Friday, 19 December 2014

New report from Norway: Electronic cigarettes - usage patterns, user groups and user culture

Last Friday (the 12th) the Norwegian Institute for Alcohol and Drug Research (SIRUS) released a report on e-cigarettes with focus on usage patterns, user groups and user culture. I talked to Rikke Tokle, who is responsible for the study, in January when the project was in the start up phase. She said back then that "the background for SIRUS to start this project is the desire for more knowledge and focus on the users and their experience with using e-cigarettes". 

Sirus published an article on their web-page on Friday where Tokle talks a bit about the report. The report and the article is only available in Norwegian at the moment, but I asked Tokle about this and the plan is to release an article in English based on the report later on. The summary of the report is also written in English, and is now available at the last pages.

With Christmas coming up and everything I haven't had the time to read the whole report yet, but I had a brief look at it and it looks like a good read (if you can read Norwegian of course), having a lot of statements from the users that Tokle interviewed in the study. The report is mainly based on interviews with 16 vapers recruited from different channels to avoid selection. In addition to this Tokle has also attended a "vape meet" and observed user controlled websites. So the main objectives of this report is to document how e-cigarettes are used, who uses them, how they got introduced to them and the users perspective on some of the political aspects of vaping. It's not a report that aims to debunk or prove any theories or health consequences of e-cigarette use, but it aims to document the user culture and the users views on things. I think this is quite an interesting angle as I can't recall having seen anything like it before. It's actually not a study of e-cigarettes but a study of e-cigarette users and usage.

As I've said before, I think if you really want to know something about vaping, you need to talk to vapers. A lot of vapers are very updated on vaping politics, the market and maybe most importantly the science and research done on the subject. There is still a lot of so-called experts in the media claiming that "we don't know enough yet" or "there is not much research done on the subject yet". In my opinion, with all the easily accessible research available just a few clicks away, such statements disqualifies anyone from being described as "an expert". SIRUS shows with this report that they have understood this and they have also done so in the media on several occasions as well, with Karl Erik Lund referencing up to date science on the subject (as opposed to certain others that points to out-of-date reports on products long gone from the market).

I'm looking forward to reading the whole report as it is the first report I've seen with this focus on the vapers and their experiences and thoughts on the subject. It is 134 pages long so don't even thing about asking me to translate the whole thing. Hopefully the above mentioned article will be released soon. However, with a lot of help from google, I've translated the article that SIRUS posted on their web-page for those of you who don't read Norwegian (which according to my statistics should be most of you):
A minority of smokers who have switched to e-cigarettes has plans to stop using e-cigarettes. This is shown the first Norwegian study of e-cigarette users.

The use of e-cigarettes is increasing, but there is currently little Norwegian research on the subject. In the report "Electronic cigarettes - usage patterns, user groups and user culture" Rikke Tokle has interviewed users of e-cigarettes, participated in "vape meets" and observed Norwegian vaping web-sites.

The report documents the perceptions and attitudes of users of electronic cigarettes in an early phase dispersion product. The phase is characterized by a lack of clear rules for the application and acquisition, and that the media conveys inconsistent messages about risk.

- E-cigarettes seems to be a successful smoke substitute because the product addresses both the physical addiction to nicotine and the psychological addiction to action and smoke ritual. Vaping is a way to keep the "smoke habit" without smoke, says Tokle.

Many of the interviewees stated that they aim to vape nicotine free [e-juice] and that they actively step down on nicotine strength with the goal of total nicotine freedom.

A harm reduction alternative to tobacco

- For smokers e-cigarettes can be a harm-reducing alternative to tobacco cigarettes because nicotine is delivered without exposing the user to tar and many of the harmful gases released during the combustion of tobacco, says Tokle.

I the report she shows that the motives for using e-cigarettes are closely related to the informants' smoking career and addiction. Quitting smoking emerges as the primary motivation for the use of e-cigarettes. E-cigarettes seems to be crucial for many of the informants' freedom from smok today. The health aspect is the primary reason for wanting smoking cessation.

Used by various groups

The report indicates that the use of e-cigarettes have gained a foothold in different groups of smokers. For daily smokers vaping is an important and integrated part of the day. They vape in situations where they have previously smoked.

Occasional smokers often tell about double use and situation dependent use, where e-cigarette usage is "for fun", as opposition, or are motivated by practical reasons.

"Versatility" also seems to affect patterns of use in that vaping can be done at several and "new" places, such as inside nightclubs, workplaces, dining places, while reading, or in front of the tv. This seems to increase the frequency of use compared to conventional cigarettes.

Smokers are the primary audience for e-cigarettes according the informants in this study, which is supported by the fact that all of them has a smoking career. The informants can be divided into three user groups:

  • The first group are those who use e-cigarettes to quit smoking and to maintain smoking cessation. This user group appears to include the majority of vapers today.
  • Activists and committed "enthusiasts" can be referred to as a separate group. Vapers that may be linked to this group is characterized by enthusiasm for e-cigarettes. This becomes apparent through participation in forums like the one run by the Norwegian Union of Vapers, wishes to recruit smokers to vaping, and for some, working closely with the authorities to influence regulation. This group also houses the "particularly interested", where vaping also has a hobby aspect.
  • A third group that differs from the former are "trendsetters" and the recreational users of e-cigarettes. E-cigarettes appears here more as a selected accessory than as a smoking substitute. The news value and the "future element" of e-cigarettes is positively described. The informants that may be linked to this community seems to be mainly gifted young adults. Some are active in the nightlife.
Dissatisfaction with current regulations

Views on current regulations and the authorities' handling of e-cigarettes are characterized by discontent. The informants appear to be particularly frustrated by the current market situation and the ban on sale of nicotine e-juice from Norwegian retailers, as several of them states that this affects the weakest and most dependent smokers. Several of them also believe that online shopping exclude older people. The planning of orders in relation to shipping and customs can complicate smoking cessation and the transition to vaping for some.

The informants instead calls for regulation and standards for increased product safety. Some of them, especially those very involved informants, also express fear of over-regulation that could lead to narrowed product variety, higher prices and standardized products with little appeal to smokers. There is also scepticism about decisions made in the EU's tobacco products directive that will prohibit threshold values above 20 mg / ml nicotine.

There are differing opinions on how e-cigarettes should be distributed. The proposals range from pharmacy and liquor store to night clubs, kiosks and grocery retailers. There is consensus among the interviewees that there should be 18-year age limit for the purchase of both e-cigarettes and e-juice.

Subtank Fivepawns

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