Motivations for use, identity and the vaper subculture: a qualitative study of the experiences of Western Australian vapers

Effects of vaping on physical and mental health in at-risk populations (VAPE): mixed-methods study of motivations for and perspectives on vaping in patients with opioid use disorder

BACKGROUND

Vaping is increasing in popularity. Vape products are offered in a wide variety and promise to reduce harms associated with cigarette smoking, among other claims. The motivations for vaping in patients with substance use disorder are largely unknown.

AIMS

To describe perceptions and motivations regarding vaping among patients with opioid use disorder (OUD) who vape.

METHOD

A convergent mixed-methods study design was used, and individual, semi-structured interviews were conducted with 41 individuals with OUD who were receiving medication for OUD and also vaped. An inductive data-driven approach was employed to characterise perspectives on vaping.

RESULTS

The mean ages at which participants had been introduced to vaping and initiated regular vaping were 33.95 years (s.d. 12.70) and 34.85 years (s.d. 12.38), respectively. Daily vaping (85%) of nicotine, flavoured nicotine or cannabis was common, with 27% reporting vaping both nicotine and cannabis. Qualitative analysis identified 14 themes describing motivations for vaping, including viewing vaping as a smoking cessation tool, convenience and popularity among youth.

CONCLUSIONS

Mixed-methods findings indicated that patients with OUD who vape perceived vaping to be healthier, cleaner and more convenient than cigarette and cannabis smoking, without appreciating the health risks. The perspectives reflected the importance of health education, guidelines and screening tools for vaping and could provide direction for healthcare providers and future vaping cessation programmes.

The transition from cigarette smoking to the exclusive or partial use of e-cigarettes: A multi-stage mixed methods study among French university students

BACKGROUND

Few studies have estimated the frequency of e-cigarette use by smoking status among French young adults, and how those who smoke tobacco start and continue to use e-cigarettes. Our aim was to describe e-cigarette use among students who smoked tobacco.

METHODS

A multi-stage, mixed methods study was conducted at the University of Bordeaux between September 2018 and March 2020. The study consisted of three different sub-studies: 1) a cross-sectional study across five campuses (n = 211), 2) a qualitative study (n = 30), and 3) an online cross-sectional study (n = 415). These were combined to form an explanatory sequential design (stage 1) and then a convergent parallel design (stage 2).

RESULTS

Although 41 % of students had tried e-cigarettes at least once in their lifetime, only 7 % were current users. Both e-cigarette experimentation and current use (i.e. occasional or daily use) were mainly found among current and former smokers. Student smokers started using e-cigarettes out of curiosity, with other vapers. Two main factors were identified as intervening in the transition from smoking to sustained vaping: the perception of smoking as problematic and personal commitment to e-cigarette use (i.e. by buying their own device, acquiring technical skills, and increasing the frequency of use). Among current vapers, exclusive vapers and dual users differed in terms of their smoking goals, the role they attributed to e-cigarettes, their identity development and their perceived social or personal benefits.

CONCLUSION

This study highlighted the complexity of the decision-making process for transitioning from smoking to sustained vaping among university students. This required a socially supportive environment and some intrinsic factors, of which the problematization of smoking and personal commitment to vaping were key factors.

"If I could try it, I'd try it": Qualitative study of the illegal vaping culture in Singapore

Aims and background

Singapore has one the world's strictest e-cigarette (vaping) regulations, with bans on e-cigarette import, sale, purchase, use and possession. Nevertheless, Singapore is seeing a growing vaping trend. Beyond estimates of vaping prevalence, little is known about vaping in countries where it is banned or the features and drivers of such illegal vaping cultures. This qualitative study thus explored the characteristics of Singapore's illegal vaping culture.

Methods

We held ten focus group discussions with 63 Singaporeans aged 21-40 years, exploring participants' experiences and views related to vaping in Singapore. Transcripts of the discussions were coded using deductive and inductive coding methods.

Results

Despite its illegal status, vaping was perceived as appealing due to the novelty flavours, ease of use, and convenient access. Harm perceptions were mixed, with concerns over the adverse health impacts along with beliefs that vaping was innocuous when used in moderation. A conspicuous vaping culture among young people, along with perceptions of lax enforcement, drove beliefs that vaping is an entrenched social norm in Singapore. This belief was in turn associated with a sentiment that Singapore should introduce a regulated e-cigarette market to better control its use among the general population.

Conclusions

The reinforcement of vaping as a social norm appears to be driving an illegal vaping culture in Singapore. Measures that denormalise vaping could help to strengthen the effectiveness of the vaping ban.

Relationship Between Product Features and the Prices of e-Cigarette Devices Sold in Web-Based Vape Shops: Comparison Study Using a Linear Regression Model

BACKGROUND

Open-system electronic cigarette (EC) product features, such as battery capacity, maximum output wattage, and so forth, are major components that drive product costs and may influence use patterns. Moreover, continued innovation and monitoring of product features and prices will provide critical information for designing appropriate taxation policies and product regulations.

OBJECTIVE

This study will examine how product features are associated with the prices of devices sold in web-based vape shops.

METHODS

We draw samples from 5 popular, US-based, web-based vape shops from April to August 2022 to examine starter kits, device-only products, and e-liquid container-only products. We implemented a linear regression model with a store-fixed effect to examine the association between device attributes and prices.

RESULTS

EC starter kits or devices vary significantly by type, with mod prices being much higher than pod and vape pen prices. The prices of mod starter kits were even lower than those of mod devices, suggesting that mod starter kits are discounted in web-based vape shops. The price of mod kits, mod device-only products, and pod kits increased as the battery capacity and output wattage increased. For vape pens, the price was positively associated with the volume size of the e-liquid container. On the other hand, the price of pod kits was positively associated with the number of containers.

CONCLUSIONS

A unit-based specific tax, therefore, will impose a higher tax burden on lower-priced devices such as vape pens or pod systems and a lower tax burden on mod devices. A volume- or capacity-based specific tax on devices will impose a higher tax burden on vape pens with a larger container size. Meanwhile, ad valorem taxes pegged to wholesale or retail prices would apply evenly across device types, meaning those with advanced features such as higher battery capacities and output wattage would face higher rates. Therefore, policy makers could manipulate tax rates by device type to discourage the use of certain device products.

Prevalence, lived experiences and user profiles in e-cigarette use: A mixed methods study among French college students

BACKGROUND

Little is known about e-cigarette use in French students. Our aims were to estimate the prevalence of e-cigarette experimentation and current e-cigarette use; describe the reasons for using e-cigarettes; explore the vaping experience and identify the profiles of e-cigarette users.

METHODS

We used a sequential, explanatory mixed methods design in a sample of French college students. Quantitative data was collected online for a cross-sectional analysis among 1698 students. Two separate analysis based on the thematic analysis and the Grounded Theory were also performed in 20 semi-structured interviews, focusing former and current smokers also current vapers.

RESULTS

The prevalence of e-cigarette experimentation was 39.3% (95% CI: 35.2-44.0) and 5.1% (95% CI: 3.2-8.0) of students were current e-cigarette users. Experimentation was opportunistic while current usage was rational, requiring to acquire a personal electronic device, getting used to its technicality, appreciating its availability, discretion, and learning the practice. In this context, three distinct groups of e-cigarette users were identified, based on assumed identity, tobacco and e-cigarette use, the functions assigned to e-cigarettes, and intentions with regards to vaping in the future.

CONCLUSION

Despite some limitations mainly related to the participants self-selection, this research showed that while many smokers and former smokers have tried e-cigarettes in this student population, few have continued to use them continuously. Moreover, these current e-cigarette users were a heterogeneous group. Longitudinal studies are needed in young adult smokers for a better understanding of how their tobacco and e-cigarette use affect each other and change over time.

The Compassion Club: A New Proposal for Transformation of Tobacco Retail

INTRODUCTION

One major assumption in the current tobacco industry is the distribution of tobacco products through a system of commercial for-profit retail. However, other models of distribution that do not rely on this mechanism exist.

AIMS AND METHODS

In this review, we examine the potential of a nonprofit Compassion Club model and discuss how the current existence of independent vape stores might provide the infrastructure to allow the transformation of tobacco distribution.

RESULTS

Compassion Clubs exist internationally with different levels of regulation and legality and have generally been focused on the distribution of illegal drugs or hard-to-access pharmaceuticals. They provide access to drugs for existing users, limit access by novices, limit negative impacts from illicit markets, and provide social support focused on reducing harms associated with drug use.

CONCLUSIONS

With decreasing prevalence of tobacco use in many countries and growing interest in a tobacco endgame, a Compassion Club model of distribution could help transition tobacco away from the model of commercial widely available distribution. More work is needed to develop the regulations and policies that might guide a compassion club model.

IMPLICATIONS

Compassion clubs are a model for the distribution of psychoactive substances that are focused on harm reduction and social support rather than profit. There has been little discussion about the possibility that this promising model could be applied to help transform the tobacco industry. Many independent vape stores already demonstrate aspects of the compassion club model that could be used to support a transition.

Psychoactive Comfort Products or Snacks: How Chinese Young Adults Perceive the Potentially Addictive Nature of E-Cigarettes

The potential health value and pitfalls of e-cigarettes are currently under dispute in the scientific community. Exploring young adult e-cigarette users' perceptions would assist in adding a public dimension of understanding to the literature and in scientific public health decision making. Therefore, in this study, we collected and analyzed data from interviews with young adult (n = 14) e-cigarette users and found that many referred to e-cigarettes as "snacks," indicating that they considered that both their frequency of use and addiction were manageable and that they could stop using e-cigarettes at any time. To further understand the behavior of Chinese young adults in relation to their perception of e-cigarettes as a "snack", the study developed a social context framework (crossroads model) and psychological judgment model to explain how youth e-cigarette users' perception of "controlled addiction and ready cessation" arises. These models can be used to assess the effectiveness of e-cigarette policy.

Navigating social interactions and constructing vaping social identities: A qualitative exploration with New Zealand young adults who smoke

INTRODUCTION

Social interactions help smoking and vaping practices evolve, and are essential when constructing social identities. Among people who smoke, vaping offers an alternative practice to 'smoking' and 'non-smoking', and using e-cigarettes blurs the boundaries between 'smoker' and 'non-smoker' social identities. In this study, we explored the development of vaping and smoking social identities over time among young adults who smoked and used e-cigarettes.

METHODS

Over 18-24 weeks during 2018-2019, we conducted five interviews with each of 11 New Zealand young adults aged 19-29 years who tried vaping to stop smoking. We analysed participants' interview transcripts for social interactions involving smoking or vaping and used social identity theory to explore their construction of vaping social identities.

RESULTS

Participants entered the study with smoke-free goals, and constructed social identities explicitly in relation to a smoke-free transition. Two key identity processes, 'adopting legitimacy' and 'transferring considerateness', informed participants' social identity construction as they attempted to reconcile their e-cigarette use with their pre-study characterisations of vaping as 'illegitimate' and 'obnoxious'. Our findings suggest that adopting a 'legitimate' vaper identity focussed on smoking cessation, and being perceived and accepted by others as a 'legitimate vaper', were essential in participants' identification as 'vapers'. Identifying as a 'legitimate' vaper was a pre-requisite to transferring a 'considerate' identity from smoking to vaping.

DISCUSSION AND CONCLUSION

Participants' construction of vaping social identities suggests that negotiating and reconciling valued aspects of a smoking social identity with nascent vaping practices may be important during smoking-to-vaping transition attempts.

The emergence of e-cigarette retail shops in a regulated tobacco control environment

ISSUE ADDRESSED

E-cigarettes are of growing concern. We aimed to determine the location and characteristics of retail shops selling e-cigarette products in Perth, Western Australia.

METHODS

Two phase study: (i) identifying all e-cigarette retailers in the Greater Capital City Statistical Area of Perth; (ii) audit at the point-of-sale to assess products, promotions and shop characteristics (n = 41).

RESULTS

Ninety-eight retailers selling e-cigarette products were identified: 43 tobacconists (44%), 21 vape shops (21% - up from one shop in 2017), 14 supermarkets (14%), 12 service stations (12%) and 8 smoke shops (8%). The most common e-cigarette product was non-nicotine e-liquid, available at 38 (93%) stores audited. Most stores sold parts of e-cigarette devices (n = 25, 61%). Front counter displays were the most frequent form of promotion (n = 40, 98%). Vape shops differed from other retailers, having bar-style layouts (n = 15, 71%), lounge areas (n = 7, 33%) and free e-liquid samples (n = 17, 89%).

CONCLUSION

The availability of e-cigarette products from retail shops and particularly vape shops is increasing. E-cigarette retailers are using traditional promotional techniques including point-of-sale displays to market their products, while vape shops are extending their appeal through bar style, lounge layouts and free trials.

IMPLICATIONS FOR PUBLIC HEALTH

Understanding the e-cigarette retail store environment is essential for identifying emergent trends, potential regulations and future research. SO WHAT?: The e-cigarette retail market in the Perth is growing, shops using traditional and new promotional techniques to market e-cigarette products. Our findings identify a need for public health surveillance, regulations and legislation.

"They're sleek, stylish and sexy:" selling e-cigarettes online

OBJECTIVE

We examined the product range, marketing strategies, access and marketing claims made by Australian and New Zealand (NZ) online e-cigarette retailers.

METHODS

Twenty Australian (n=10) and NZ (n=10) e-cigarette retail websites were identified via Google using a combination of keywords nominated by an expert panel and identified via a literature review: 'e-cigarette', 'e-cigs', 'vape', and 'vaping', combined with 'Australia', 'AU', 'New Zealand' and 'NZ' and then examined.

RESULTS

Products were extensive (disposable, pod-based, reusable, replacement parts), 95% (n=19) offered 'Starter Kits,' flavoured e-liquid (n=1,032), most containing nicotine (70%, n=14). Most retailers (85%, n=17) offered price discounts and free delivery. There were unsubstantiated health claims (80%, n=16), cessation claims (65%, n=13) and cost-benefit claims (50%, n=10) promoting e-cigarette use. Most (n=14) website age verification features simply required the purchaser to indicate they were aged 18 years.

CONCLUSIONS

Although e-cigarette regulations are different in Australia and NZ, the online product range, marketing strategies, access and marketing claims were similar and sold e-liquid containing nicotine. The health and cessation e-cigarette marketing claims were outlandish and unsubstantiated.

IMPLICATIONS FOR PUBLIC HEALTH

Most purchasing of e-cigarettes occurs online. Regulations and enforcement to limit access and stop unsubstantiated marketing claims must be a public health priority.

Subculture wars: The struggle for the vape industry

Drawing on a 2-year study, I argue that the UK vape industry is engaged in a classificatory struggle between a subcultural industry and its "other", the mainstream industry. I build on Thornton's analysis of club culture to characterize the subcultural vape industry as a community of taste built round a masculine aesthetic and a commitment to authenticity and DIY practice. Its attachment to complex systems and masculine spaces risked excluding customers without specialist knowledge or interest. The mainstream industry included tobacco companies which promoted vaping as a complementary category to smoking, linking their own vaping products to historic meanings of the cigarette as a lifestyle product. This task was hampered by the toxic legacy of combusted tobacco and its increasing reversion to a generic category rather than a branded product. Finally, the success of the price-focused vaping industry has been largely overlooked, but suggests that for most consumers, electronic cigarettes are still a contrasting category to combusted tobacco and are purchased largely on price. I conclude that the exclusion of a feminized, classed "other" is a defining element of subcultural formation, itself an overwhelmingly male mechanism of group identity construction.

Inhaled or Ingested, Which Is Worse, E-Vaping or High-Fat Diet?

Long term e-cigarette vaping induces inflammation, which is largely nicotine independent. High-fat diet (HFD) consumption is anoter cause of systemic low-grade inflammation. The likelihood of using e-cigarettes as a weight control strategy is concomitant with the increase in obesity. In Australia, only nicotine-free e-fluid is legal for sale. Therefore, this study aimed to investigate how nicotine-free e-cigarette vapour exposure affects inflammatory responses in mice with long term HFD consumption. Mice were fed a HFD for 16 weeks, while in the last 6 weeks, half of the chow and HFD groups were exposed to nicotine-free e-vapour, while the other half to ambient air. Serum, lung, liver and epididymal fat were collected to measure inflammatory markers. While both e-vapour exposure and HFD consumption independently increased serum IFN-γ, CX3CL1, IL-10, CCL20, CCL12, and CCL5 levels, the levels of IFN-γ, CX3CL1, and IL-10 were higher in mice exposed to e-vapour than HFD. The mRNA expression pattern in the epididymal fat mirrors that in the serum, suggesting the circulating inflammatory response to e-vapour is from the fat tissue. Of the upregulated cytokines in serum, none were found to change in the lungs. The anti-inflammatory cytokine IL-10 was increased by combining e-vapour and HFD in the liver. We conclude that short-term nicotine-free e-vapour is more potent than long term HFD consumption in causing systemic inflammation. Future studies will be needed to examine the long-term health impact of nicotine-free e-cigarettes.

E-Cigarette Promotion on Twitter in Australia: Content Analysis of Tweets

BACKGROUND

The sale of electronic cigarettes (e-cigarettes) containing nicotine is prohibited in all Australian states and territories; yet, the growing availability and convenience of the internet enable the promotion and exposure of e-cigarettes across countries. Social media's increasing pervasiveness has provided a powerful avenue to market products and influence social norms and risk behaviors. At present, there is no evidence of how e-cigarettes and vaping are promoted on social media in Australia.

OBJECTIVE

This study aimed to investigate how e-cigarettes are portrayed and promoted on Twitter through a content analysis of vaping-related tweets containing an image posted and retweeted by Australian users and how the portrayal and promotion have emerged and trended over time.

METHODS

In total, we analyzed 1303 tweets and accompanying images from 2012, 2014, 2016, and 2018 collected through the Tracking Infrastructure for Social Media Analysis (TrISMA), a contemporary technical and organizational infrastructure for the tracking of public communication by Australian users of social media, via a list of 15 popular e-cigarette-related terms.

RESULTS

Despite Australia's cautious approach toward e-cigarettes and the limited evidence supporting them as an efficacious smoking cessation aid, it is evident that there is a concerted effort by some Twitter users to promote these devices as a health-conducive (91/129, 70.5%), smoking cessation product (266/1303, 20.41%). Further, Twitter is being used in an attempt to circumvent Australian regulation and advocate for a more liberal approach to personal vaporizers (90/1303, 6.90%). A sizeable proportion of posts was dedicated to selling or promoting vape products (347/1303, 26.63%), and 19.95% (260/1303) were found to be business listings. These posts used methods to try and expand their clientele further than immediate followers by touting competitions and giveaways, with those wanting to enter having to perform a sequence of steps such as liking, tagging, and reposting, ultimately exposing the post among the user's network and to others not necessarily interested in vaping.

CONCLUSIONS

The borderless nature of social media presents a clear challenge for enforcing Article 13 of the World Health Organization Framework Convention on Tobacco Control, which requires all ratifying nations to implement a ban on tobacco advertising, promotion, and sponsorship. Countering the advertising and promotion of these products is a public health challenge that will require cross-border cooperation with other World Health Organization Framework Convention on Tobacco Control parties. Further research aimed at developing strategies to counter the advertising and promotion of e-cigarettes is therefore needed.