"Skittles & Red Bull is my favourite flavour": E-cigarettes, smoking, vaping and the changing landscape of nicotine consumption amongst British teenagers - implications for the normalisation debate (2016)

Aims: From an academic discourse explaining trends in drug-related attitudes and behaviours, "normalisation" now also encompasses public health policy advocating "denormalisation" of smoking. This study explored young people's attitudes and behaviours to cigarettes and e-cigarettes to ascertain whether a process of "renormalisation" was underway.
Methods: A six-month multi-method study was conducted in NW England. Data collection in April-July 2014 included a convenience sample survey of 233 students; secondary analysis of a 3,500 respondent survey; stakeholder interviews; participant observation sessions; focus groups; and participatory research events with over 100 students.
Findings: With the public performance of "vaping" valued as an indicator of experienced use, young people used e-cigarettes primarily for flavour combinations and to perform "tricks". Smoking cessation and nicotine consumption were less important motivations. When comparing e-cigarettes with eight indicators of normalisation - additionally, legal status and risk perception - there were indications of a growing cultural accommodation of "vaping".
Conclusion: The changing landscape of nicotine and non-nicotine products challenges traditional conceptualisations of "smoking" and "non-smoking" and problematises the notion of linear processes of normalisation in respect not just of young people's tobacco and nicotine use, but more generally, of delivery systems and the drugs dispensed within them, suggesting marketplace-differentiated normalisation.