Views and opinions regarding e-cigarettes and vaping: a focus group study in South Australia

Methodological approach and research team

A qualitative ‘descriptive’ approach (as compared to a more ‘interpretive’ approach) was the methodology chosen for this project. Qualitative descriptive approaches are ‘the method of choice when straight descriptions of phenomena are desired’.⁶ The project was approved by Flinders University’s Human Research Ethics Committee (Project ID 5120). This project was conducted by a fulltime male researcher in public health with a Doctorate of Philosophy who is currently undertaking a Masters of Public Health (ZM), supported by a female lecturer and course coordinator (LM) with a Masters of Public Health. The topic was selected as vaping was viewed as an issue of public health importance by the course coordinator (LM). The Consolidated Criteria for Reporting Qualitative Studies (COREQ), a reporting standard for studies using interviews and focus groups, was used to guide the report.⁷

Setting and sample

This focus group consisted of 5 participants and one moderator. Participants were non-vapers. Participants were convenience sampled and recruited and invited form the moderator’s (ZM) social group. As such, the participants were aware of the researcher’s personal goals and reasons for doing this research. Participants were initially contacted via instant messaging applications to determine if they would be interested in taking part of this study. The focus group was scheduled to run for approximately an hour and was scheduled for a time that was most convenient for the participants. Refreshments were provided for the group but participants were not otherwise reimbursed. Participants were free to take part in the focus group as they wished, and were not coerced to do so. The focus group occurred in the kitchen of the moderator’s house around a large table. There were no others present except for the moderator and the participants. All participants were provided with a plain language statement, and provided written consent to take part in the study by signing a consent form. No participants withdrew from the research.

Data collection

Focus groups are a data collection method consisting of a group discussion with a number of participants, and although various definitions exist, all of these ‘centre on the use of interaction among participants as a way of accessing data that would not emerge if other methods were used’ (p. 800).⁸ As Kitzinger (1995) states, focus groups can be used not only to discover what people think, but how and why they think that way.⁹ Focus groups are a useful data collection technique when aiming for a qualitative description⁶ of a phenomenon. This focus group was recorded using voice memos on an iPhone and then transcribed verbatim by the moderator (ZM). A standard focus group protocol was used to facilitate these discussions; however the focus group moderator allowed the discussion to veer away from the predetermined questions as long as it was still on the topic of views and opinions of vaping and providing data useful for the purposes of this study. Confidentiality was maintained with participants assigned a number during transcription. The moderator had received training in focus groups and had run focus groups previously. The focus group was conducted at 8.15 pm at night, lasting 63 minutes in total.

Data analysis

The focus group was transcribed verbatim by the lead researcher (ZM). These were not returned to the participants for comment or correction. Data was analysed using NVivo (version 12, Lumivero (https://help-nv.qsrinternational.com/12/win/v12.1.115-d3ea61/Content/about-nvivo/product-editions.htm) (Opensource alternative Taguette) by only the lead researcher (ZM), who had a license to sue this tool. The focus group analysis used a qualitative thematic analysis approach,¹⁰ which is a method of choice in qualitative descriptive studies.¹¹ Field notes were made immediately after the interview. The first phase of analysis involved the researcher immersing themselves within the data by reading and re-reading the transcription of the focus group. During this process the researcher was able to identify and generate initial codes. The next stage of analysis included the grouping of codes into themes based on their similarity of meaning. These were then reviewed and refined. Participants did not provide feedback on the findings. Data is finally presented under thematic headings representing the perceptions and opinions regarding e-cigarettes and vaping.

Participant characteristics

The focus group participants were from the moderator’s peer group. The moderator is a 37 year old researcher and married male. The focus group consisted of five participants; 4 males and 1 female. All participants had not used nicotine vapes in the past. Two of the participants were married, whilst the remaining three were in de facto relationships or engaged. All participants lived in Adelaide, South Australia and were born in Australia. All participants were in the 35-39 year old bracket. Only one participant lived with someone who uses e-cigarettes or vapes (Table 1).

Findings

Participants were provided a number from 1 through to 5 in the transcript. Data was analysed via a process of thematic analysis. There were 6 themes from 36 codes (Table 2).

Vaping for social reasons

The group discussed their views on who vapers are and why people vape, with views that there are shared experiences that vaping offers, as shown in this quote from this participant ‘… this idea that everyone’s sitting around maybe having a drink. And you’re talking about vapes. Yeah, what flavour do you have? Where do you get yours? And it’s, it’s become a social fun thing’. There were views that vaping is a fad or a novelty, and many want to experiment with it. However, it was noted that there is also an element of peer pressure, as ‘it’s a social, almost peer pressure type thing’. ‘Oh, this is great, it’s so sweet here. Try it’ (mimics someone pressuring someone else to vape). The group saw vapers largely as young people, including young trade workers, who may be more susceptible to peer pressure, with one participant describing that ‘tradies are big on vaping for all the reasons that we’ve touched on. It’s something they can have on their persons at all time. And easily fits into one of their 1 million pockets, they can do it on the site anywhere.’

Vaping is superior to cigarettes

The group perceived many advantages of vaping over cigarettes, with the group discussing vaping as a smoking cessation tool but also being superior to cigarette smoking in many ways. The group discussed how vaping likely had health benefits as compared to smoking: ‘I think if we go back to what they were invented for, to get people off smoking, there’s, there’s huge benefit to that. Because if the long-term effects are that bad, chances are it’s probably not as bad as smoking a pack a day.’ However, many other benefits were mentioned, such as a reduced stigma with vaping as compared to cigarettes, vaping being more convenient, cheap and less smelly. For example, one participant stated that ‘when people smoke cigarettes, they tend to go outside or somewhere else to smoke their cigarettes. But because there’s this perception that vapes aren’t toxic or particularly smelly. People feel more open doing them anywhere.’

Attraction of vaping

Vaping was seen as attractive for other reasons in addition to the social reasons and as an alternative to cigarettes. Firstly, there was the view that there are psychological reasons for vaping, where vaping may offer some relief or help for people to get through the day, as described in the following quote: ‘someone that’s just needing that extra something to get them through, like just a, just a habit to get their mind off something else, or take into a different space, more of mental reasons why you might start.’ Others may simply enjoy the smells and tastes: ‘I’ve had work colleagues who liked the smell so they just started hanging out with the people smoking, with the different flavours and then wanting to try because they liked the sweet smells.’ Alternatively, there was a view that vaping can be a way to have a smoke break from work.

Vaping is invasive and pervasive

There were strong views from the group that vaping seemed to be everywhere and was increasing in popularity, with it being invasive on people’s personal space and lives. It was occurring in places where you would not expect it, as discussed by one participant: ‘you pick up mates and they do it in cars and are vaping – nobody smokes cigarettes in cars anymore. People do it in the change rooms at the footy clubs.’ There was a perception that vapers were possibly disrespectful when choosing where to vape, as mentioned by another participant: ‘to be clear, I don’t have a problem with vaping itself. I have a problem with people vaping inside next to me or inside of where I am.’ This led to a discussion about the need to set personal boundaries around vaping, with one participant recalling having to tell a friend who was vaping their house: ‘nah stop, stop now, if you wanna do it go outside.’

Addiction and impacts of vaping

There were views on the risk of addiction and adverse health effects from vaping. Some of this was linked to uncertainty regarding what people were actually vaping, with no one truly knowing what goes in to an individual vaping product: ‘since they banned liquid, liquid nicotine, it’s all the pre-packaged ones now and who knows what’s in them. Before there was people pouring their own vape juice and you knew a bit more what was in it.’ The group discussed the health effects, both short and long-term, that could occur as a result of vaping, and that we could see the same issues with smoking once again, as demonstrated by this participant: ‘I think we’re hurtling towards an almost epidemic of respiratory problems down the line, again, going back to when probably cigarettes were first introduced, … I just can’t see how doing something like that for an extended period of time couldn’t lead to anything other than problems.’

Prevention and cessation of vaping

There were views expressed by the group regarding how to prevent and promote cessation of vaping. When questioned whether vaping was preventable or able to be eradicated, it was clear that the view was ‘it’s too far gone’ to eradicate it, but it is possible to prevent some people from vaping and for others to quit. In terms of prevention, there was an idea that education and celebrity endorsement would help with public health messages: ‘Imagine how many vapes would get dropped if Taylor Swift was to come out and explain how bad vaping is for you and whatnot. So we’re starting to see that with Dr. Karl popping up, saying no, vaping is not actually harmless. So that’s starting to happen but, um, so you can’t go past good education and celebrity endorsement for trying to promote something or stop something.’ There were also suggestions to follow measures that have been used to prevent cigarette smoking: ‘Put the stigma on it. Put, put the plain packaging and the awful imagery on every single vape.’ There was a view that it is possible to stop vaping: ‘but like, like anything, everything’s quitable. That person has to want to quit.’ However, others thought quitting wasn’t as likely: ‘There’s no incentive to quit. We aren’t getting told there’s harms later.’