"They're thinking, well it's not as bad, I probably won't get addicted to that. But it's still got the nicotine in it, so ": Maturity, Control, and Socializing: Negotiating Identities in Relation to Smoking and Vaping-A Qualitative Study of Young Adults in Scotland.

Objective: To explore the understandings of and engagement with e-cigarettes, of young adults from disadvantaged backgrounds, and how these may have an impact on existing smoking identities. Methods: Twenty-two small group and 11 individual qualitative interviews were conducted in Central Scotland with 72 16-24 year olds between September 2015 and April 2016. Participants were mostly smokers and ex-smokers from socioeconomically disadvantaged backgrounds. Results: Although most participants had tried e-cigarettes, they generally held ambivalent views about e-cigarettes and vaping. Two overarching themes were identified which helped in understanding this. Firstly, e-cigarettes were understood by the participants in relation to their existing smoking identities. Vaping was viewed as less controllable and more addictive than smoking, which did not fit with their self-identity as controlled smokers. Secondly, they felt that vaping could not replace the social and cultural importance that smoking had in their lives. Conclusion: This study suggests that though young adults from disadvantaged areas are trying e-cigarettes for various reasons, vaping is rarely sustained. Through their own experiences of vaping and their observations of others vaping, the participants perceive the behavior as endangering an existing acceptable and controlled smoking identity. Additionally, e-cigarettes were considered to be a jarring presence in existing social situations where smoking was valued. This study, therefore, provides insights into how young adults may be rationalizing their continued smoking in the face of potentially less harmful alternatives. Implications: As new and novel nicotine delivery devices, and due to their similarity to smoking, e-cigarettes have the potential to help smokers in their quit attempts. However, the findings from this study raise questions about whether e-cigarettes are regarded as having this potential by young adult smokers from disadvantaged socioeconomic environments where smoking is more commonplace and acceptable.

E-cigarettes, vaping and performativity in the context of tobacco denormalisation.

E-cigarettes are devices through which a nicotine solution is 'vapourised' and inhaled by the user. Unlike cigarettes, the process involves no tobacco combustion. However, the inhalation and exhalation of vapour is reminiscent of smoking and there is debate about the possible harms and benefits of e-cigarette use, including the 'renormalisation' of smoking. Despite these debates, there has been little exploration into the embodied and semiotic similarities between smoking and vaping. This paper views the practices of vaping and smoking through the lens of performativity that is, the accumulation of meaning associated with the habits over time and space. Through in-depth interviews, we explore how young adults from primarily disadvantaged areas in Scotland, understand the similarity in practices between smoking and vaping. Participants talked about financial barriers to using different types of e-cigarettes, and how their use reflected their views on smoking cessation. They also discussed the embodied similarities between smoking and vaping, with divergent opinions on whether this continuance of habit was beneficial or not, revealing still developing and ambiguous norms around performativity. The norms of vaping were also frequently discussed, with participants' experiences and views reflecting the contested position of vaping in an environment where cigarette smoking is denormalised.

Using e-cigarettes in the home to reduce smoking and secondhand smoke: disadvantaged parents' accounts.

Electronic cigarettes (e-cigarettes) are subject to considerable public health debate. Most public health experts agree that for smokers who find it particularly challenging to quit, e-cigarettes may reduce harm. E-cigarette use in the home may also reduce children's secondhand smoke (SHS) exposure, although e-cigarette vapour may pose risks. This is the first qualitative study to explore disadvantaged parents' views and experiences of e-cigarettes in relation to reducing SHS exposure in the home. Interviews with 25 disadvantaged parents from Edinburgh who smoked and had children aged 1-3 were conducted in 2013, with 17 re-interviewed in 2014. Accounts of e-cigarette perceptions and use were analysed thematically. E-cigarettes were seen by some as potentially valuable in helping quitting or reducing smoking in difficult circumstances, and protecting children from SHS when smoking outside is constrained. However, parents raised concerns about safety issues and continuing their nicotine addiction. In relation to children, concerns included possible health effects of the vapour, children playing with them and role-modelling e-cigarette use. While significant concerns remain about e-cigarettes, for some parents who find it challenging to quit or safely leave their children to smoke outside, e-cigarettes may offer potential for reducing the harm to them and their children.

Smokers' and ex-smokers' understanding of electronic cigarettes: a qualitative study.

OBJECTIVE: To explore among a diverse range of smokers and recent ex-smokers, particularly those from disadvantaged groups, how nicotine-containing products, particularly electronic cigarettes (e-cigarettes), are understood and experienced. METHODS: Qualitative study of 64 smokers and ex-smokers in Central Scotland. Twelve focus groups and 11 individual interviews were carried out with a range of purposively selected groups. RESULTS: Nicotine replacement therapies and e-cigarettes were regarded as being very different products. Nicotine replacement therapies were viewed as medical products for smokers who want to quit, while e-cigarettes emerged as an ambiguous product whose meanings are still being negotiated. Participants' attitudes and intentions about smoking and quitting were especially important in shaping their understanding of these products. Four main interpretations of e-cigarettes were identified: a more satisfying replacement for smoking, an ambiguous but potentially useful device, a less desirable cigarette and a threat to smoking cessation. The acceptability of continued nicotine addiction and the similarity of e-cigarettes to conventional cigarettes were central themes on which participants held conflicting views. There was considerable uncertainty among participants around the constituents and safety of e-cigarettes. CONCLUSIONS: Different groups of smokers bring diverse expectations, requirements and concerns to their evaluations and therefore to the potential use of nicotine-containing products. The ambiguity around e-cigarettes in public health debates and medical practice is reflected in the positions and concerns of smokers. There is a need for both clear, up-to-date trustworthy information about their benefits and risks, and stronger regulation.

News media representations of electronic cigarettes: an analysis of newspaper coverage in the UK and Scotland.

OBJECTIVE: Electronic Nicotine Delivery Systems (ENDS) have recently been attracting interest for their potential as a less harmful alternative to smoking, their rising popularity and the regulatory issues they raise. The news media can play an important role in shaping public perceptions of new technologies. It is, therefore, important to understand the ways the news media present ENDS. This paper examines how ENDS are represented in the UK and in the Scottish press. METHODS: Twelve national UK and Scottish newspapers and the three most popular online news sources were searched between 2007 and 2012. A thematic analysis was conducted to explore how the meanings, uses and users of ENDS are presented, and whether and how this has changed. RESULTS: Newspaper coverage of ENDS increased substantially over this period. Five key themes emerged from the analysis: getting around smokefree legislation; risk and uncertainty; healthier choice; celebrity use; price. CONCLUSIONS: Drawing on the diffusion of innovations theory, we suggest that newspaper constructions of ENDS provide readers with important information about what ENDS are for, how they work, and their relative advantages. These themes, and dominance of more positive meanings, raise a number of issues for tobacco control, including concerns around celebrity use and promotion; the impact of increasing ENDS use on social norms around smoking; their potential to undermine smokefree legislation; and their promotion as effective cessation aids.

Regulatory issues concerning the development and circulation of nicotine-containing products: a qualitative study.

INTRODUCTION: This paper explores perceptions of how the regulation of nicotine-containing products (NCPs) impacts the development and availability of more effective cigarette substitutes. METHODS: Qualitative study using semistructured interviews with 20 key stakeholders (7 academic experts in tobacco control, 5 representatives of 3 pharmaceutical companies, and 8 representatives of organizations involved in tobacco-control policy making) and documentary analysis. RESULTS: Four main themes were identified. In general, currently available nicotine replacement therapies (NRTs) were considered to be relatively unsuccessful as substitutes because they deliver insufficient nicotine too slowly. Stronger, faster-acting nicotine products were deemed necessary. However, issues were raised about how smokers may perceive stronger, faster-acting products linked to misunderstandings about nicotine. Pharmaceutical companies have shown reluctance to pursue NRT development; discussions around harm reduction are shifting company attitudes, although concerns remain about the impact of developing more addictive products on company image and whether such products would be problematic to license. The greater cost of producing an NCP within the medical regulatory regime, compared with cigarettes, was underlined. Recreational NCPs were considered problematic as they do not currently need to meet the high regulatory standards required for medications. CONCLUSIONS: Although experts generally agreed that NRT development ought to focus on stronger and faster-acting products, questions were raised over whether this aligns with smokers' understandings and requirements. A more nuanced grasp of how smokers understand harm-reduction approaches and products is required. Pharmaceutical companies may not be best placed to innovate, indicating that the market may well be left to other actors including the tobacco industry.

Harm reduction and the medicalisation of tobacco use.

In tobacco control the focus has, for some time, been on abstinence from all types of tobacco use as the only solution to the problem of smoking, and harm reduction approaches are controversial. The most recent English tobacco strategy has incorporated harm reduction approaches in the form of new 'routes' to quitting smoking that encourage those who cannot quit to use safer sources of nicotine. This move away from a focus on abstinence can be seen as the result of gradual shifts over the past 50 years in the way that that the problem of smoking is understood and the solutions that are offered. These shifts have involved increasingly seeing tobacco use as a medical problem. This article uses conceptual tools from science and technology studies to examine developments over the last decade in England, primarily the increasing importance of harm reduction approaches. Drawing on 20 semi-structured qualitative interviews with key stakeholders and documentary analysis, I suggest that the shape harm reduction has taken in English tobacco control policy has been another shift towards the medicalisation of tobacco use, but that this process has occurred in ways that provide a contrast to commonly outlined 'drivers' of medicalisation.

The regulation of nicotine in the United Kingdom: how nicotine gum came to be a medicine, but not a drug.

This article explores the utility of actor-network theory (ANT) as a tool for socio-legal research. ANT is deployed in a study of the evolution of divided regulatory responsibility for tobacco and medicinal nicotine (MN) products in the United Kingdom, with a particular focus on how the latter came to be regulated as a medicine. We examine the regulatory decisions taken in the United Kingdom in respect of the first MN product: a nicotine-containing gum developed in Sweden, which became available in the United Kingdom in 1980 as a prescription-only medicine under the Medicines Act 1968. We propose that utilizing ANT to explore the development of nicotine gum and the regulatory decisions taken about it places these decisions into the wider context of ideas about tobacco control and addiction, and helps us to understand better how different material actors acted in different networks, leading to very different systems of regulation.

Tobacco point-of-sale displays in England: a snapshot survey of current practices.

BACKGROUND: Tobacco displays at the point of sale (PoS) are an important means for the tobacco industry to communicate with consumers. With regulations prohibiting PoS displays recently having come into force in Ireland, passed into law in England, Wales and Northern Ireland and some Australian states, and being considered in New Zealand, Finland and Brazil, this is an increasingly important issue. This study explores the nature of displays, the extent to which they are tobacco industry funded, and the relation between the tobacco companies and retailers. METHODS: Three areas were chosen to gain a snapshot of PoS displays in England. Over 100 retailers were visited, with interviews taking place on site. Information was gathered on the type and size of tobacco display, who was paying for the display, requirements and incentives, and visits by industry representatives. RESULTS: The majority of retailers had gantries provided by tobacco companies. A minority of these were fitted with automated dispensers called retail vending machines. Attractive lighting and colour were often used to highlight particular products. Most retailers were being visited by industry representatives who checked displays. Some retailers also reported incentives offered to them for displaying products. CONCLUSIONS: The results suggest that the tobacco industry presence and control in the retail environment is significant. Tobacco companies overwhelmingly provided tobacco gantries in the shops surveyed and influenced displays through a combination of requirements and incentives. The extensive involvement of tobacco companies in providing and monitoring retail displays suggests the importance of implementing policies to end this form of advertising.

Small Retailers' Tobacco Sales and Profit Margins in Two Disadvantaged Areas of England.

AIM: To explore tobacco profit margins and sales among small retailers in England. METHODS: Interviews with managers/owners of 62 small retail shops that sold tobacco in disadvantaged areas of Newcastle and London, England. The interviews included questions about tobacco sales and profit margins, and interest in reducing reliance on tobacco sales. RESULTS: The majority of retailers (89%) reported low overall profit margins on tobacco sales (< 6%). The most common response was a profit margin of 4-6%,with some reporting lower margins for price-marked packs of cigarettes (1-6%) and higher margins for non-price marked or premium brands (7% to over 10%). A few mentioned higher profit margins for e-cigarettes. Despite this, most thought tobacco sales were important (90%), and attributed this reliance to footfall (81%), i.e., customers purchasing tobacco also purchasing other products. 42% of retailers expressed interest in reducing their reliance on tobacco sales. CONCLUSIONS: Small retailers report low tobacco profit margins, but high reliance on tobacco sales because of footfall. Retailer interest in reducing reliance on tobacco sales warrants further research into opportunities for disinvestment. Additionally, retailers' belief that they are reliant on tobacco sales because of footfall should be further investigated.

Smoking spaces and practices in pubs, bars and clubs: young adults and the English smokefree legislation.

Young adulthood is an important but overlooked period in the development of smoking behaviour. We know little about the impact of smokefree policies on this group. In a secondary analysis of longitudinal, qualitative interview data we explore smoking practices in young adulthood, the role of smoking in the spaces of the night-time economy, and the impact of smokefree legislation. Participants carefully managed their smoking in different spaces in relation to the self they wished to present. This was shaped by the transitional nature of young adulthood. Smoking played a role in constructing time-out periods from the demands of everyday life in a similar way to alcohol use. The restrictions imposed by the smokefree legislation quickly became normal for most; however, the experience of smoking was influenced by the nature and quality of smoking spaces. The re-spatialisation of smoking necessitated by the smokefree legislation may reaffirm processes of social denormalisation and stigmatisation of smoking, whilst simultaneously allowing young adult smokers to produce, in some contexts, a positive, fun, sociable smoker identity.