MRC/CSO Social and Public Health Sciences Unit

By Marissa Smith, Caroline Vaczy and Shona Hilton.

Data from Action on Smoking and Health has suggested that over the last year there has been an increase in the number of young people using e-cigarettes (or vapes). We conducted a series of focus groups with young people in 2022, in which young people raised concerns about the marketing of vaping targeted at young people. They also expressed that their voices are not heard by people in charge of making decisions about the regulation of e-cigarettes. Given the rise in vaping among young people, and the concerns they have expressed during the course of the Cancer Research UK project about these products, we wanted to help empower them to co-produce a video. In this video, young people share their thoughts and opinions about vaping to illustrate their concerns about these products.

It was clear throughout the course of the project that young people had many unanswered questions and concerns about vaping. These concerns were also shared with their school workers, including teachers, campus police officers, and youth workers who also felt uninformed and worried about these relatively new products. This blog attempts to answer some of the questions posed by young people and school workers during this project.

Are e-cigarettes just flavoured water/vapour?

The answer is no.  E-cigarettes are battery-powered devices that heat a liquid, often containing nicotine, flavourings, vegetable Glycerin and propylene glycol, into a vapour that is inhaled by the user. Young people often asked us if “e-cigarettes [are] just flavoured water/vapour?”  The heated liquid becomes an aerosol that usually contains nicotine, flavourings, and other chemicals in addition to water. 

Are there different types of e-cigarettes?

Yes, there are. Since the development of the first e-cigarette in 2003, there are now a variety of models or ‘generations’ available.

• First-generation e-cigarettes (sometimes referred to as ‘Cigalikes’) were disposable and designed to mimic the look and feel of combustible cigarettes. Over time, new e-cigarette types were developed to deliver the nicotine contained in e-liquid more effectively.
• Second-generation e-cigarettes are larger and are generally refillable using e-liquids.
• Third-generation e-cigarettes (tanks or mods) are much larger than the previous generations and are refillable and rechargeable. They are modifiable devices (‘mods’), meaning the user can customise the substances in the device and adjust the power of the device.
• The fourth generation of e-cigarettes is called ‘Pod Mod’. They contain a prefilled or refillable ‘pod’ or pod cartridge with a modifiable ‘mod’ system (‘Pod-Mod’). Recently, disposable e-cigarettes (such as ‘Puff-bar’, ‘Elf-bar’ or ‘Geek-bar’) have started to dominate the market. In Great Britain, data captured in 2022 found that disposable e-cigarettes have become the most common device type, with Elf Bar and Geek Bar being the most popular brands. Despite the popularity of disposable e-cigarettes, little is known about their design, chemical characteristics, or how they may impact health.

Are e-cigarettes designed for young people?

Definitely not. E-cigarettes are meant to be for adults who are trying to quit smoking. In Scotland, it’s illegal to sell tobacco and e-cigarettes to people under the age of 18 or to buy tobacco and e-cigarettes on behalf of someone under 18.

Are young people using e-cigarettes?

Unfortunately, yes. Data from the Scottish Government’s Health and Wellbeing Census 2021/2022 indicate that 10.1% of 15-year-olds and 4.3% of 13-year-olds report using e-cigarettes regularly. This is a significant increase from data in 2018 which showed regular vaping by 15-year-olds and 13-year-olds at 3% and 2% respectively. In our paper “Young people’s engagement and perceptions of disposable e-cigarettes: a UK focus group study,” published in BMJ Open, we look at young people’s perceptions of and engagement with disposable e-cigarettes. Our study highlights that disposable e-cigarettes are perceived by young people to be ‘cool’, ‘fashionable’, and enticing and are viewed as a modern lifestyle ‘accessory’.

Are young people exposed to e-cigarette advertising and marketing?

Yes. Evidence is mounting on the harms of exposing young people to e-cigarette advertising. Social media can influence young people’s understanding of products, including e-cigarettes. In our paper, “User-generated content and influencer marketing involving e-cigarettes on social media: a scoping review and content analysis of YouTube and Instagram,” we examined the content and characteristics of vaping videos on YouTube and posts on Instagram. The dominant presence of reviews of vaping products and the lack of age and health warnings highlight that social media can expose young people to an array of products meant for adult use only. We found that the vast majority of information on YouTube and Instagram about vaping promotes products and their use and depicts the use of e-cigarettes as socially acceptable. This can have implications for young people who may be susceptible to such advertising. Although there are methods to deter young people from viewing the content (like age or health warnings), we found a large proportion of the videos and posts did not use such methods.

In our study “Youths’ exposure to and engagement with e-cigarette marketing on social media: a UK focus group study” young people highlighted a variety of tactics e-cigarette companies use, including influencer or celebrity endorsement, attractive flavours, bright colours and emotional appeal to advertise and promote their products directly to young people. 

We found that young people are also exposed to e-cigarette advertising offline in their day-to-day lives. Below are examples of some of the photos taken by project participants.

When asked to discuss the photos they took, young people stated that these adverts were effective and “persuade people to buy them.” As in the focus groups in the early stages of the project, this group of youths stated that the adverts include “eye-catching colours” which are attractive to them. One young person stated, “I feel as though, in a way, they’re like marketed towards our age group, because of the colours and the flavours.”

Considering that most young people access various social media platforms multiple times per day and that exposure to marketing is related to the use of social media, these findings point to a significant public health concern.

Yes. Most e-cigarettes contain nicotine, which is addictive. A critical point here is that it is better if young people do not experiment or use e-cigarettes as there is a high risk that they will become addicted to nicotine. As young people's brains are still developing, they can quickly become addicted to nicotine and research has shown that nicotine can have a negative impact on brain development in young people.

Are e-cigarettes dangerous to young people?

Yes. Based on current evidence, using e-cigarettes is less harmful and risky than smoking—but if you have never smoked it is better not to use e-cigarettes. It is important to reiterate that e-cigarettes are not products for children and young people or non-smokers because they are health-harming products. They are only useful as a potential route for people who currently smoke cigarettes to stop or decrease how much they smoke.

Are there any health concerns?

We don’t know much about the long-term health effects of vaping; however, there is growing evidence to indicate that these are health-harming products.

Want to find out more?

The video can be found on YouTube. We have recently submitted a response to the UK Government’s consultation on youth vaping. We have also written a blog on disposable vapes as well as some published papers which have been cited throughout this blog.

 

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First published: 12 December 2023