A Qualitative Investigation into Smokers’ and Non-Smokers’ Accounts of E-cigarettes

Background: Around 3.2 million adults currently use e-cigarettes (ECs) in the United Kingdom (UK) and there are now more ex-smokers (2.5 million) using ECs than current smokers (1.9 million). Despite growing acceptance that combustion is the major harm from tobacco, the controversies surrounding tobacco harm reduction (THR) and ECs in particular have become progressively fraught. Ambiguity and fluctuating guidelines, combined with an abundance of conflicting information on regulations, brands, flavours, and models have led to public uncertainty, distrust and misunderstanding of ECs. It is important to develop a broad understanding of EC accounts from a diverse range adults with varied EC/smoking experiences so practical guidance can be given to health professionals and policymakers. Aim: To understand the facilitators and barriers of EC use in adult smokers and non-smokers. Method: This exploratory research consists of a multi-method programme of three distinct but overlapping qualitative studies. The first study (Study One) consisted of an online open-ended questionnaire methodology to generate initial ideas about smokers’ and non-smokers’ accounts of ECs. The second study (Study Two) consisted of semi-structured interviews to add further insight into the results obtained from the first study. Both Study One and Study Two were analysed using inductive thematic analysis. The final study consisted of a focus group methodology to understand how people use language to communicate perceptions of ECs using blended discourse analysis informed by discursive perspectives. Results: Data were collected between October 2019 and May 2020, in total, 73 participants took part in the research. An examination of the triangulated outcomes from all three studies indicated that the encouraging and deterring factors ECs for adult smokers and non-smokers are related to three overarching factors. Social factors (1) relate to the utilisation and understanding of the social representations of ECs. Informative factors (2) capture the impact of conflicting EC related communication in shaping EC understanding. Practical factors (3) captures how device functionality and health implications are experienced. These findings demonstrate the variability of EC experiences, it is therefore important not expect homogeneous patterns. 4 Conclusion: This thesis presents a number of novel contributions to the existing literature on facilitators and barriers of EC use. There are varying levels of social acceptability and associated stigma between EC devices, irrespective of conventional tobacco cigarettes (CTC) use. Encouraging a flexible growth mindset may be useful in reducing such stigma and subsequently may be beneficial in terms of THR. Findings also suggest the potential benefits of EC peer support networks within cessation services for those struggling with the functional aspects of the devices. It is also important to consider the ‘next steps’ for ex-smokers who continue using ECs but wish to discontinue