good thesis statements for vaping

• Research article
• Open access
• Published: 15 October 2020

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

• Kahlia McCausland   ORCID: orcid.org/0000-0001-7071-6491 1 ,
• Jonine Jancey 1 ,
• Tama Leaver 2 ,
• Katharina Wolf 3 ,
• Becky Freeman 4 &
• Bruce Maycock 1 , 5  

BMC Public Health volume  20 , Article number:  1552 ( 2020 ) Cite this article

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Vaping is a relatively new practice, and therefore its symbolic meanings and social practices are yet to be fully understood, especially within Australia where the practice is strictly regulated. This study aimed to examine vapers motivations for use, reinforcing influences, and association with the vaper subculture.

Working from a constructivist epistemology and a symbolic interaction framework, in-depth interviews were conducted with a purposive sample of 37 current (89%) and former (11%) adult vapers, 70% male, mean age of 32.5. Data was analysed via thematic analysis.

Vapers largely started vaping to quit smoking and underwent common experiences during their initiation phase. Subsequently, vapers tended to adopt one of two dominant identities, that of the ‘cloud chaser’ or the ‘substitute’, which some users moved between during different stages of their vaping career. The social and symbolic meaning of e-cigarettes and vaping varied and involved concepts of harm reduction, addiction, pleasure, stigma and community, and for some, connection to the vaper subculture.

Conclusions

Understanding the complexities of vaping, and the nuanced differences of ‘cloud chasers’ and ‘substitute’ vapers may have important implications for health communication, research and policy. E-cigarette users within this sample were not a homogeneous group and differed in their motivations for use, association with the vaper subculture and relationship with the vape community. These findings provide new insights into the socialisation process and subsequent identity adoption of vapers within the unique regulatory environment of Western Australia.

Peer Review reports

Since entering the American market in 2007 [ 1 ], e-cigarettes have undergone a rapid evolution, with three broad classifications of vaping devices now recognised i) disposable (cig-a-like), ii) closed reusable (vape pen, pod-based), and iii) open reusable (mod) [ 2 ]. Cig-a-likes closely resemble a cigarette with a glowing tip that lights up upon inhalation and is disposed of once the e-liquid is consumed. Closed reusable systems use replaceable pre-filled cartridges which tend to be limited in functionality (i.e. inability to adjust the temperature) and were originally designed to resemble cigarettes. However, the most recent generation of closed reusable vaping devices, pod-based systems, have diverged from cigarettes and now resemble USB sticks [ 2 ]. Finally, open reusable systems comprise a refillable liquid reservoir or ‘tank’, which users fill with their preferred choice of e-liquid.

E-cigarettes were originally developed as an alternative form of nicotine delivery and potential smoking cessation device [ 3 ]. However, over the short period since their inception, they have transformed into high-tech nicotine delivery devices appealing to both non-smokers and youth [ 4 ], an outcome largely stemming from increased investment by the tobacco industry [ 5 ]. This investment has contributed to their use moving beyond their touted role as a nicotine replacement and tobacco cessation device, to a social, recreational and sensory delivery device [ 6 ] associated with new rituals and social practices [ 7 ].

Smokers cite numerous reasons for starting vaping, these include: to ease nicotine cravings and withdrawal symptoms; to quit smoking or avoid relapse; to use e-cigarettes where smoking is prohibited; reduce cost; and the belief that e-cigarettes are less harmful than tobacco [ 8 , 9 , 10 , 11 ]. However, recently, research has investigated the rise in ‘alternative’ e-cigarette use behaviours such as dripping (i.e. applying e-liquid directly on the atomiser) [ 12 ] and vape tricks (i.e. creating shapes from exhaled aerosol) [ 12 , 13 ] which may contribute to the perception that e-cigarettes are ‘cool’ or to be used for recreation [ 13 ].

Research from Europe has explored e-cigarette user’s motivations, self-identity as vapers and involvement in vaping subcultures. Farrimond [ 14 ] identified differing motivations for use of, and varying political engagement in, vaping regimes among a sample of vapers in the United Kingdom (UK) and constructed three main typologies to describe these users: vaping for pleasure, vaping as medical treatment and ambivalent e-cigarette use, suggesting that the motives of vaping may be linked to different social identities. Similarly, a study of Norwegian vapers identified two dominant vaper identities, who Tokle and Pedersen [ 15 ] labelled ‘cloud chasers’ and ‘substitutes’. Cloud chasers were dedicated vapers who identified with symbols and values in the subculture, many of whom were politically engaged in improving e-cigarette regulation, describing a sense of belonging to the vape community. Whereas substitute vapers were former daily smokers who used e-cigarettes for smoking cessation, to improve their health, escape the stigma of smoking and manage nicotine addiction. These studies echo other international research pointing to the symbolic and identity aspects of vaping [ 16 , 17 , 18 , 19 ].

Vaping is a relatively new practice, and therefore its symbolic meanings and social practices are yet to be fully understood. However, it appears that through the uptake of vaping, personal and collective identities have been established and a vaping subculture has emerged [ 14 , 15 , 20 ]. Considering the limited extant research investigating e-cigarette use within Australia, this study aimed to examine vapers motivations for use, reinforcing influences, and association with the vaper subculture within Western Australia.

In Australia, liquid nicotine is classified as a ‘Schedule 7-Dangerous Poison’ under the Federal Poisons Standard [ 21 ]. Hence, the only legal avenue for obtaining it is through a personal importation scheme [ 21 ], which states the user must have a prescription from a physician. E-cigarettes that do not contain nicotine can be sold in some Australian jurisdictions, provided manufacturers do not make therapeutic claims. However, in Western Australia, the context of this study, it is currently an offence under the Tobacco Products Control Act 2006 [ 22 ] to sell products that resemble tobacco products, regardless of whether they contain nicotine or not.

Since the early 1990s, Governments in Australia have enacted progressive comprehensive legislation to reduce the impact of tobacco [ 23 ], and as a result, smoking rates have steadily declined. The 2019 National Drug Strategy Household Survey (NDSHS) [ 24 ] reports daily tobacco smoking rates in Australia have more than halved (11.0%) since 1991 (24.3%), and the daily use of tobacco products is most common among people aged 40–59 years (31.7%). Conversely, e-cigarette use has increased and current use is most common among those aged 18–29 (32.4%). During the time this study was undertaken the number of vape retail stores within the Greater Capital City Statistical Area (GCCSA) of Perth, Western Australia, had multiplied exponentially [ 25 ], which has resulted in increased exposure and access to these products, and perhaps reflects an increase in demand.

Vaping devices are referred to by users and scholars by a multitude of terms, including e-cigarette, ENDS (electronic nicotine delivery device), vape and mod. In this paper, the term e-cigarette is used to represent all of the various consumer products available.

Theoretical framework

Symbolic interactionism is a micro-level sociological theory providing the theoretical framework underpinning this study [ 26 ]. Symbolic interactionism is situated in a constructivist epistemology, focussing on the interactions between individuals rather than large scale social structures, examining how people navigate their interactions with others and allocate meanings based on their interpretation of those interactions [ 26 , 27 ]. Symbolic interactionism has a history of being used to investigate drug use, the creation of deviance, and the exploration of meaning associated with new phenomena [ 28 , 29 , 30 ]. The symbolic interaction framework, therefore, assists in understanding a society (e-cigarette users) which is created through the repeated interactions between vapers [ 26 , 27 ].

Participants were purposively sampled for maximum variation in demographic characteristics (i.e. sex, age, Index of Relative Socio-Economic Advantage and Disadvantage (IRSAD) - a ranking derived from the economic and social conditions of people and households within an area [ 31 ]) within the sampling frame. Data collection and analysis occurred simultaneously (March – November 2018), facilitating appropriate and targeted recruitment. Eligible participants were current and former (vaped within the last 12 months) vapers, aged over 18 years residing within the GCCSA of Perth, Western Australia [ 32 ]. Eligibility criteria were stipulated on all recruitment material.

Recruitment

A multipronged approach to recruit participants was utilised. Recruitment flyers and posts were placed on four online vaping forums (AussieVapers, Vaping in Australia, Vaper Café Australia and E-Cigarette Forum); seven subreddits on Reddit; and 30 closed vaping Facebook groups. The lead author created personal accounts on each of the forums and social media. Facebook groups were accessed by requesting permission to enter the group as a researcher to recruit study participants. Vape retail stores, online and bricks and mortar, within the GCCSA of Perth were contacted via email, social media and webpage submission forms. Snowball sampling was also utilised.

Interested individuals were invited to contact the lead author via email or telephone to express their interest in participating and receive further details about the project and what their participation entailed. After reading the participant information statement and providing informed consent, interviews were arranged at convenient safe public locations (e.g. local café, university campus). Interviews were conducted in English by the lead author who has experience in qualitative data collection. Interviews lasted on average 49 min (range 25–86 min) and were audio-recorded with participant consent. Participants were provided with an AUD$25 gift voucher at completion of the interview as an honorarium for their time.

Data collection

A semi-structured interview guide was developed to allow flexibly and adaptability within each interview [ 33 ], and pilot tested with two participants. The interview guide addressed the following topic areas: reasons for vaping; pathway to using; knowledge, attitudes, and beliefs associated with e-cigarette use; devices and products used; means of accessing products; attitudes of friends, family and society towards vaping and their use; and emergent subculture (see Additional file  1 ). As new ideas and concepts were identified within the data these data-driven concepts were fed back into the data collection process and further guided sampling and adaption of the interview guide [ 34 ]. Sampling was terminated when thematic saturation was reached [ 35 ], which was determined through the constant comparison of data with preceding data until few new themes were generated.

Analysis and interpretation

All interviews except one (file corrupt) were transcribed verbatim by an independent professional transcription service and checked for accuracy by the lead author. The detailed notes taken by the lead author during and after interviews were sent via email to the participant the following day to review for accuracy and validation. Amendments from the participant were returned via email. Transcripts and interpretations were not provided to participants for respondent validation. Interview transcripts and detailed notes were anonymised and imported into NVivo (v12) to facilitate data organisation and linkage. The lead author conducted all coding, allowing for a single researcher to be immersed in both the data collection and analysis, thereby ensuring that the coding frame adequately described the intentions and content of the interviews [ 36 ].

The analytical process followed the steps proposed by Braun and Clarke [ 37 ] for thematic analysis and drew upon the initial and axial coding process of grounded theory [ 38 ]. The lead author played an active role in the analysis by searching for and identifying themes “to theorize the sociocultural contexts, and structural conditions, that enable the individual accounts that are provided” [ 37 ] (p. 85). Line-by-line analysis was undertaken to look for patterns of meaning and issues of interest important to the research objective and to generate a range of initial codes [ 38 ]. Codes were developed based on theoretical interest and emergent concepts that arose during interaction with and interpretation of the data. Axial coding examined the initial codes at a conceptual level to combine and connect codes to form overarching ‘candidate’ themes and subthemes in a meaningful way for the phenomenon under investigation [ 38 ]. Revision of the candidate themes then occurred at two levels. Level one involved reviewing all the data collated under each candidate theme to consider whether the data formed an intelligible pattern [ 37 ]. Some themes and sub-themes were refined during this process to create new themes/subthemes and to separate and combine others [ 37 ]. Level two involved a similar process, whereby the data were reviewed and further refined. This process, however, concerned the validity of the individual themes in relation to the data set ensuring participants meanings and voices were accurately reflected [ 37 ]. A detailed analysis was then written for each theme to report the content and meaning of patterns [ 37 ]. Working theme titles were reviewed to ensure they accurately reflected the respective analysis and the most vivid quotes were selected that best illustrated the essence of the point being described [ 37 ].

Strategies to enhance the rigour of the research included the use of a codebook to provide structure and agreement about code definitions, constructs, and themes; in-depth rich description of the research methods through field notes, personal reflections and analytic memos [ 39 ]; and discussions with team members about meaning and interpretation of findings and conceptual maps [ 40 ].

Demographic and behavioural data were analysed using descriptive statistics (SPSS v26). The reporting of this study is guided by the consolidated criteria for reporting qualitative research (COREQ) checklist [ 41 ] (see Additional file  2 ).

Participants

Thirty-seven interviews were conducted with current ( n  = 33, 89%) and former vapers ( n  = 4, 11%) (Table  1 ), with a mean of age of 32.5 ( SD  = 7.411, range 20–45 years). Thirty-two participants (87%) were current or former cigarette smokers and five (13%) were vaping despite having never been a regular smoker. Five participants were dual users of tobacco and e-cigarettes. Former ( n  = 24, 65%) and current ( n  = 8, 22%) smokers had been using tobacco on average for 14 years ( SD  = 8.268, range 3–38 years). In comparison, participants had been vaping on average for 2.4 years ( SD  = 2.011, range 1 month – 7 years).

Two identities and approaches to vaping emerged from the data, which we labelled ‘substitute’ vapers and ‘cloud chasers’ after the dominant vaper identities constructed by Tokle and Pedersen [ 15 ]. Cloud chasing is the act of expelling large amounts of vapour using an e-cigarette, we use the term in a broader, more symbolic sense. As such, the ‘cloud chaser’ identity is formed by the experiences articulated by 19 dedicated vapers who connect with at least some aspect of the vaper subculture, whether that be engaging with hobbyist activities, the trick culture or technological aspects of vaping. Whereas the experiences of the ‘substitute’ vaper are derived from 18 vapers who primarily viewed vaping as a means to manage their nicotine addiction and quit smoking. The identity prescribed to each user was not ‘fixed’ as some participants described their movement between the two identities over time as the meaning they attributed to vaping changed (i.e. hobby to primarily smoking cessation).

The narrative summary describes the commonalities experienced by vapers and then the experiences unique to the ‘substitute’ and ‘cloud chaser’ identity. Quotes from participants are provided in italics, followed by their pseudonym, attributed identity and age.

The common experience

“can i have a go of that”: an introduction to vaping.

Participants were predominantly introduced to e-cigarettes through work colleagues, friends, and during their time abroad in locations where e-cigarettes were more readily available (e.g. the UK). For the majority of participants, this introduction marked the first occasion they had seen or heard about e-cigarettes. Subsequently, participants asked if they could “have a go on that” or the e-cigarette user suggested they try their vape. No one spoke of being pressured into trying their first e-cigarette with experimentation occurring spontaneously, either alone with the user or in the company of friends. Rarely did participants report communal experimentation where the vape was passed around to multiple people, rather it was most commonly a discrete encounter. Participants were mostly curious to try this device which in most instances functioned like a cigarette, however, were told it was not. Participants regularly reported coughing upon trying their first vape which could be attributed to several factors including the type of device (e.g. first/second versus third/fourth-generation device), device functionality (e.g. variable temperature, wattage, airflow or resistance), nicotine concentration, and the users smoking history, if any. Those who were smokers described this experience as being similar to that of their first drag of a cigarette, whereas non-smokers had difficulty articulating their experience as they had nothing to compare it to.

“As a non-smoker, it was really hard for me to grasp the concept. Everyone was trying to explain it to me like it's either like a cigarette or a bong. I was like, ‘I don't know what you're talking about.’ They were like, ‘mouth-to-lung, or direct-to-lung’ and I still can't even understand the concept. If I had to explain to you what I do, I don't know what I do. I press the trigger, I breathe it in, it comes out.” Karis, cloud chaser [ 33 ]

The inhalation of vapour reportedly took some time to get used to as the vapour from the e-cigarette was “moist” compared to the “dry heat” of a cigarette. Participants went on to purchase an e-cigarette for themselves after enjoying their first experience, or after disliking the encounter chose not to pursue it until another opportunity arose, years later in some instances.

“I was a silly teenager”: motivations for vaping

Thirty-two users were tobacco smokers for many years and described themselves as being “very addicted” which had resulted in several failed quit attempts. Participants had tried multiple methods to quit smoking, including going ‘cold turkey’, hypnotherapy, and nicotine replacement and drug therapies. The increasing cost of tobacco, real and feared deterioration of their health, and encouragement from loved ones to quit smoking were other significant drivers to commence and subsequently maintain vaping. For those users who had never been committed smokers, their motivations for initiating vaping were varied and included socialisation with other vapers, to appease food cravings, and as a diversion from alcohol or illicit drugs.

“On their way to their vaping journey”: starting off

Most participants opted to start their “vaping journey” with a disposable (cig-a-like) or pen-style closed-system device which introduced them to vaping at a rudimentary level, as explained by River [ 42 ] “… something basic, where you push the button, you suck on it…” . Most, however, described these devices as unsatisfying (e.g. mute flavour, inadequate throat hit), poorly fabricated and not producing enough vapour. Subsequently, most participants progressed to an open-system device which provided functionalities to enhance and personalise their flavour profile, adjust temperature, voltage, resistance, airflow and nicotine concentration, and comprised a refillable tank and rechargeable batteries. These features were particularly important for tobacco smoking participants, and were conducive to replicating the “throat hit” they were accustomed to.

“It [e-liquid] had no nicotine in it, as is Australian rules. I ended up actually putting my own [nicotine] in it because it was just, too smooth basically, you could taste it, but you couldn't feel it which is what I want, I want to feel it [throat hit].” Brody, substitute [ 34 ]

Transitioning to vaping from “analogue cigarettes” was a daunting process for some, and more so for those who had never been committed smokers. Participants explained that other vapers had tried to describe to them how they were required to inhale to achieve the desired throat hit and experience the best flavour.

“My friends were kind of just like, ‘Just pull it in. You'll cough if you do it hesitantly.’ I was super scared of just going-- [inhales], on this thing that's firing. The first few times that I did it, I don't think I was doing it properly because I was firing it for a really short amount of time, taking like really small puffs. Then when I did do it properly, I was like, oh this is what it's meant to feel like and taste like." Karina, substitute [ 24 ]

For those who were smokers, they described the inherent challenges, actions and processes of transitioning from cigarettes to e-cigarettes which took perseverance, including no longer lighting a cigarette, maintaining a charged device, importing, mixing and storing liquid nicotine, and accepting the physicality of the device compared to the slender profile of a cigarette.

“Filling it up, charging it up, carrying it around, because it f***ing weighs a ton, as well. It just became too hard filling it up. It was always leaking, and it's not as simple as clicking a button and smoking it. You have to set it to what you want and all that.” Jonathan, substitute [ 27 ]

“A bit of a learning curve”: gaining knowledge and understanding

The majority of users reported being proactive in conducting intensive ‘self-learning’ through the internet and social networking platforms, other vapers, and to a lesser extent, retail stores, to acquire relevant skills (i.e. nicotine strength, mixing and safety; steeping; inhalation style “direct-to-lung” or “mouth-to-lung” ; building and changing coils), information on health and safety, the meaning of vaping specific language and jargon, and troubleshooting techniques. Vape forums, social media (i.e. Facebook) and content sharing platforms (i.e. YouTube) were usually the first resources accessed to acquire knowledge and support. Participants reported simultaneous active (i.e., contributing content) and passive (i.e., viewing content posted) engagement in multiple local and international vaping groups and forums to discuss personal experiences, exchange information, and obtain new knowledge. Passive engagement provided newcomers with an opportunity to observe the online community and its rules, whereas more established vapers kept their “finger on the pulse” by monitoring the rise of new products. Conversely, active contribution to these fora provided opportunities for learning among ‘newbies’ and mentorship for more experienced vapers.

“Well, that's where I got most of my knowledge from [online vaping groups]. It's hard to explain, it's a little family sort of thing, like whether it's starting off fresh or you know plenty of s**t you can always go there, get the advice that you need. That's definitely a helpful thing as well. … You've got people in those groups that have been vaping for 10 or so years, like starting off when it was just a tiny industry, a fresh industry. Then you've got people that are trying to get off the smokes and they ask for advice from there.” Timothy, cloud chaser [ 20 ]

“There is something for everyone”: finding the right product

During the transition phase from cigarettes to vaping, some respondents reportedly struggled to quit smoking, relapsing on occasion, and/or dual using with cigarettes until they found the right combination of flavour, nicotine concentration and device. Finding the right combination was the moment many sensed they could quit smoking, citing the sophisticated features of the second (closed reusable) and third-generation (open reusable) devices most effective for smoking cessation.

“For me, it was getting used to the action but also … finding the right flavours and then it was getting the nicotine level right, then it was finding the right device that was going to satisfy my intake, my draw in and my exhale… I’d buy one and go, ‘Oh it’s a bit crap. I still want a cigarette. Why do I still want a cigarette?’ Then eventually I found another device which was a bit more powerful and I found flavours that I actually liked and so when I found that flavour I can tell you it was 48 hours between finding this particular flavour blend to when I had my last cigarette.” Ursula, cloud chaser [ 43 ]

“I haven’t quit I’ve upgraded”: from one addiction to another

Smoking cessation was viewed very differently to nicotine cessation, with the majority of users opting to continue using nicotine in their vapouriser to keep them from relapsing to cigarettes. Three of the five users who had never been committed smokers chose to use nicotine in their vapouriser after being introduced to it by a romantic partner or friend. All three users described themselves as not being addicted and that they could easily give it up if they tried. The end goal for many participants was not to be reliant on nicotine at all, and they explained how they were, or had, implemented strategies to reduce the concentration of nicotine they were using, such as alternating between nicotine and nicotine-free vapourisers and gradually tapering down the nicotine concentration. Four users had successfully quit smoking and were continuing to vape nicotine-free. Those users who were happy to continue to use nicotine in a “cleaner” and “healthier” form (e-cigarettes), or felt they were not ready to “wean” themselves off for fear of relapsing to smoking, recognised that they had completely transferred the behavioural and sensorimotor aspects of smoking to vaping. However, they believed because they were no longer smoking any potential ill-health inferred by vaping seemed inconsequential.

“As it stands, I have no intention of stopping [vaping] because whilst I'm using that [vapoursier] I have no intention to have a cigarette. That's how passionately I don't want to smoke again, but I'm not prepared to risk it at this time, but who knows? … Do you know what, I often think I probably do need to cut back a little bit and I think, well I'm not smoking?” Ursula, cloud chaser [ 43 ]

Previous cigarette users observed that vaping fit nicely into their routine, which was once occupied by cigarettes (i.e. driving, coffee). Vaping allowed them to continue to enjoy the social aspects of smoking (i.e. drinking alcohol) and to placate feelings of stress or anxiety.

“Yeah, I still make a point of, especially when I first quit, of keeping that routine of going outside to smoke, or vape, just so it felt a little bit more like I was having a cigarette. It wasn't such a drastic change. You know like straight after a meal or things like that, my trigger moments. I would still get up, keep it to that little bit of a routine. Get up, go outside, have my vape, go back inside.” Ella, substitute [ 41 ]

Socialising with other vapers and smokers was said to reinforce and maintain their use of e-cigarettes. Even amongst those who were never committed smokers and those who were now vaping nicotine-free.

“I’m not a smoker. I’m a vaper”: breaking free of tobacco

In general, users referred to their device as a vape, themselves as a vaper, and the practice as vaping. Some felt the term ‘e-cigarette’ too closely aligned with smoking discourse and supported associations with negative connotations of death and disease. Vape products were generally not considered to be tobacco products, especially with the evolution of vaping devices and how they no longer resembled a cigarette, as earlier generations had.

“They need to stop calling them e-cigarettes because they're not cigarettes. That s**ts me up the wall, they're not cigarettes.” Ian, cloud chaser [ 29 ]

Several users documented how they had experienced the “ignorance” of both smokers and non-vapers, and many seized the opportunity to “educate” these people. They highlighted the features which distinguished vaping from smoking, such as not containing tobacco and the production of vapour, not smoke, and the perceived positive changes to their health they had experienced since starting vaping, in the hope of reducing the stigma and the estrangement they felt.

“… people will say, ‘why don't you just smoke cigarettes?’ which I think is a strange thing to say. People just misunderstanding the health risks.” Julia, substitute [ 26 ]

For some, they could not escape their internalised feelings of smoking-related stigma, and as a result, avoided vaping in public.

“I generally try not to vape in public because it is not stealthy unless you're using a little stealthy device … People can see you a mile away, and I get really embarrassed. But I used to hide when I was a smoker as well. At least when I was a smoker I could hide in my car. Even with my vape, I get in my car and there's big clouds coming out.” Ursula, cloud chaser [ 43 ]

The substitute vaper

“a means to an end”: vaping to quit smoking.

For those ‘substitute’ vapers who were former smokers, they viewed their vaping experience as a practical means to quit smoking and valued the positive effect vaping had on their health and wallet. They were aware of the existence of more enthusiastic vapers, however, at the time did not associate with the vaper subculture as ‘cloud chasers’ did.

“I see people, and it's kind of a sport for them, they make big clouds … I don’t really buy into that. … It's not where my mindset is. For me, yeah it [vaping] really is a means to an end [nicotine/smoking cessation].” Ella, substitute [ 41 ]

“It’s just a revolving circle”: stigma

Although many acknowledged the stigma they had endured as a smoker in Western Australia, some vapers holding the ‘substitute’ identity now projected these same negative feelings to fellow vapers associated with the ‘cloud chasers’ subculture, perpetuating the circle of stigma.

“People think that people smoking vapes think they’re ‘cool’. Sitting in their car and they've got big clouds coming out of the car. Even I do it. When I see clouds like that I think, ‘You d***head. You think you’re cool vaping like that?’ … Like I’ve seen the way people blow out their clouds I’m like, ‘You’re one of these d***heads who’s overclocking the battery’ … .” Milo, substitute [ 36 ]

“It is not stealthy”: managing vaping in public

Vaping is notorious for producing large vapour clouds (although some products such as JUUL are very discrete), and as such some ‘substitute’ vapers spoke of how they disliked the attention vaping brought them from bystanders, and spent energy devising strategies to manage their e-cigarette use in discreet ways, such as vaping alone. This was especially pertinent for some young women:

“It is a bit showy because like there's a lot more vapour. I guess the only place in public that I do it and feel kind of safe is like just at the park when I'm taking a walk or something.” Karina, substitute [ 24 ]

The cloud chasers

“i’ve gone full enthusiast”: the vaper subculture.

This group of respondents shared the view that e-cigarettes are a healthier alternative to smoking, however, more importantly, vaping also offered social and symbolic functions not provided by “analogue cigarettes” .

Vaping was differentiated from smoking, with some describing it as a hobby, which at times could be all-consuming and expensive. Nevertheless, many genuinely enjoyed customising their experience through the collection of various flavoured liquids and coloured devices, experimenting with the creation of their own juices, engaging in the technological aspects of vaping and building accessories, such as coils.

“I play around with them [making coils], I do all my own, I build all the things, I use all the rebuildable stuff. So yeah, it has become a bit of a hobby, which is why I think it appeals to certain people, because it has that sort of community aspect where it becomes like a hobby … they all sort of get together…” Wade, cloud chaser [ 28 ]

A minority of vapers reported attending “build days” and “vape meets” where users got together to learn about Ohm’s law and battery safety, how to build coils, and to meet new people and socialise, as the Western Australian vape community was reportedly not as established as others in the Eastern States of Australia.

Participants commented on the various ‘types’ of vapers (i.e. hobbyist, flavourist) and ‘levels’ (i.e. novice, advanced user, expert, veteran) one could progress to. Participants categorised themselves by comparing their preferences and level of experience with others, which was influenced by various factors including vaping duration, type of device they were capable of safely using (regulated vs unregulated (no circuit board and runs directly off a battery)), possessing an online profile or presence, and experience in the retail industry.

“[I’m] close to the expert stage. An advanced user, I'd say. When you start using mechanical mods, that's when you're an advanced user.” Zadie, cloud chaser [ 27 ]

“I've gone full enthusiast … I want to have the experience. I'm also hoping to get a job in one of the vape shops in Perth because I'm really enthusiastic about health or being able to help people.” Quade, cloud chaser [ 24 ]

A small proportion of ‘cloud chasers’ were highly immersed in the vaping subculture and were actively involved in, or managed specialised vape groups, provided product reviews to YouTube, Instagram and Facebook, and some were even ‘sponsored’ by local or international e-cigarette brands to promote their products on social media. Relationships between these vapers and their sponsors were established by one of them contacting the other, usually through social media.

“I'm part of this group called Cloud Kings Australia. Cloud Kings are basically all over the world. There's a group of them in Sweden, Mexico, Germany, France, Amsterdam, mostly in Europe. We get sponsored by companies, get free product from those companies, and then we rep[resent] those companies.” Zadie, cloud chaser [ 27 ]

Few were also deeply entrenched in the vape trick culture:

“Absolutely, there's an absolute technique [to vape tricks]. We've got it down to a really fine art. There's names of [tor]nados that you can do like specialised ones and stuff like the DNA, the double, oh it’s crazy. So we go all out. Like you've got to wet the table, make it stick, and you've got to layer it. So we do layer upon layer upon layer of smoke. No one’s allowed to breathe. If you breathe, you're dead.” Clara, cloud chaser [ 33 ]

“Vaping brings people together”: for the cause and the community

The vape community, especially the online community, was described as “free of judgement” and provided for many a sense of connection and belonging. Participants described how their communication with like-minded vapers gave them the forum and permission to “nerd out” and voice their struggles and triumphs with a group who they felt would listen and be responsive, which some users did not feel they were able to do with their non-vaping friends and family. For those who were more experienced vapers, they felt it was important to give back to the community and chose to mentor new vapers through the initiation process.

“I'm in a lot of Australia-wide groups ... and it’s community-minded. … It's a way to quit smoking, sure, it's a health choice, but it's also a hobby for a lot of people, so I think these groups are both support networks and hobbyists. … I think it is important because there's nowhere else to get that support to quit smoking. For me that's what vaping is all about, it's about quitting smoking and staying off the cigarettes. … For people like myself who have tried everything … It is important for me to give back, so I give a lot of advice to people that say ‘Hey I don't know what to do.’ I try and give people the advice that I didn't get but also just making friends Australia-wide, getting to know people. It's awesome. It's a pretty cool community, yeah.” Ursula, cloud chaser [ 43 ]

Further, some participants had turned vaping into a business; were currently working, or aspiring to work in the retail industry; or were creating a social media presence (i.e. reviewing products, seeking sponsorship) for themselves. Some of these participants who were heavily involved in the online community and/or retail industry expressed frustration with the “childish” and “bitchy” behaviour displayed by some of the vape community online, especially among local and inter-state retailers. Instances of online users “dobbing” on people to the authorities who were selling nicotine and/or devices were described, as well as general unsocial behaviour as illustrated by one local business owner:

“They're [vape retailers] just very childish, … and because it's still quite a small community, everything's a personal attack against someone else. Like, if so and so were to have a sale and then he'd think that it was a direct attack on him. It is very clicky and very immature a lot of the time, I don't know why. I don't really bother doing much with Facebook groups because that’s just where it all is. When it's in-store and stuff and it's all very professional, everyone's very eager to help, it’s just everyone seems to become a keyboard warrior online.” Wade, cloud chaser [ 28 ]

Users who heavily invested in the culture or hobbyist ethos were inclined to perceive their device as an accessory, or a status symbol which was dependent on having the very latest and greatest device. For these vapers, vaping not only encompassed their passion and desire to help others quit smoking but their livelihood, which now strongly aligned with their core values.

“All my life I've had trouble [working] in retail because I have an ethical code where I can't sell something that I don't believe in and I believe 100% in the industry of vaping and what their motives are. I think it's good. It is entirely good and all the people that I've met who also promote it and stand behind it have good intentions, and their sole drive is to see people get well and stop smoking. We want to make smoking history just as much as the non-smokers. That's the thing … almost all vapers are reformed smokers…” Quade, cloud chaser [ 24 ]

The Australian NDSHS has been regularly conducted since 1985, and first provided limited data about e-cigarette use in 2013. Data from the most NDSHS [ 24 ] reports the most prevalent e-cigarette users are male current and former smokers, which is reflective of our sample population. Data does not distinguish whether users use nicotine in their vapourisers, nor what type of device they use. Enhanced surveillance and reporting of e-cigarette use within Australia would contribute to a deeper understanding of the population using e-cigarettes, the reasons for using and devices used among this cohort, and would assist policymakers to determine where public health efforts should be focussed.

Thirty-two vapers in this sample were committed smokers for several years and five participants were dual users of tobacco and e-cigarettes. The primary reason for initiating vaping was to quit smoking, citing less than optimal successes with other TGA (Therapeutics Goods Administration Footnote 1 ) approved smoking cessations aids, as also described by a sample of American vapers [ 44 ]. Vaping was considered more satisfying and therefore more supportive of successfully quitting smoking compared to other methods due to its similarity with conventional smoking, namely the inhale and exhale of vapour, nicotine hit, and the hand-to-mouth action, as also documented in other international research [ 16 , 18 , 43 ]. Furthermore, vaping does not expect one to relinquish the rituals and habits connected to smoking [ 45 ]. The conclusions surrounding the effectiveness of e-cigarettes as a smoking cessation aid and their harm reduction potential, however, are varied and depend on several factors, such as whether the smoker switches completely to e-cigarettes, becomes a dual user with cigarettes, and whether the user becomes a sustained and persistent vaper [ 42 ].

The majority of vapers in this sample were former smokers, however, several respondents had taken up the practice despite having never smoked. Understanding how vapers ‘make sense’ of their health practices [ 46 ] is required to understand the processes by which vapers make health behaviour choices, such as choosing to vape, so that appropriate tailored communication on the risks and benefits of e-cigarette use can be developed [ 47 ]. Limiting vaping uptake by non-smokers is essential and the supportive role Australia’s strict regulation plays in limiting this uptake and exposure to marketing is discernibly apparent when compared with vaping prevalence within countries with more liberal regulation (i.e. United States (US) [ 48 , 49 ] and UK [ 50 , 51 ]).

Participants within this study generally exhibited limited knowledge of the potential health effects of e-cigarettes. However, as reported by vapers abroad [ 52 , 53 ], they expressed many positive attitudes towards e-cigarettes, held very strong opinions that vaping offered them an alternative means to consume nicotine, and based their decision to use e-cigarettes on perceived harm reduction compared to cigarettes. For them, the individual health benefits experienced and the tangible sense of satisfaction since ceasing smoking outweighed the potential health risks of maintaining vaping. Furthermore, continued nicotine addiction was largely perceived as unproblematic so long as it helped maintain a cigarette-free lifestyle, also documented by others [ 43 , 54 ]. This concept has been studied by Oakes and Chapman [ 55 ] who explored the rationalisations smokers use to explain their justification of continued smoking and suggest a series of self-exempting beliefs may provide smokers with a false sense of security and ultimately block them from exploring the importance of quitting. Given the complexity of nicotine and addiction, and the assortment of information presented on e-cigarettes, it is not unexpected that users in this study and overseas [ 56 ] rely on their own experiences, and that of others, to inform their behaviour and decision-making processes [ 18 ]. This highlights the need for accessible, clear and impartial information about e-cigarette use which communicates the benefits, risks and current uncertainties to health professionals and the public about e-cigarettes [ 43 ] and continued support for nicotine cessation through approved cessation methods.

Participants mostly described positive reactions from friends and family to their e-cigarette use, particularly when their goal was to abstain from smoking. In this sample of vapers, few had close friends who vaped and therefore sought camaraderie through online fora and vape retail stores. As found in other qualitative inquires [ 16 ], the notion of a vaping community was recurrent. However, participating in a community that accepts the practice may make it difficult for individuals to quit and therefore contribute to sustained use [ 57 ]. These findings suggest that social norms surrounding e-cigarette use have a potentially powerful influence on initiation and maintenance and that understanding social networks is integral to prevention efforts.

Although tobacco smoking is legal in Australia, the decline in prevalence combined with the denormalisation of smoking and societal aversion has fated the behaviour to be predominantly relocated to the fringes of society and viewed as a deviant and marginalised behaviour [ 58 ]. For some smokers in this study, feeling stigmatised for being a tobacco smoker was the catalyst for them to redefine themselves as ‘vapers’, as supported by findings from Barbeau and Burda [ 16 ], making the language used (i.e. not referring to vaporises as e-cigarettes) incredibly important in an attempt to escape the stigma attached to cigarette smoking [ 44 ]. This redefinition and transition from smoker to non-smoker has been argued to play a key role in supporting successful smoking cessation [ 59 ]. However, through the quest to obtain the socially desirable non-smoker status, smokers have adopted another behaviour that maintains addiction and deviates from current societal norms, an unapproved and unconventional means to quit smoking.

Two approaches to vaping emerged from our data, that of the ‘cloud chaser’ and the ‘substitute’. Vapers within this sample displayed similar subcultural elements and practices to those reported in the international literature examining the motivations of e-cigarette users, identity formation and involvement in the vaping subculture [ 14 , 15 ] which could be diffused via global structures such as social media. However, some subcultural elements are localised to Australian vapers due to the unique social conditions under which the behaviour has evolved. For example, the vaping subculture which has emerged in the US is more encompassing than in Australia, which may be attributed to differences in the countries regulatory contexts [ 60 ], access to nicotine products, and exposure to mass marketing [ 61 ] and subcultural practices (e.g. vaping conventions [ 62 ] and abundant vape stores [ 63 ]).

Supported by Farrimond [ 14 ] and McQueen and Tower [ 64 ], ‘cloud chasers’ perceived their affiliation and connection with the vape community in the online and offline milieu as a positive source of support and reinforcement. Moreover, vaping was regarded as an integral part of their social identity, influencing how they behaved and the social and political activities they engaged in. Given the loss of identity and social engagement reported by individuals who quit smoking, the social opportunities, and group and community experience of vaping may be a particularly appealing aspect of the endeavour [ 6 , 16 , 53 ]. Furthermore, vaping was explicitly differentiated from cigarette smoking and referred to by many ‘cloud chasers’ as a hobby. Several dimensions of ‘pleasure’ were identified, including the sensory experience (i.e. flavours) and electronic and technological aspects of vaping [ 6 , 65 ]. Such descriptions of enjoyment are not usual in the substance-use discourse [ 66 ] due to the dominance of the ‘pathology paradigm’ which marginalises the idea of pleasure concerning drug use [ 67 ].

The assessment that e-cigarettes are a tool to manage nicotine addiction among ‘substitute’ vapers may explain why these users did not strongly identify with, or actively rejected connection with the social identity of vaping, and enjoyment did not play a substantive role in their use and maintenance [ 14 ]. Research suggests that cessation goal-oriented vapers may be less likely to become persistent e-cigarette users compared with vapers who do not stipulate future intentions to quit [ 68 , 69 ]. The nuanced differences in experiences of ‘cloud chasers’ and ‘substitute’ vapers may, therefore, contribute important insights for health communication. Australia has implemented a suite of effective strategies [ 23 ] to combat tobacco smoking that could be applied to e-cigarettes, such as supplementing health communications with legislation (e.g. health warnings, plain packaging, smoke-free laws that include e-cigarette use), until there is scientific evidence regarding their safety and efficacy as a tobacco cessation therapy [ 70 ].

E-cigarettes are both technically complex devices, which novice users may find difficult to spontaneously start, and a non-medical consumer product, which has resulted in the need for many aspiring users to look to other vapers as their experts, building a vast and international social network of shared knowledge and identity [ 14 ]. A common experience among this cohort of vapers was their use of e-cigarette forums and social media groups to discuss personal experiences, exchange information, and obtain new knowledge, similarily reported by vapers in New Zealand [ 18 ]. Seasoned vapers and newcomers disclosed periods of both active and passive engagement (also known as ‘lurking’ [ 71 ]). Lurking served newcomers with an opportunity to observe the community and its rules [ 72 ], whilst it provided more established vapers with the opportunity to monitor changes in the industry and the development of new products. Conversely, active contribution to these fora provided opportunities for learning among ‘newbies’ and mentorship for more experienced vapers. Some research suggests that joining and actively participating in e-cigarette-related social media communities [ 13 , 73 , 74 ] may play an important role in the development of ones vaping identity [ 14 , 18 ] and can exert a significant influence on attitudes and behavioural intentions toward e-cigarettes [ 75 ]. The investigation of dedicated vaping fora, therefore, may be valuable to study interactions among users and how these interactions shape e-cigarette knowledge, attitudes and behaviours.

These findings were gathered from a small purposive sample within a specific geographical context and time, and therefore may not be generalisable to the broader vaping community or e-cigarette users abroad due to Australia’s regulatory environment, absence of mass media advertising and lack of Government endorsement as a smoking cessation aid [ 76 ]. However, the consistency with other research suggests our findings are not atypical. All participants in this study were adults, therefore these results may not be generalisable to younger vapers.

Few studies have explored vapers motivations for use, reinforcing influences, and association with the vaper subculture, especially within the unique regulatory context of Australia. We found that our sample of vapers largely started vaping to quit smoking and underwent common experiences during their initiation phase. Subsequently, vapers tended to adopt one of two vaper identities, that of the ‘cloud chaser’ or the ‘substitute’, which some users moved between during different stages of their vaping career. The social and symbolic meaning of e-cigarettes and vaping were diverse. ‘Cloud chasers’ connected with the vaper subculture in varying degrees and involved concepts of pleasure, community and performance. However, the aesthetic and performance part of the subculture, in particular, had little appeal to ‘substitute’ vapers who largely viewed their use of e-cigarettes as a means to quit smoking, and enjoyment did not play a substantive role in their use. Understanding the complexities of vaping, and the nuanced differences of ‘cloud chasers’ and ‘substitute’ vapers may have important implications for health communication, research and policy. Our findings add to the understanding of the varying motives for use and provide new insights into the socialisation process and subsequent identity adoption of Western Australian vapers.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

The Therapeutic Goods Administration is the regulatory body for therapeutic goods in Australia and is responsible for conducting assessment and monitoring activities to ensure that therapeutic goods available in Australia are of an acceptable standard and that access to therapeutic advances is in a timely manner.

Abbreviations

Electronic cigarette

Electronic Nicotine Delivery Device

COnsolidated criteria for REporting Qualitative research

Greater Capital City Statistical Area

Index of Relative Socio-Economic Advantage and Disadvantage

National Drug Strategy Household Survey

Therapeutic Goods Administration

United States

United Kingdom

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Acknowledgements

We wish to thank the people who participated in this study and willingly provided their time and insights.

This research was supported by a Healthway Exploratory Research Grant [grant number 32803] and an Australian Government Research Training Program Scholarship. The Scholarship is provided by the Commonwealth of Australia to support the general living costs for students undertaking Doctoral Research studies. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

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Conception and design of the work: JJ, BM, KM, TL, KW; Data acquisition and analysis: KM; Data interpretation: KM, BM; Writing – original draft: KM; Writing - review and editing: JJ, BM, BF, KW, TL. All authors read and approved the final manuscript.

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Participants gave written (at the time of the interview, or via email), and in one case verbal consent before participating in a face-to-face ( n  = 35) or telephone ( n  = 2) interview. All procedures were performed in compliance with relevant laws and institutional guidelines and the study protocol was approved by the Human Research Ethics Committee of Curtin University (HRE2017–0144).

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Competing interests

BF is a member of the NHMRC Electronic Cigarettes Working Committee (May 2020). She has received consulting payment for e-cigarette policy review for the NSW National Heart Foundation (December 2019). She had travel expenses (flight and registration) reimbursed to attend Oceania Tobacco Control Conference 2017 to present on e-cigarette and cessation. She provided her opinion (unpaid) at Australian Parliament’s Standing Committee on Health, Aged Care and Sport public hearing into the Use and Marketing of Electronic Cigarettes and Personal Vaporisers (September 8, 2017). She led a contract on e-cigarette regulation in Australia for the Commonwealth Department of Health (2016). She had travel expenses reimbursed by National Taiwan University for presenting on e-cigarette regulation (2016). The other authors have no conflicts to declare.

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Additional file 1..

Data collection guide. The data collection guide includes the information recorded about the interview, participant’s demographic and behavioural information and the interview guide.

Additional file 2.

COREQ checklist. A checklist of items that should be included in reports of qualitative research.

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McCausland, K., Jancey, J., Leaver, T. et al. Motivations for use, identity and the vaper subculture: a qualitative study of the experiences of Western Australian vapers. BMC Public Health 20 , 1552 (2020). https://doi.org/10.1186/s12889-020-09651-z

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Published : 15 October 2020

DOI : https://doi.org/10.1186/s12889-020-09651-z

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The Vaping Teenager: Understanding the Psychographics and Interests of Adolescent Vape Users to Inform Health Communication Campaigns

Associated data.

Supplemental material, Supplemental_material for The Vaping Teenager: Understanding the Psychographics and Interests of Adolescent Vape Users to Inform Health Communication Campaigns by Carolyn Ann Stalgaitis, Mayo Djakaria and Jeffrey Washington Jordan in Tobacco Use Insights

Background:

Adolescent vaping continues to rise, yet little is known about teen vape users beyond demographics. Effective intervention requires a deeper understanding of the psychographics and interests of adolescent vape users to facilitate targeted communication campaigns.

We analyzed the 2017-2018 weighted cross-sectional online survey data from Virginia high school students (N = 1594) to identify and describe subgroups of adolescents who vaped. Participants reported 30-day vape use, identification with 5 peer crowds (Alternative, Country, Hip Hop, Mainstream, Popular), social prioritization, agreement with personal values statements, social media and smartphone use, and television and event preferences. We compared vaping rates and frequency by peer crowd using a chi-square analysis with follow-up testing to identify higher-risk crowds and confirmed associations using binary and multinomial logistic regression models with peer crowd scores predicting vaping, controlling for demographics. We then used chi-square and t tests to describe the psychographics, media use, and interests of higher-risk peer crowds and current vape users within those crowds.

Any current vaping was the highest among those with Hip Hop peer crowd identification (25.4%), then Popular (21.3%). Stronger peer crowd identification was associated with increased odds of any current vaping for both crowds, vaping on 1 to 19 days for both crowds, and vaping on 20 to 30 days for Hip Hop only. Compared with other peer crowds and non-users, Hip Hop and Popular youth and current vape users reported greater social prioritization and agreement with values related to being social and fashionable. Hip Hop and Popular youth and current vape users reported heavy Instagram and Snapchat use, as well as unique television show and event preferences.

Conclusions:

Hip Hop and Popular adolescents are most likely to vape and should be priority audiences for vaping prevention campaigns. Findings should guide the development of targeted health communication campaigns delivered via carefully designed media strategies.

Introduction

Current (past 30-day) vaping among U.S. adolescents has increased dramatically in recent years. 1 , 2 Rates almost doubled from 2017 (11.0% of 12th graders) to 2018 (20.9%), the largest substance use increase ever observed in the 44-year history of the national Monitoring the Future study. 1 Vapes have been the most commonly used tobacco product among adolescents since 2014, 2 and more than 5 million middle and high school students were current vape users in 2019. 3 These dramatic increases have offset reductions in cigarette smoking, fueling an overall increase in adolescent current tobacco use. 1 , 4

This explosion of vaping is concerning because of the risks associated with adolescent vape use. Adolescents who vape are more likely than non-users to initiate cigarette smoking and escalate smoking among those who have already experimented with cigarettes, 5 - 11 though this association may be due to shared risk factors for vaping and smoking. 12 Researchers are beginning to understand the chemical constituents and health implications of vape juice and aerosols, which include carcinogens and irritants. 8 , 13 - 17 Although long-term health effects are unknown, vaping may be associated with short-term risks including respiratory symptoms, asthma, and bronchitis among adolescents. 8 , 18 , 19 In addition, nicotine exposure affects adolescent brain development, leading to long-term cognitive issues including memory and attention impairment. 20 - 22

Despite the alarming increase, teens who vape remain a minority of the adolescent population. 3 Little is known about which youth are at the greatest risk beyond demographic descriptions, leaving public health interventionists with a limited understanding of who should be prioritized in prevention efforts. Current vaping is more prevalent among male, non-Hispanic White, higher socioeconomic status, and lesbian, gay, and bisexual adolescents and young adults. 23 - 27 In addition, young current vape users often have friends and family members who vape or who accept vaping, 28 and use other substances including cigarettes and marijuana. 29 - 31

Audience psychographics move beyond demographics to provide health communicators with critical insights about values, identities, and interests that can inform effective messaging and campaign strategies. 32 - 35 In addition, these insights are critical for the effective planning and execution of modern digital media campaigns that rely on interest-based targeting to deliver digital advertisements to the intended audience. 36 Past studies describing ever and current vape users have typically focused on vaping attitudes and beliefs, 37 - 40 or have used psychographics and motivations to segment adult, but not adolescent, vape users into discrete subgroups. 41 , 42 Only a few studies have examined the psychographics of adolescent or young adult vape users, revealing that novelty-seeking, sensation-seeking, and lower social conservatism are generally associated with ever and current vaping in these populations. 27 , 43 , 44 From this basis, we seek to expand health communicators’ understanding of the psychographics, identities, media use, and interests of adolescent current vape users to inform the development of effective vaping prevention campaigns.

Knowing which adolescents vape, what other substances they use, what they care about, and what influences them is crucial to addressing adolescent vaping. Commercial marketing, including vape marketing, relies on audience segmentation to identify population subgroups with shared desires and needs for whom a tailored brand can be built and marketed via targeted media channels. 45 In health communications, a similar approach is necessary to counter industry marketing by identifying adolescent subgroups at the greatest risk for vaping, developing targeted campaigns that appeal to their shared values, beliefs, and interests, and delivering campaign content via specific media channels and strategies to ensure the target audience is reached. 45 Health campaigns designed around the psychographics of their target audiences are effective, 45 - 47 but this approach requires a clearly defined audience with unique characteristics for whom appealing content can be tailored. Importantly, campaigns must both tailor messaging (by selecting messaging that caters to audience preferences, values, and interests to capture attention and increase persuasion) and target media delivery (by selecting highly specialized media channels and using state-of-the-art ad-targeting technologies) to effectively reach their target audiences in the modern, cluttered media environment. 47 Although much is known about the demographics of adolescent vape users, health educators lack crucial information about their values, influences, and interests that is necessary to define an audience and deliver effective, targeted communications.

To fill this gap, we used online survey data to describe the risk profile, psychographic characteristics, and interests of adolescent current vape users in a single U.S. state. We had 2 primary objectives: to identify potential target audiences for adolescent vaping prevention campaigns and to describe the psychographics, media use, and interests of these higher-risk youth to inform campaign planning. First, we sought to define potential target audiences by applying a peer crowd audience segmentation approach. Peer crowds are macro-level subcultures with shared interests, values, and norms 47 , 48 which are associated with adolescent and young adult health behaviors 49 - 57 and have served as the basis for targeted health interventions. 58 - 64 For example, the Commune campaign targeting Hipster peer crowd young adults resulted in reductions in cigarette smoking associated with stronger anti-tobacco attitudes among those recalling the campaign, 58 , 62 whereas engagement with the Down and Dirty campaign was associated with stronger anti-chewing tobacco attitudes and lower odds of current use among Country peer crowd teens. 61 In this study, we examined vaping behavior for 5 adolescent peer crowds previously established in the literature: Alternative (counterculture, value creativity and uniqueness), Country (patriotic, value hard work and being outdoors), Hip Hop (confident, value overcoming struggles and proving themselves), Mainstream (future-oriented, value organization and stability), and Popular (extroverted, value socializing and excitement). 47 , 49 , 50 , 52 , 54 , 55 , 61 After identifying the highest risk peer crowds, we sought to create a profile of these audiences by examining their broader health risk profiles, psychographics (social prioritization and personal values), digital behaviors (social media and smartphone use), and interests (television shows and events). With this information, we aimed to identify and describe segments of adolescents most in need of targeted vaping interventions to provide clear guidance for health message development and media targeting.

Sample and design

We collected cross-sectional online survey data from high school students ages 13 to 19 living in the U.S. state of Virginia (N = 1594). Participants were recruited from November 2017 to January 2018 using paid Instagram and Facebook advertisements that directed interested individuals to a screener to determine eligibility (13-19 years old, current high school student, and Virginia resident). Eligible youth were invited to participate in the full survey and provided electronic assent (ages 13-17) or consent (ages 18-19). We delivered a parental opt-out form via email for participants ages 13 to 17. Qualified participants who completed the full survey received a US$10 electronic gift card incentive. We implemented numerous fraud prevention and detection measures to maximize data integrity, including concealing eligibility criteria during screening, collecting email addresses to prevent duplicate completions, and reviewing responses for inconsistencies. Chesapeake IRB approved the study (No. Pro00023204).

To address our research objectives, we examined participant demographics; current vaping, tobacco, and other substance use; peer crowd identification; 2 psychographic measures, namely, social prioritization 65 and personal values; social media and smartphone use; and television show and event preferences.

Demographics

Participants provided their birthdate, from which we calculated their age. Participants also indicated their gender (male, female) and race/ethnicity (Hispanic, non-Hispanic White, non-Hispanic Black, non-Hispanic Asian-Pacific Islander, and non-Hispanic other including multiracial and American Indian or Alaska Native).

Past 30-day vape use

Participants reported the number of days in the past 30 days on which they used e-cigarettes or vapes, with response options of 0, 1 or 2, 3 to 5, 6 to 9, 10 to 19, 20 to 29, and all 30 days. To mirror commonly reported statistics, we examined both any current vaping (1-30 days) and frequency of vaping defined as occasional use (1-19 days) or frequent use (20-30 days). 66

Past 30-day tobacco and substance use

Participants also reported the number of days in the past 30 days on which they used cigarettes; cigars, cigarillos, and little cigars (cigar products); smokeless tobacco; hookah; alcohol; marijuana; and prescription medication without a prescription. Those who reported any past 30-day use were considered current users of that item.

Peer crowd identification

Participants completed Rescue Agency’s I-Base Survey®, a photo-based tool that measured identification with 5 peer crowds: Alternative, Country, Hip Hop, Mainstream, and Popular. The I-Base Survey has identified consistent patterns of peer crowd prevalence and health risks in adolescents across the United States. 49 - 52 , 55 , 57 , 61 , 64 In brief, participants viewed a grid of 40 photos of unknown female adolescents and selected 3 who would best and 3 who would least fit with their main group of friends; they then repeated the process with male photos. Photos were presented in random order to each participant to reduce order effects, and represented a mix of races/ethnicities and peer crowds determined through prior qualitative research. Participants earned positive points for the peer crowds of photos selected as the best fit and negative points for those selected as the least fit, resulting in a score ranging from −12 to 12 for each of the 5 crowds. For analyses, we assigned participants to each crowd with which they had at least some identification, defined as a score of 1 or more on the I-Base Survey for that crowd. Participants could be assigned to more than 1 peer crowd as they could score positively for multiple crowds.

Social prioritization index

Participants completed the social prioritization index (SPI), a validated measure of the degree to which an individual places importance on their social life that is associated with young adult cigarette use. 58 , 59 , 65 The SPI included 13 questions: 8 items wherein participants selected 1 response that best described them from a pair (up for anything/pick and choose what to do, outgoing/low-key, center of attention/lay low, street smart/book smart, partier/studier, wing it/plan it out, the carefree one/the responsible one, in a picture I . . . strike a pose/smile big); 3 true or false items (In groups of people, I am rarely the center of attention; I have considered being an entertainer or actor; I can look anyone in the eye and tell a lie with a straight face); 1 item asking how many nights they went out for fun in the past week (0-1, 2-3, 4-5, 6-7 nights); and 1 item asking how late they typically stayed out when they went out for fun (9:59-10:59  pm , 11:00  pm -12:59  am , 1:00-2:59  am , 3:00  am or later). To calculate the SPI score (range: 0-17), participants received 1 point for each socially oriented selection for the 8 descriptive pairs and 3 true/false questions, and received 0 points for selecting 0-1 nights per week or 9:59-10:59  pm , 1 point for 2-3 nights per week or 11:00  pm -12:59  am , 2 points for 4-5 nights per week or 1:00-2:59  am , and 3 points for 6-7 nights per week or 3:00  am or later.

Personal values

Participants viewed 26 personal values statements (e.g., I think it is more important to live in the moment than focus on the future) and rated each on a 5-point Likert-type scale from 1 (strongly disagree) to 5 (strongly agree).

Past 7-day social media use

Participants reported if they had consumed or created content on 6 social media platforms in the past 7 days: Facebook, Instagram, Twitter, Tumblr, Snapchat, and Pinterest.

Lifetime smartphone use

Participants were asked if they had a smartphone, and if so, if they had ever used their smartphone to engage in 9 different activities (e.g., listen to an online radio or a music service such as Pandora or Spotify; watch movies or TV shows through a paid subscription service like Netflix).

Television show preferences

Participants selected all television shows they regularly watched from a list of 24 broadcast and streaming shows popular with youth (e.g., 13 Reasons Why, Ridiculousness ).

Event preferences

Participants selected all events they regularly attended from a list of 25 leisure time events youth might attend (e.g., sports games, high school dances).

Statistical analysis

Respondents were required to complete the survey, so no data were missing. Data were weighted to the gender, race/ethnicity, and urban/rural demographics of Virginia teens for all analyses. As a first step, we ran weighted and unweighted frequencies and means for demographic measures.

To address our first objective of identifying which adolescents were at the greatest risk, we used chi-square tests to compare the rates of current vaping and vaping frequency among those who did and did not identify with each crowd, using follow-up z tests with Bonferroni correction to identify specific significant differences. To confirm that associations persisted while controlling for demographics, we ran separate binary and multinomial logistic regression models for each peer crowd, with a single peer crowd’s score (range: –12 to 12) predicting odds of current vaping, or of occasional or frequent vaping, while controlling for age, gender, and race/ethnicity. We also ran binary logistic regression models for each crowd to predict odds of any current cigarette, cigar product, smokeless tobacco, hookah, alcohol, and marijuana use, and any current prescription medication misuse, to understand the broader risk profile of the peer crowds. We ran separate models for each peer crowd to avoid multicollinearity associated with including all 5 scores in a single model.

After identifying 2 peer crowds at elevated risk for vaping, we addressed our second objective of developing interest-based profiles of these potential target audiences by describing their psychographics (SPI and personal values), social media and smartphone use, and television and event preferences. We first compared frequencies and means for those who did and did not identify with the 2 crowds of interest, using chi-square tests and t tests to identify significant differences. Then, within the 2 peer crowds, we compared frequencies and means between current vape users and non-users, using chi-square tests and t tests to identify significant differences. This approach allowed us to identify the characteristics of the 2 peer crowds of interest to inform campaign content and media targeting, as well as to hone in on psychographics and interests that specifically characterized current vape users within the higher-risk crowds. Due to the relatively small subset of participants who were frequent vape users, we focused on any current use to improve the reliability of results. Tables present items that differed significantly between groups in at least 1 analysis and had endorsement rates above 5.0%.

The weighted mean age of the sample was 16.47 years, and about half identified as female (50.8%) and as non-Hispanic White (55.3%) ( Table 1 ). The most common peer crowd identifications were Popular (63.1%) and Mainstream (62.6%). Race/ethnicity and gender breakdowns differed by crowd ( Supplemental Appendix Table 1 ).

Unweighted and weighted sample descriptive statistics.

Consistent with 2018 National Youth Tobacco Survey results, 2 20.6% of Virginia high school students in our sample currently vaped ( Table 2 ). A significantly greater proportion of those with any Hip Hop peer crowd identification currently vaped (25.4%) than those with no Hip Hop identification (18.0%, P  < .001). In binary logistic regression models using each peer crowd score (–12 to 12) to predict odds of current vaping while controlling for demographics, a 1-point increase in the Popular score was associated with a 4% increase in odds of current vaping, whereas a 1-point increase in the Hip Hop score was associated with a 10% increase.

Weighted frequencies and adjusted odds ratios for peer crowd risk behaviors.

Abbreviation: AOR, adjusted odds ratio.

Percentages represent the use rate for those with and without identification with a given peer crowd; asterisks indicate a statistically significant difference between “in crowd” and “not in crowd” for each peer crowd. Regression models use the peer crowd score (range: –12 to 12) to predict odds while controlling for age, gender, and race/ethnicity. Boldface indicates statistical significance ( P  < .05).

Further differentiating current vape users in the sample, 17.0% were occasional vape users (1-19 days in the past 30 days) and 3.7% were frequent users (20-30 days). Those with any Hip Hop identification reported higher rates of occasional vaping (21.2%) than others (14.6%, P  < .05). Although rates of frequent vaping did not differ significantly for any peer crowd, stronger Hip Hop identification was associated with greater odds of both occasional and frequent vaping. Stronger Popular identification was associated with greater odds of occasional vaping only. In addition, stronger Hip Hop identification was associated with greater odds of current cigarette, cigar product, hookah, alcohol, and marijuana use, whereas stronger Popular identification was associated with lower odds of use for many products.

Based on the chi-square tests and logistic regression results, we identified the Hip Hop and Popular peer crowds as being at elevated risk for vaping. We then characterized the psychographics ( Table 3 ), social media and smartphone use ( Table 4 ), and interests ( Table 5 ) of Hip Hop and Popular youth in general, as well as Hip Hop and Popular current vape users in particular.

Weighted frequencies for psychographic measures by peer crowd and current vaping status.

Abbreviation: SPI, social prioritization index.

Boldface indicates statistical significance ( P  < .05).

Weighted frequencies for past 7-day social media and lifetime smartphone use by peer crowd and current vaping status.

Boldface indicates statistical significance (P < .05).

Weighted frequencies for television show and event preferences by peer crowd and current vaping status.

Overall, Hip Hop participants were social, trendy individuals interested in hip hop/rap music and sports. Compared with those with no Hip Hop identification, Hip Hop youth had higher SPI scores, in particular describing themselves as partiers, street smart, and carefree ( Table 3 ). Hip Hop youth more often agreed that they make decisions quickly, are fashionable, are social people with lots of friends, and are tougher than most people. In contrast, they less often agreed that they are patriotic, good students, care what others think about them, care about keeping their bodies free from toxins, and follow the rules. A greater proportion of Hip Hop youth used Snapchat in the past week and used their smartphones to look up sports scores or analyses than those with no Hip Hop identification ( Table 4 ). Many TV shows more often endorsed by Hip Hop youth revolved around hip hop/rap musical interests, such as Love & Hip Hop, The Rap Game , and Wild ’N Out ( Table 5 ). Similarly, Hip Hop youth more often indicated that they regularly attend hip hop concerts and dance clubs than others, as well as basketball and football games.

Characteristics of vape users within the Hip Hop peer crowd largely reflected an amplification of the broader crowd’s profile. Hip Hop vape users had higher SPI scores than non-users within the crowd, and they described themselves as partiers, street smart, carefree, and up for anything ( Table 3 ). They more often agreed that they are fashionable, use their clothes to express their identity, and are tough, and less often agreed that they follow the rules, follow tradition, and care about keeping their bodies free from toxins than non-users. A greater proportion of Hip Hop vape users reported using Snapchat, Instagram, and Twitter in the past week than non-users ( Table 4 ). Hip Hop vape users also more often reported using their smartphones to look up sports scores and analyses, stream music, and make video calls than non-users. Hip Hop vape users more often reported watching 2 cartoon shows, The Boondocks and Bob’s Burgers , than non-users ( Table 5 ). Similar to the overall crowd, a greater proportion of Hip Hop vape users indicated that they attend dance clubs, hip hop concerts, basketball games, and football games than non-users.

Popular youth shared some characteristics with Hip Hop youth, but also differed in key ways. Although Popular and Hip Hop youth both reported higher SPI scores than others, the specific SPI items they endorsed often differed ( Table 3 ). Though both Hip Hop and Popular youth described themselves as partiers, Popular youth also described themselves as the center of attention, outgoing, and up for anything, which were not significant in Hip Hop analyses. Similar to Hip Hop youth, Popular youth more often agreed that they are fashionable and are social people with lots of friends. However, Popular youth also more often agreed that they care about being good students, keeping their bodies free from toxins, and being patriotic, items with which Hip Hop youth less often agreed. Popular youth also more often agreed that family is important, that they try to follow tradition, and that they are religious than other youth. Popular youth more often reported using Instagram, Snapchat, and Twitter than other youth and more often used their smartphones to look up sports scores or analyses and to stream music or video content ( Table 4 ). Compared with others, Popular youth more often reported watching teen dramas, including 13 Reasons Why, Jane the Virgin, Pretty Little Liars , and Riverdale ( Table 5 ). Sports were favored by Popular youth, as they more often reported attending basketball, football, baseball, and soccer games than others. They also more often reported attending church events, community service events, high school dances, and pop and country music concerts.

Popular vape users shared many traits with the broader Popular crowd as well as with Hip Hop vape users. Similar to Hip Hop vape users, Popular vape users reported higher SPI scores than non-users, describing themselves as outgoing, partiers, street smart, carefree, and up for anything ( Table 3 ). Popular vape users also more often agreed that they care about being fashionable, social, and tough than non-users and less often agreed that they care about keeping their bodies free from toxins and following the rules, similar to Hip Hop vape users. Although, overall, Popular youth more often agreed that they value family, tradition, and religion than other youth, Popular vape users less often agreed with these items than non-users. Similar to the broader Popular peer crowd and to Hip Hop vape users, Popular vape users more often reported using Instagram and Snapchat, and using their smartphones to look up sports scores and place video calls ( Table 4 ). Popular vape users, like Hip Hop vape users, more often reported watching The Boondocks and Bob’s Burgers than non-users ( Table 5 ). Similar to the broader Popular crowd, Popular vape users more often reported attending sports games, high school dances, and concerts than non-users, though they less often reported attending church events.

This study identified a subset of adolescents at the greatest risk for vaping, and the psychographic characteristics and interests that should inform the creation of targeted health communications messages and media delivery strategies for these youth. The Hip Hop and Popular peer crowds were at the greatest risk for current vaping, aligning with earlier representative data from Virginia and similar studies of young adults. 52 , 53 , 56 Interestingly, although both crowds were at increased risk for current vaping, their broader risk profiles diverged, indicating a need for differentiated health messaging for the 2 crowds. Hip Hop youth had greater odds of vaping frequently, which may indicate an escalation to nicotine addiction, and were more likely to use other tobacco products and substances. Popular youth, however, were at increased risk for occasional vaping only, with reduced risk for several other substances including cigarettes.

Understanding the psychographics and interests of Hip Hop and Popular youth, and Hip Hop and Popular current vape users in particular, provides insights for health communications campaign development and hints at possible explanations for differential risk by crowd. Hip Hop and Popular youth and current vape users reported higher mean SPI scores than other youth, and endorsed personal values related to being fashionable and sociable. These findings paint a psychographic portrait of Hip Hop and Popular youth and current vape users as individuals who care about their social lives, are trend sensitive, and are strongly influenced by their social environments. This portrait aligns with vape marketing campaigns, which often feature celebrities, associate vaping with socializing and partying, and use sleek, modern designs reminiscent of trendy technology such as iPhones, 37 , 67 - 69 all of which likely appeal to the youth described here. To effectively counter industry marketing and media depictions that may appeal to Hip Hop and Popular adolescents, health educators must create relevant messaging that breaks the connection between vaping and social status or trendiness, and motivates youth to reconsider vaping as a key feature of their social lives. Furthermore, as current vape users in this study cared less about following rules and protecting their bodies from toxins than non-users, campaign messaging must look beyond authoritative tones and typical scare tactic messaging to cultivate a socially influential brand that can persuade higher-risk youth to avoid vaping by speaking directly to their priorities and values.

Hip Hop and Popular adolescents and current vape users also reported extensive smartphone and social media use, in particular the use of Instagram, Snapchat, sports analysis sites, and video/music streaming services. Heavy social media use may contribute to adolescent vaping as user- and industry-generated vaping content abounds across platforms, 70 - 74 and early research suggests that heavier social media use and exposure to vape advertisements on social media are associated with willingness and intentions to vape. 75 Given the known association between exposure to online tobacco marketing and adolescent tobacco initiation and progression, 76 , 77 heavy social media use among Hip Hop and Popular adolescents may further explain why these youth vape. At the same time, these findings can guide health communicators in selecting relevant campaign channels and delivering content via targeted advertisements. Vaping prevention campaigns must meet higher-risk adolescents where they are to deliver messaging to the target audience using the cutting-edge ad-targeting technology employed by commercial advertisers. Although not yet ubiquitous in public health, the targeted placement of paid campaign advertising has been successfully applied to deliver health communications to intended audiences for initiatives including the U.S. Food and Drug Administration’s The Real Cost general market and Fresh Empire Hip Hop adolescent tobacco education campaigns. 35 , 61 , 78 , 79 In addition, to counter the abundance of pro-vaping content youth encounter online, health communication campaigns must cultivate active, appealing social media presences to establish themselves as relatable and trustworthy social influencers and interject tailored prevention messaging into the pro-vaping social media environments of higher-risk youth. 80 , 81

Finally, Hip Hop and Popular youth and current vape users reported specific television and event preferences. Although vaping is currently rare in television programming, 82 , 83 exposure to vape advertisements on television and to vaping in other forms of media including music videos is common and may promote positive attitudes toward vaping among youth. 84 - 89 Although it is unclear if Hip Hop and Popular adolescents are disproportionately exposed to vape advertisements or onscreen vaping, continued monitoring is warranted to track how vaping is depicted over time and if exposure to vaping in media is associated with risks similar to that of exposure to cigarette smoking in movies. 90 In addition, little is known about vape industry sponsorship or promotion at events, an important topic for future work given the tobacco industry’s historical use of events for product promotion. 91 , 92 Although less is known about how television and event preferences may influence vaping risk, this information is incredibly useful to health educators for campaign tailoring and media targeting. Interests can be used to build media targeting profiles that concentrate message delivery and dosage on those most at risk, increasing chances for successful attention and persuasion. Television preference data can inform media buys, 93 identify potential influencer partnerships, and reveal opportunities to engage with the target audience about relevant televised events. 81 Event preference data can inform the selection of relevant settings for advertisements and identify opportunities for in-person engagement with the target audience. With this wealth of information, health educators can develop targeted health communication interventions that effectively reach and persuade higher-risk adolescents.

Although the Hip Hop and Popular peer crowds shared some psychographics and preferences, differences between the crowds indicate that separate campaigns are necessary. In particular, different messaging approaches are needed to appropriately address the more frequent, established nature of vaping among Hip Hop youth, who may require cessation resources, and the less frequent, possibly social nature of vaping among Popular youth. Experimental studies have demonstrated the promise of peer crowd-targeted smoking prevention messaging, 94 - 96 and evaluation studies of peer-crowd-targeted campaigns reveal success in addressing cigarette and smokeless tobacco use. 58 - 62 , 64 Peer crowd targeting may also be a means of more effectively addressing tobacco use disparities. Previous literature suggests that non-Hispanic White youth are at the greatest risk for vaping, 23 - 25 , 27 but this study indicates that the Hip Hop peer crowd, which overrepresents racial/ethnic minorities ( Supplemental Appendix Table 1 ), 50 - 52 , 54 is at the greatest risk for frequent vaping, identifying a higher-risk group that might otherwise be missed by campaigns using demographic segmentation. This study provides a preliminary insight into who these youth are, what they care about, and the media they consume; future research must test potential campaign messages with youth from the targeted peer crowd to ensure that tailored content resonates and motivates positive behavior change.

Limitations

It is important to note several limitations of this study. Generalizability is unclear as we surveyed a convenience sample recruited via social media from a single state, although peer crowd risk findings did align with previous observations from varied samples and locations. 52 , 53 , 55 , 56 We did not collect vape brand preferences, and did not distinguish between vaping nicotine, tetrahydrocannabinol (THC) or marijuana products, and flavors only, which should be explored to determine if users of different products have unique characteristics and interests. We also cannot discern causality, such as whether any of these psychographic characteristics or interests predisposed teens to increased interest in vaping, or if targeted industry marketing or other factors may have contributed to disparities.

Conclusions

Tackling adolescent vaping requires understanding who is at the greatest risk and how to reach them with relevant, persuasive messaging. Although current vaping is increasingly common among U.S. adolescents, risk is not evenly distributed, and prevention efforts should rely on psychographic segmentation, audience tailoring, and media targeting to effectively and efficiently reach higher-risk adolescents. 45 Although establishing a deeper understanding of the psychographics and interests of higher-risk adolescents may appear burdensome, in fact it is necessary to ensure that limited public health funds are spent on the populations facing the greatest challenges, 46 particularly in today’s online media environment where platform targeting tools cater toward advertisers who know the interests of their audiences. Our findings provide a detailed portrait of adolescents who are at increased risk for current vaping, information which should directly inform health communication campaign planning. Future campaigns should incorporate our findings to create messages relevant to the psychographics and risk profiles of these youth, which are delivered using carefully selected media strategies reflecting the greatest opportunities to reach the target audience efficiently. Addressing the urgent adolescent vaping crisis requires looking deeper than demographics to understand and leverage knowledge about who adolescent vape users are and what they care about, to create health communications campaigns that appeal to and persuade those at the greatest risk.

Supplemental Material

Acknowledgments.

The authors would like to thank Rebeca Mahr, Molly Moran, and Jon Benko for their assistance with data collection; Jensen Saintilien and Gwenyth Crise for their assistance with reviewing the literature; and Sharyn Rundle-Thiele for her feedback on a draft of the manuscript.

Author Contributions: CAS conducted analyses and drafted the manuscript. MD and JWJ contributed to study conception/design and manuscript revisions.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplemental Material: Supplemental material for this article is available online.

Home — Essay Samples — Nursing & Health — Smoking — Vaping: All You Need to Know about this Trend

Vaping: All You Need to Know About This Trend

• Categories: Smoking

About this sample

Words: 712 |

Published: Dec 18, 2018

Words: 712 | Pages: 2 | 4 min read

Table of contents

Vaping a fashion, vaping business, what’s the final point.

• House of Vapes
• Prohibition Vapes
• Vape & Juice
• The Wheatsheaf
• Prospect of Whitby

Hook Examples for Vaping Essay

• The Rise of Vapor: Step into the world of vaping and explore how this modern trend has taken the world by storm, reshaping the way people consume nicotine.
• Invisible Dangers: Uncover the hidden health risks lurking behind the enticing flavors and billowing clouds of vapor, as we delve into the alarming consequences of vaping.
• The Marketing Maze: Discover the strategies employed by vaping companies to target a new generation of users, and how the industry’s advertising tactics have raised ethical concerns.
• Teen Epidemic: Examine the startling rise in teenage vaping and the impact it has on adolescent health, education, and society as a whole.
• A Path to Quit: Explore the potential vaping holds as both a smoking cessation tool and a harm reduction method, considering the debates and challenges surrounding this approach.

Works Cited

• Cooper, R. (2018). Skipping a Beat: Assessing the state of gender equality in the Australian music industry. University of Sydney.
• Hibberd, J. (2020, March 8). How Women Are Changing the Indie Rock Scene. Rolling Stone.
• LISTEN. (n.d.). About. Retrieved from https://www.listenlistenlisten.org/about
• McMahon, K. (2019, April 29). The Triple J Gender Imbalance Is Being Highlighted Again By Industry Experts. Junkee.
• Merritt, S. (2019, October 3). Where are all the women in music production? Sydney Morning Herald.
• Music Industry Observer. (2021, January 25). How COVID-19 Has Impacted Women in the Music Industry. Music Industry Observer.
• O’Connor, R. (2018, March 8). International Women’s Day: Meet the women trying to change the face of the Australian music industry. ABC News.
• Rogers, K. (2018, November 21). An In-Depth Look at the State of Women in the Music Industry. Mixmag.
• Triscari, C. (2020, December 1). The music industry is finally waking up to its diversity problem. NME.
• UN Women. (2015). Gender Equality and the Music Industry. UN Women.

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How to write a 5 paragraph essay, openai prepares to launch web search feature for chatgpt, rivaling google and perplexity, why e-cigarettes are better for smokers than regular ones essay sample, example.

Smoking tobacco is probably one of the worst habits humankind has developed. Originating as a tradition of the Native Americans, practiced mostly on special occasions, smoking has gradually become a kind of mass addiction. Due to the efforts of tobacco companies seeking to increase their sales, people started smoking more and more often; the evolution of a more traditional pipe to a cigarette took some time, but eventually tobacco became more affordable and easier to use (you now simply need to light it up, instead of having to always carry a tobacco pouch, stuff a pipe, puff it, and so on). As a result, deaths and health issues connected to tobacco consumption became a worldwide concern.

A popular belief is that it is nicotine that kills. It is only partially true: although nicotine does harm one’s health (mostly affecting the cardiovascular system), it is the tar, carbon monoxide, hard particles contained in cigarette smoke, and a bunch of toxic emissions and heavy metals that deal the most damage. Nicotine causes addiction, and the smoke does the rest.

Nowadays, there are alternatives to analogue tobacco smoking: the widely popular electronic cigarettes. Although it is hotly debated whether e-cigarettes are harmful to smokers’ health or not, it is hard to argue that substituting cigarettes with these devices does more good than bad, since they possess a number of advantages that cannot be neglected easily. And whereas smoking still remains a dangerous and unacceptable addiction, e-cigarettes might be a decent way to break free of it.

Electronic cigarettes deliver nicotine to a smoker not through burning (which obviously implies inhaling harmful and toxic smoke), but through the evaporation of nicotine-containing liquids. An e-cigarette heats up the liquid in a special container called an atomizer; the liquid evaporates, and through this vapor a smoker receives their dose of nicotine. Thus, the process of nicotine consumption in this case should be called “vaping,” not “smoking.” These liquids usually comprise glycerol, propylene glycol, ethylene glycol, propanediol, and some other components ( NCBI ). Although some of them are not completely harmless, the chemical composure of e-cigarette liquids is definitely safer than the one of a regular cigarette. However, thorough control over the composure of these liquids should be established, and the usage of such components as ethylene glycol and propanediol should probably be banned. Still, if a smoker does not plan to quit, he or she might want to consider using e-cigarettes instead of real tobacco.

Another good reason for a smoker to start using e-cigarettes is that the aforementioned liquids can contain different amounts of nicotine. A heavy smoker might want to start vaping using liquids containing up to 24 milligrams of nicotine, and the good news for them is that it is possible to gradually decrease the dose until zero milligrams are present.

Although some smokers might experience physical symptoms when trying to quit smoking tobacco, in the majority of cases, it is a strong psychological component that does not let a smoker give up their addiction. It can be assumed that there are five main components of this psychological addiction: 1) believing in the relaxing/stimulating effect of nicotine that helps a smoker deal with stressful situations; 2) a smoker’s need to “keep hands busy” when bored, waiting for something, feeling nervous, and so on; 3) socializing with “fellow smokers”; 4) unconsciously and “automatically” following the habit; 5) the fear that if a smoker quits, he or she will lose something valuable, a source of psychological support or pleasure. In addition, some smokers find it aesthetic to inhale/exhale smoke, or have other reasons to continue tobacco consumption. Generally speaking, smoking is a behavioral pattern consisting of repeating situations and reactions. Without neglecting or challenging these reasons, it can be said that an e-cigarette is probably a safer alternative for a person who does not want to give up nicotine. They still deliver nicotine to a smoker’s body (thus fulfilling the reasons 1 and 5); they disrupt automatic smoking described in points 2 and 4 (since e-cigarettes function differently from their traditional analogues); they allow a person to continue socializing with other smokers during breaks at work, or on other occasions, as mentioned in point 3. But, while performing the same functions as regular cigarettes, electronic devices are safer and more socially acceptable.

In addition, a purely aesthetic reason to prefer e-cigarettes over their analogues: when evaporated, the liquids taste and smell better than tobacco. They are sold in a variety of flavors: melons, apples, cherry, tropical fruit, mint, blueberry, and so on. At the same time, regular tobacco smells and tastes awful not only for the non-smokers, but for a smoking person as well. So, why not stop poisoning oneself with toxic smoke, and at least substitute it with pleasantly smelling vapor?

Nicotine addiction in any of its forms, regardless of whether it is smoking or vaping, is a huge problem for addicts. It leads to a number of severe, chronic diseases and even to death. At the same time, there might be a healthier alternative for those smokers who realize the harm they cause to themselves, but who cannot yet give up their addiction. Electronic cigarettes are nowadays considered to be safer than regular cigarettes. Liquids used in these e-cigarettes contain fewer toxic elements, and do not include the products that are commonly burned in cigarettes. Vapor from e-cigarettes is mostly harmless to non-smokers; it tastes and smells better, which makes smoking e-cigarettes a less reproached habit. Finally, many smokers might discover that e-cigarettes do not obstruct their reasons to continue smoking, while making it possible to decrease the amounts of consumed nicotine and to eventually break the habit. Therefore, without praising or advertising e-cigarettes, it can still be stated that they are a more preferable alternative for smokers.

Works Cited

• “Electronic Cigarettes: Overview of Chemical Composition and Exposure Estimation.” NCBI . BioMed Central, 2014. Web. 14 Nov. 2016.

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235 Smoking Essay Topics & Examples

Looking for smoking essay topics? Being one of the most serious psychological and social issues, smoking is definitely worth writing about.

🏆 Best Smoking Essay Examples & Topic Ideas

🥇 good titles for smoking essay, 👍 best titles for research paper about smoking, ⭐ simple & easy health essay titles, 💡 interesting topics to write about health, ❓ essay questions about smoking.

In your essay about smoking, you might want to focus on its causes and effects or discuss why smoking is a dangerous habit. Other options are to talk about smoking prevention or to concentrate on the reasons why it is so difficult to stop smoking. Here we’ve gathered a range of catchy titles for research papers about smoking together with smoking essay examples. Get inspired with us!

Smoking is a well-known source of harm yet popular regardless, and so smoking essays should cover various aspects of the topic to identify the reasons behind the trend.

You will want to discuss the causes and effects of smoking and how they contributed to the persistent refusal of large parts of the population to abandon the habit, even if they are aware of the dangers of cigarettes. You should provide examples of how one may become addicted to tobacco and give the rationales for smokers.

You should also discuss the various consequences of cigarette use, such as lung cancer, and identify their relationship with the habit. By discussing both sides of the issue, you will be able to write an excellent essay.

Reasons why one may begin smoking, are among the most prominent smoking essay topics. It is not easy to begin to enjoy the habit, as the act of smoke inhalation can be difficult to control due to a lack of experience and unfamiliarity with the concept.

As such, people have to be convinced that the habit deserves consideration by various ideas or influences. The notion that “smoking is cool” among teenagers can contribute to the adoption of the trait, as can peer pressure.

If you can find polls and statistics on the primary factors that lead people to tweet, they will be helpful to your point. Factual data will identify the importance of each cause clearly, although you should be careful about bias.

The harmful effects of tobacco have been researched considerably more, with a large body of medical studies investigating the issue available to anyone.

Lung cancer is the foremost issue in the public mind because of the general worry associated with the condition and its often incurable nature, but smoking can lead to other severe illnesses.

Heart conditions remain a prominent consideration due to their lethal effects, and strokes or asthma deserve significant consideration, as well. Overall, smoking has few to no beneficial health effects but puts the user at risk of a variety of concerns.

As such, people should eventually quit once their health declines, but their refusal to do so deserves a separate investigation and can provide many interesting smoking essay titles.

One of the most prominent reasons why a person would continue smoking despite all the evidence of its dangers and the informational campaigns carried out to inform consumers is nicotine addiction.

The substance is capable of causing dependency, a trait that has led to numerous discussions of the lawfulness of the current state of cigarettes.

It is also among the most dangerous aspects of smoking, a fact you should mention.

Lastly, you can discuss the topics of alternatives to smoking in your smoking essay bodies, such as e-cigarettes, hookahs, and vapes, all of which still contain nicotine and can, therefore, lead to considerable harm. You may also want to discuss safe cigarette avoidance options and their issues.

Here are some additional tips for your essay:

• Dependency is not the sole factor in cigarette consumption, and many make the choice that you should respect consciously.
• Cite the latest medical research titles, as some past claims have been debunked and are no longer valid.
• Mortality is not the sole indicator of the issues associated with smoking, and you should take chronic conditions into consideration.

Find smoking essay samples and other useful paper samples on IvyPanda, where we have a collection of professionally written materials!

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• Tobacco Smoking: Bootleggers and Baptists Legislation or Regulation The issue is based on the fact that tobacco smoking also reduces the quality of life and ruins the body in numerous ways.
• Ban Smoking in Cars Out of this need, several regulations have been put in place to ensure children’s safety in vehicles is guaranteed; thus, protection from second-hand smoke is an obvious measure that is directed towards the overall safety […]
• Smoking: Causes and Effects Considering the peculiarities of a habit and of a disease, smoking can be considered as a habit rather than a disease.
• Smoking Behavior Under Clinical Observation The physiological aspect that influences smokers and is perceived as the immediate effect of smoking can be summarized as follows: Within ten seconds of the first inhalation, nicotine, a potent alkaloid, passes into the bloodstream, […]
• Smoking and Its Effect on the Brain Since the output of the brain is behavior and thoughts, dysfunction of the brain may result in highly complex behavioral symptoms. The work of neurons is to transmit information and coordinate messengers in the brain […]
• Smoking Causes and Plausible Arguments In writing on the cause and effect of smoking we will examine the issue from the point of view of temporal precedence, covariation of the cause and effect and the explanations in regard to no […]
• Post Smoking Cessation Weight Gain The aim of this paper is to present, in brief, the correlation between smoking cessation and weigh gain from biological and psychological viewpoints.
• Marketing a Smoking Cessation Program In the case of the smoking cessation program, the target group is made up of smokers who can be further subdivided into segments such as heavy, medium, and light smokers.
• Smoking Cessation for Ages 15-30 The Encyclopedia of Surgery defines the term “Smoking Cessation” as an effort to “quit smoking” or “withdrawal from smoking”. I aim to discuss the importance of the issue by highlighting the most recent statistics as […]
• Motivational Interviewing as a Smoking Cessation Intervention for Patients With Cancer The dependent variable is the cessation of smoking in 3 months of the interventions. The study is based on the author’s belief that cessation of smoking influences cancer-treated patients by improving the efficacy of treatment.
• Factors Affecting the Success in Quitting Smoking of Smokers in West Perth, WA Australia Causing a wide array of diseases, health smoking is the second cause of death in the world. In Australia, the problem of smoking is extremely burning due to the high rates of diseases and deaths […]
• Media Effects on Teen Smoking But that is not how an adult human brain works, let alone the young and impressionable minds of teenagers, usually the ads targeted at the youth always play upon elements that are familiar and appealing […]
• “Passive Smoking Greater Health Hazard: Nimhans” by Stephen David The article focuses on analyzing the findings of the study and compares them to the reactions to the ban on public smoking.
• Partnership in Working About Smoking and Tobacco Use The study related to smoking and tobacco use, which is one of the problematic areas in terms of the health of the population.
• Cigar Smoking and Relation to Disease The article “Effect of cigar smoking on the risk of cardiovascular disease, chronic obstructive pulmonary disease and cancer in Men” by Iribarren et al.is a longitudinal study of cigar smokers and the impact of cigar […]
• Quitting Smoking: Motivation and Brain As these are some of the observed motivations for smoking, quitting smoking is actually very easy in the sense that you just have to set your mind on quitting smoking.
• Health Effects of Tobacco Smoking in Hispanic Men The Health Effects of Tobacco Smoking can be attributed to active tobacco smoking rather than inhalation of tobacco smoke from environment and passive smoking.
• Smoking in Adolescents: A New Threat to the Society Of the newer concerns about the risks of smoking and the increase in its prevalence, the most disturbing is the increase in the incidences of smoking among the adolescents around the world.
• The Importance of Nurses in Smoking-Cessation Programs When a patient is admitted to the hospital, the nursing staff has the best opportunity to assist them in quitting in part because of the inability to smoke in the hospital combined with the educational […]
• New Jersey Legislation on Smoking The advantages and disadvantages of the legislation were discussed in this case because of the complexity of the topic at hand as well as the potential effects of the solution on the sphere of public […]
• Environmental Health: Tabaco Smoking and an Increased Concentration of Carbon Monoxide The small size of the town, which is around 225000 people, is one of the reasons for high statistics in diseases of heart rate.
• Advanced Pharmacology: Birth Control for Smokers The rationale for IUD is the possibility to control birth without the partner’s participation and the necessity to visit a doctor just once for the device to be implanted.
• Legislation Reform of Public Smoking Therefore, the benefit of the bill is that the health hazard will be decreased using banning smoking in public parks and beaches.
• Female Smokers Study: Inferential Statistics Article The article “Differential Effects of a Body Image Exposure Session on Smoking Urge between Physically Active and Sedentary Female Smokers” deepens the behavioral mechanisms that correlate urge to smoke, body image, and physical activity among […]
• Smoking Bans: Protecting the Public and the Children of Smokers The purpose of the article is to show why smoking bans aim at protecting the public and the children of smokers.
• Clinical Effects of Cigarette Smoking Smoking is a practice that should be avoided or controlled rigorously since it is a risk factor for diseases such as cancer, affects the health outcomes of direct and passive cigarette users, children, and pregnant […]
• Public Health and Smoking Prevention Smoking among adults over 18 years old is a public health issue that requires intervention due to statistical evidence of its effects over the past decades.
• Smoking in the US: Statistics and Healthcare Costs According to the Centers for Disease Control and Prevention, tobacco smoking is the greatest preventable cause of death in the US.
• Smoking Should Be Banned Internationally The questions refer to the knowledge concerning the consequences of smoking and the opinions on smoking bans. 80 % of respondents agree that smoking is among the leading causes of death and 63, 3 % […]
• Microeconomics: Cigarette Taxes and Public Smoking Ban The problem of passive smoking will be minimized when the number of smokers decreases. It is agreeable that the meager incomes of such families will be used to purchase cigarettes.
• Alcohol and Smoking Impact on Cancer Risk The research question is to determine the quantity of the impact that different levels of alcohol ingestion combined with smoking behavioral patterns make on men and women in terms of the risks of cancer.
• Teenagers Motivated to Smoking While the rest of the factors also matter much in the process of shaping the habit of smoking, it is the necessity to mimic the company members, the leader, or any other authority that defines […]
• Indoor Smoking Restriction Effects at the Workplace Regrettably, they have neglected research on the effect of the legislation on the employees and employers. In this research, the target population will be the employees and employers of various companies.
• Hypnotherapy Session for Smoking Cessation When I reached the age of sixty, I realized that I no longer wanted to be a smoker who was unable to take control of one’s lifestyle.
• Stopping Tobacco Smoking: Lifestyle Management Plan In addition, to set objective goals, I have learned that undertaking my plan with reference to the modifying behaviour is essential for the achievement of the intended goals. The main intention of the plan is […]
• Smoking Epidemiology Among High School Students In this way, with the help of a cross-sectional study, professionals can minimalize the risk of students being afraid to reveal the fact that they smoke. In this way, the number of students who smoke […]
• Social Marketing: The Truth Anti-Smoking Campaign The agreement of November 1998 between 46 states, five territories of the United States, the District of Columbia, and representatives of the tobacco industry gave start to the introduction of the Truth campaign.
• Vancouver Coastal Health Smoking Cessation Program The present paper provides an evaluation of the Vancouver Coastal Health smoking cessation program from the viewpoint of the social cognitive theory and the theory of planned behavior.
• Smoking Experience and Hidden Dangers When my best college friend Jane started smoking, my eyes opened on the complex nature of the problem and on the multiple negative effects of smoking both on the smoker and on the surrounding society.
• South Illinois University’s Smoking Ban Benefits The purpose of this letter is to assess the possible benefits of the plan and provide an analysis of the costs and consequences of the smoking ban introduction.
• Smoking Cessation in Patients With COPD The strategy of assessing these papers to determine their usefulness in EBP should include these characteristics, the overall quality of the findings, and their applicability in a particular situation. The following article is a study […]
• Smoking Bans: Preventive Measures There have been several public smoking bans that have proved to be promising since the issue of smoking prohibits smoking in all public places. This means it is a way of reducing the exposure to […]
• Ban Smoking Near the Child: Issues of Morality The decision to ban smoking near the child on father’s request is one of the demonstrative examples. The father’s appeal to the Supreme Court of California with the requirement to prohibit his ex-wife from smoking […]
• The Smoking Ban: Arguments Comparison The first argument against banning smoking employs the idea that smoking in specially designated areas cannot do harm to the health of non-smokers as the latter are supposed to avoid these areas.
• Smoking Cessation and Patient Education in Nursing Pack-years are the concept that is used to determine the health risks of a smoking patient. The most important step in the management plan is to determine a date when the man should quit smoking.
• Philip Morris Company’s Smoking Prevention Activity Philip Morris admits the existence of scientific proof that smoking leads to lung cancer in addition to other severe illnesses even after years of disputing such findings from health professionals.
• Tobacco Smoking and Its Dangers Sufficient evidence also indicates that smoking is correlated with alcohol use and that it is capable of affecting one’s mental state to the point of heightening the risks of development of disorders.
• Virginia Slims’ Impact on Female Smokers’ Number Considering this, through the investigation of Philip Morris’ mission which it pursued during the launch of the Virginia Slims campaign in 1968-1970 and the main regulatory actions undertaken by the Congress during this period, the […]
• Cigarette Smoking and Parkinson’s Disease Risk Therefore, given the knowledge that cigarette smoking protects against the disease, it is necessary to determine the validity of these observations by finding the precise relationship between nicotine and PD.
• Tuberculosis Statistics Among Cigarette Smokers The proposal outlines the statistical applications of one-way ANOVA, the study participants, the variables, study methods, expected results and biases, and the practical significance of the expected results.
• Smoking Ban and UK’s Beer Industry However, there is an intricate type of relationship between the UK beer sector, the smoking ban, and the authorities that one can only understand by going through the study in detail The history of smoking […]
• Status of Smoking around the World Economic factors and level of education have contributed a lot to the shift of balance in the status of smoking in the world.
• Redwood Associates Company’s Smoking Ethical Issues Although employees are expected to know what morally they are supposed to undertake at their work place, it is the responsibility of the management and generally the Redwood’s hiring authority to give direction to its […]
• Smokers’ Campaign: Finding a Home for Ciggy Butts When carrying out the campaign, it is important to know what the situation on the ground is to be able to address the root cause of the problem facing the population.
• Mobile Applications to Quit Smoking A critical insight that can be gleaned from the said report is that one of the major factors linked to failure is the fact that smokers were unable to quit the habit on their own […]
• Behavior Modification Technique: Smoking Cessation Some of its advantages include: its mode of application is in a way similar to the act of smoking and it has very few side effects.
• Quitting Smoking: Strategies and Consequences Thus, for the world to realize a common positive improvement in population health, people must know the consequences of smoking not only for the smoker but also the society. The first step towards quitting smoking […]
• Effects of Thought Suppression on Smoking Behavior In the article under analysis called I suppress, Therefore I smoke: Effects of Thought Suppression on Smoking Behavior, the authors dedicate their study to the evaluation of human behavior as well as the influence of […]
• Suppressing Smoking Behavior and Its Effects The researchers observed that during the first and the second weeks of the suppressed behavior, the participants successfully managed to reduce their intake of cigarettes.
• Smoking Cessation Methods These methods are a part of NRT or nicotine replacement therapy, they work according to the principle of providing the smoker with small portions of nicotine to minimize the addiction gradually and at the same […]
• Understanding Advertising: Second-Hand Smoking The image of the boy caught by the smoke is in the center of the picture, and it is in contrast with the deep black background.
• People Should Quit Smoking
• Importance of Quitting Smoking
• Cigarette Smoking in Public Places
• Ban of Tobacco Smoking in Jamaica
• Anti-Smoking Campaign in Canada
• Electronic Cigarettes: Could They Help University Students Give Smoking Up?
• Psychosocial Smoking Rehabilitation
• The Program on Smoking Cessation for Employees
• Tips From Former Smokers (Campaign)
• Combating Smoking: Taxation Policies vs. Education Policies
• The Program to Quit Smoking
• Smoking Culture in Society
• Possible Smoking Policies in Florida
• Smoking Ban in the State of Florida
• Core Functions of Public Health in the Context of Smoking and Heart Disease
• Smoking: Pathophysiological Effects
• Putting Out the Fires: Will Higher Taxes Reduce the Onset of Youth Smoking?
• Smoking Bans in US
• Smoking as Activity Enhancer: Schizophrenia and Gender
• Health Care Costs for Smokers
• Medical Coverage for Smoking Related Diseases
• Exposure to mass media proliferate smoking
• The Realm of reality: Smoking
• Ethical Problem of Smoking
• The Rate of Smoking Among HIV Positive Cases.
• Studying the Government’s Anti-Smoking Measures
• Smoking Should Be Banned In the United States
• Effectiveness of Cognitive Behavioral Theory on Smoking Cessation
• Effectiveness of the Cognitive Behavioral Therapy for Smoking Cessation
• Wayco Company’s Non-smoking Policy
• Adverse Aspects of Smoking
• Negative Impacts of Smoking on Individuals and Society
• Dealing With the Increase in the Number of Smokers Between Ages 17 and 45
• Cannabis Smoking in Canada
• Smoking Ban in the United States of America
• Dangers of Smoking Campaign
• Should Cigarettes Be Banned? Essay
• Smoking Ban in New York
• Smoking and Adolescents
• Trends in Smoking Prevalence by Race/Ethnicity
• Business Ethics: Smoking Issue
• Where Does the Path to Smoking Addiction Start?
• Public Health Communication: Quit Smoking
• Are Estimated Peer Effects on Smoking Robust?
• Are There Safe Smoking and Tobacco Options?
• What Are the Health Risks of Smoking?
• Does Cigarette Smoking Affect Body Weight?
• Does Cigarette Smuggling Prop Up Smoking Rates?
• What Foods Help You Quit Smoking?
• How Can People Relax Without Smoking?
• Does Education Affect Smoking Behaviors?
• Is Vaping Worse Than Smoking?
• Do Movies Affect Teen Smoking?
• What Is Worse: Drinking or Smoking?
• Does Smoking Affect Breathing Capacity?
• Does Smoking Cause Lung Cancer?
• Does Having More Children Increase the Likelihood of Parental Smoking?
• Does Smoking Cigarettes Relieve Stress?
• Does Time Preference Affect Smoking Behavior?
• How Does Smoking Affect Cardiovascular Endurance?
• How Hypnosis Can Help You Quit Smoking?
• How Does Smoking Affect Brain?
• How Nicotine Affects Your Quit Smoking Victory?
• How Does Secondhand Smoking Affect Us?
• Why Is Smoking Addictive?
• How Smoking Bans Are Bad for Business?
• Why Smoking Should Not Be Permitted in Restaurants?
• Why Public Smoking Should Be Banned?
• Why Has Cigarette Smoking Become So Prominent Within the American Culture?
• What Makes Smoking and Computers Similar?
• Does Smoking Affect Schooling?
• What Effects Can Cigarette Smoking Have on the Respiratory System?
• What Are the Most Prevalent Dangers of Smoking and Drinking?
• Social Security Paper Topics
• Drugs Titles
• Cannabis Essay Titles
• Global Issues Essay Topics
• Cardiovascular Diseases Titles
• Marijuana Ideas
• NHS Research Ideas
• Hypertension Topics
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Ban on flavored vaping may have led teens to cigarettes, study suggests.

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When San Francisco voters overwhelmingly approved a 2018 ballot measure banning the sale of flavored tobacco products — including menthol cigarettes and flavored vape liquids — public health advocates celebrated. After all, tobacco use poses a significant threat to public health and health equity, and flavors are particularly attractive to youth.

But according to a new study from the Yale School of Public Health (YSPH), that law may have had the opposite effect. Analyses found that, after the ban’s implementation, high school students’ odds of smoking conventional cigarettes doubled in San Francisco’s school district relative to trends in districts without the ban, even when adjusting for individual demographics and other tobacco policies.

The study, published in JAMA Pediatrics on May 24, is believed to be the first to assess how complete flavor bans affect youth smoking habits.

“ These findings suggest a need for caution,” said Abigail Friedman , the study’s author and an assistant professor of health policy at YSPH. “While neither smoking cigarettes nor vaping nicotine are safe per se, the bulk of current evidence indicates substantially greater harms from smoking, which is responsible for nearly one in five adult deaths annually. Even if it is well-intentioned, a law that increases youth smoking could pose a threat to public health.”

Friedman used data on high school students under 18 years of age from the Youth Risk Behavior Surveillance System’s 2011-2019 school district surveys. Prior to the ban’s implementation, past-30-day smoking rates in San Francisco and the comparison school districts were similar and declining. Yet once the flavor ban was fully implemented in 2019, San Francisco’s smoking rates diverged from trends observed elsewhere, increasing as the comparison districts’ rates continued to fall.

To explain these results, Friedman noted that electronic nicotine delivery systems have been the most popular tobacco product among U.S. youth since at least 2014, with flavored options largely preferred.

“ Think about youth preferences: some kids who vape choose e-cigarettes over combustible tobacco products because of the flavors,” she said. “For these individuals as well as would-be vapers with similar preferences, banning flavors may remove their primary motivation for choosing vaping over smoking, pushing some of them back toward conventional cigarettes.”

These findings have implications for Connecticut, where the state legislature is currently considering two flavor bills: House Bill 6450 would ban sales of flavored electronic nicotine delivery systems, while Senate Bill 326 would ban sales of any flavored tobacco product. As the U.S. Food and Drug Administration recently announced that it will ban flavors in all combustible tobacco products within the next year, both bills could result in a Connecticut policy that is similar to the complete ban enacted in San Francisco.

The San Francisco study does have limitations. Because there has been only a short time since the ban was implemented, the trend may differ in coming years. San Francisco is also just one of several localities and states that have implemented restrictions on flavored tobacco sales, with extensive differences between these laws. Thus, effects may differ in other places, Friedman wrote.

Still, as similar restrictions continue to appear across the country, the findings suggest that policymakers should be careful not to indirectly push minors toward cigarettes in their quest to reduce vaping, she said.

What does she suggest as an alternative? “If Connecticut is determined to make a change before the FDA’s flavor ban for combustible products goes into effect, a good candidate might be restricting all tobacco product sales to adult-only — that is 21-plus — retailers,” she said. “This would substantively reduce children’s incidental exposure to tobacco products at convenience stores and gas stations, and adolescents’ access to them, without increasing incentives to choose more lethal combustible products over non-combustible options like e-cigarettes.” 

This work was supported by a grant from the National Institute on Drug Abuse of the National Institutes of Health and FDA Center for Tobacco Products (CTP) . The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health or the Food and Drug Administration.

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