A qualitative study of e-cigarette emergence and the potential for renormalisation of smoking in UK youth
de Lacy, E.
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Background: Growth of e-cigarette use among smokers has raised concerns over uptake by non-smokers, particularly young people. Legislative changes aimed in part at reducing youth exposure to e-cigarettes include the EU Tobacco Products Directive (TPD). A core justification for such measures is the belief that e-cigarettes can lead to tobacco smoking through mechanisms of renormalisation including: mimicking and normalizing the act of smoking; increasing product acceptability via marketing; nicotine exposure. These mechanisms are here explored in relation to findings from qualitative research. Methods: This paper reports results from twenty-one group interviews with 14–15 year olds in Wales, England and Scotland, conducted as part of an ongoing evaluation of the impact of the TPD on youth smoking and e-cigarette use. Interviews were conducted around the end of the transitional period for TPD implementation, and explored perceptions of e-cigarettes and tobacco, as well as similarities and differences between them. Results: Young people differentiated between tobacco and e-cigarettes, rejecting the term e-cigarette in favour of alternatives such as ‘vapes’. Experimental or occasional use was common and generally approved of where occurring within social activity with peers. However, regular use outside of this context was widely disapproved of, unless for the purpose of stopping smoking. Increased prevalence of e-cigarettes did not challenge strongly negative views of smoking or reduce perceived harms caused by it, with disapproval of smoking remaining high. Nicotine use was variable, with flavour a stronger driver for choice of e-liquid, and interest more generally. Conclusion: The extent to which participants differentiated between vaping and smoking, including styles and reasons for use in adults and young people; absence of marketing awareness; and continued strong disapproval of smoking provides limited support for some of the potential mechanisms through which e-cigarettes may renormalise smoking. However caution over nicotine exposure is still necessary.
International Journal of Drug Policy;
Brown, R., Bauld, L., de Lacy, E., Hallingberg, B., Maynard, O., McKell, J., Moore, L. and Moore, G. (2020) 'A qualitative study of e-cigarette emergence and the potential for renormalisation of smoking in UK youth', International Journal of Drug Policy, 75, p.102598. DOI: 10.1016/j.drugpo.2019.11.006.
Article published in International Journal of Drug Policy on 27 November 2019 (online), available open access at: https://doi.org/10.1016/j.drugpo.2019.11.006.
Cardiff Metropolitan University (Grant ID: Cardiff Metropolian (Internal))
Funded by the National Institute for Health Research (NIHR) in England under its Public Health Research Board (grant number 16/57/01).
The work was undertaken with the support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UKCRC Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged.
The work was undertaken with support from the School Health Research Network (SHRN). SHRN is part of the National Centre for Population Health and Wellbeing Research funded by Health and Care Research Wales, Welsh Government (http://www.healthandcareresearch.gov.wales/).
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