think so. I think people when they start vaping, they vape more because they think it's better for them than what smoking is.' ( FG13, Female, non-smoking group, aged under 21, in employment)
• Vaping is 'just a phase': 'My little brother came home with one, he's a health freak, and just because of the simple fact it was a Jägerbomb flavour, he came home with this vape stick, no nicotine in it, but he had it for a couple of weeks and it was just a phase, he just put it away and that was it.' ( FG8, Female, smoking group, aged 19-25, in employment)

7.7 However, others thought the progression to smoking might occur in certain circumstances or that certain individuals might be inclined to start smoking after trying vaping.

'I think it depends on the personality, because you're either interested or you're not.' ( FG12, Female, non-smoking group, aged 19-25, in employment)

7.8 Participants also pointed to the 'hassle' of vaping which could make smoking seem more attractive to some people:

'I think so because sometimes the vape can be a bit of a hassle, like if it runs out of charge and you're on a night out then you're going to go and buy cigarettes, and then that's when you start, when you have that one cigarette when you're drunk.' ( FG11, Female, vaping group, aged 19-25, in employment)

7.9 There were a few participants who knew of someone (usually a younger teenager) who had started smoking after experimenting with vaping. The general view, however, was that this was unusual.

7.10 Some non-smokers also thought that certain people might be inclined to take up smoking after trying vaping. However, all said that they themselves would not be interested in this.