E-cigarette appeal in context:a qualitative study in deprived areas into the role of packaging in e-cigarette purchasing and use.

Abstract

Electronic cigarettes (e-cigarettes), also known as vapes, are battery-powered devices thatheat a liquid, usually containing nicotine, creating a vapour for users to inhale. Evidencecurrently suggests that e-cigarettes are far less harmful than smoking [1] and can be a usefultool to help people quit smoking [2]. However, as vaping still involves exposure to sometoxicants, e-cigarettes should not be used by people who have never smoked [1]. There areconcerns that e-cigarette packaging may make e-cigarettes more appealing to people who donot currently smoke. New disposable e-cigarettes that have had a recent surge in popularityamongst young people are of particular concern [3]. On the other hand, the currentmandatory health warnings on e-cigarette packaging may increase widespreadmisperceptions of the relative risk of vaping and smoking and deter people who smoke fromswitching to a less harmful alternative to smoking [4]. Higher rates of smoking in more deprived populations contribute to higher cancer incidencewithin these groups [5]. The use of tools to aid quitting attempts, like e-cigarettes, could helpto displace smoking and consequently improve smoking-related health inequalities. Althoughthere is evidence that e-cigarettes are a more effective smoking cessation tool than NicotineReplacement Therapy (NRT), there is an evidence gap regarding the efficacy of e-cigarettes ingroups with high rates of smoking. However, concerns have been raised that people whosmoke may be put off switching to e-cigarettes due to product initial cost, productunreliability, and mistaken perceptions of relative risk compared to smoking [5], [6]. The Tobacco and Related Products Regulations (TRPR) provide the regulatory framework fore-cigarette packaging, product contents and flavours and the advertising and promotion of e-cigarette products. Regarding the regulations for e-cigarette packaging, it is relevant for thisstudy that there must be health warnings stated on the external packaging of the e-cigaretteproduct. For product content, the e-liquid capacity of devices must not exceed 2ml and themaximum strength of these e-liquids no more than 20mg per ml (2%). Additionally, theadvertising of e-cigarettes on TV, radio, social media, and most print media is prohibited.Lastly, it is relevant for this study that sales to people under the age of 18 are prohibited, asare proxy sales, when an adult buys on behalf of someone under the age of 18. The overall aim of this study was to build our understanding of the role of e-cigarette packaging and health warnings in purchase and use decisions, as well as the appeal of disposable devices. Findings will help determine whether regulatory changes could decrease the appeal of e-cigarettes to people who have never smoked and young people, whilst avoiding any unintended consequences which could discourage people who are quitting smoking from using e-cigarettes as a quitting tool. The report brings together findings from interviews with 50 study participants with various levels of vaping experience and 10 vape shop staff in Great Britain. Participants experiencing factors linked with high smoking incidence and cancer inequalities were recruited in areas of County Durham, Fife, Manchester, South Wales and South London with high levels of deprivation. The final sample included 21 dual users (people smoke and vape), 20 who used to smoke and now vape. The other nine participants; four people who smoke and used to vape; two people using vapes who had never smoked; one person who had never smoked or vaped; one person who no longer smokes or vapes and one person who formerly smoked but had never vaped. 13 participants were aged 16-17, 11 were aged 18-24, 21 were aged 25-40 and five were over 40.