“Skittles & Red Bull is my favourite flavour”: E-cigarettes, smoking, vaping and the changing landscape of nicotine consumption amongst British teenagers – implications for the normalisation debate

Abstract

Aims: From an academic discourse explaining trends in drug-related attitudes and behaviours, “normalisation” now also encompasses public health policy advocating “denormalisation” of smoking. This study explored young people’s attitudes and behaviours to cigarettes and e-cigarettes to ascertain whether a process of “renormalisation” was underway. Methods: A six-month multi-method study was conducted in NW England. Data collection in April-July 2014 included a convenience sample survey of 233 students; secondary analysis of a 3,500 respondent survey; stakeholder interviews; participant observation sessions; focus groups; and participatory research events with over 100 students. Findings: With the public performance of “vaping” valued as an indicator of experienced use, young people used e-cigarettes primarily for flavour combinations and to perform “tricks”. Smoking cessation and nicotine consumption were less important motivations. When comparing e-cigarettes with eight indicators of normalisation – additionally, legal status and risk perception – there were indications of a growing cultural accommodation of “vaping”. Conclusion: The changing landscape of nicotine and non-nicotine products challenges traditional conceptualisations of “smoking” and “non-smoking” and problematises the notion of linear processes of normalisation in respect not just of young people’s tobacco and nicotine use, but more generally, of delivery systems and the drugs dispensed within them, suggesting marketplace-differentiated normalisation.

• E-cigarettes
• normalisation
• smoking
• vaping

Declaration of interest

The authors report no conflicts of interest.

Notes

1. The gateway hypothesis, strongly disputed within the field of drug studies, suggests that the use of “soft” drugs such as cannabis can lead to the use of ”hard” drugs such as heroin and cocaine. This progression draws on pharmacological explanations (changes in brain functioning); market explanations (access and opportunity); and social/psychological “inadequacies” (such as low self-esteem), (Coomber, McElrath, Measham, &Moore, 2013, for summary and Blackman, 2004, for critique).

2. For example, the Avant Garde Bespoke Vaping Bar, billed as “the UK's first high-end vaping bar”, opened in London's West End in February 2015 (Bentley, 2015).

3. Amongst secondary school children rates of having tried a cigarette have fallen from 42% to 22% in 2003-2013 with rates of cigarette trying now at their lowest levels since the survey began in 1982 (Fuller and Hawkins, 2014).

4. With thanks to Chris Lee of Lancashire County Council for his ongoing support for the emerging drug trends research programme, and to Jo McCullough and Lee Harrington from Lancashire County Council and Donald Read from Blackburn with Darwen Council, for their support during the research process. This is the fifth report in the Emerging Drug Trends (EDT) Programme funded by Public Health Lancashire (formerly Lancashire Drug and Alcohol Action Team (LDAAT)) and, for Phase Five, Blackburn with Darwen Public Health. The EDT programme is an ongoing series of short action research projects informing local health service provision directed by Professor Fiona Measham. To date five research projects have explored changing trends in legal and illicit drug use and their policy implications across Lancashire through a series of studies in different leisure contexts and with different communities and social groups. Phase Five was undertaken by Professor Fiona Measham, Dr. Kate O’Brien and Gavin Turnbull at Durham University (Measham, O'Brien, & Turnbull, 2014). For previous reports see: http://www3.lancashire.gov.uk/corporate/web/?siteid=6119&pageid=35445&e=e

5. UK ‘further education’ colleges teach a wide variety of academic and occupational subjects targeted predominantly at the 16–18 age group, after secondary school and before ‘higher education’ at university.

6. Oxford Dictionaries chose “vape” as their word of 2014 (Storr, 2014).

7. The survey of students at two further education colleges produced a sample with an average age of 18 years old, 58% female, 46% living in Blackburn with Darwen, 31% in Preston and 21% in other areas of Lancashire. 213 indicated their self-defined ethnicity: 58% identified as white, 25% Asian (the majority from Blackburn with Darwen), 9% Black and 5% mixed race.

8. By comparison, similarly 59% of TSNW respondents aged 14–17 reported never having smoked.

9. The design of some e-cigarettes specifically to target weekend night-time economy customers was noted by Michael Clapper, owner of multi million pound UK ENDS company Vapestick (Storr, 2014) and included features such as pastel colours and sparkly tips.

10. https://www.youtube.com/watch?v=1Gi2DFj0cAw

11. For example, HBO True Detective series 2 and advertising campaign for ElevenParis clothing brand (autumn 2014).