Switching from smoking to Electronic Delivery Systems: Changing practices and identities

Aotearoa has a daring goal to become smokefree by 2025, but smokers are not currently quitting quickly enough to realise this ambition. Many people who smoke have tried to quit but only a small proportion become and remain smokefree. Some find nicotine replacement treatments less satisfying than smoking and others miss the rituals they have built into their smoking practices. Unlike patches, gum, lozenges or sprays, ENDS can recreate physical elements of smoking such as inhaling and exhaling, and substitute the hand and mouth feel associated with cigarettes. Yet despite these similarities, only a small proportion of people who trial ENDS go on to adopt them and switch from smoking to exclusive ENDS use.

Researchers from the University of Otago, led by Professor Janet Hoek and Ms Mei-Ling Blank, have theorised that people may seek more than a physical re-creation of smoking. Gathering together a multi-disciplinary team comprising public health researchers, health psychologists, consumer behaviour theorists and biostatisticians, their Marsden Fund project explores how people move from identifying as smokers and attempt to negotiate new identity positions as ENDS users. The study involved researchers buying study participants an ENDS device, then meeting with them up to five times over an 18-20 week period and asking them to record their daily smoking and ENDS use. Participants also recorded their mood states and recorded their smoking and ENDS use in a daily diary.

The project, which is in its third year, has documented behaviour patterns to provide a foundation for later analyses of how participants negotiated new identity patterns as they switched to ENDS or continued smoking. Daily diary findings have provided the first fine-grained insights into smoking and ENDS use over an extended period. Using novel visualisations, the researchers found weekly dual use established quickly and continued for many participants, although some later reported either exclusive ENDS use or reversion to exclusive smoking. Considerable switching between weekly dual use and exclusive ENDS use occurred, and there were relatively few instances where participants neither smoked nor used ENDS. These findings suggest movement from smoking to ENDS use is not linear but highly variable, and that this variability occurs both within and between individuals. Recognising high variability as normal could reset expectations regarding movements from smoking to ENDS use.

Data extracted from in-depth interviews enabled an exploration of variety-seeking in e-liquid flavours, which remains a topic of contention given that recently enacted vaping legislation has restricted the flavours “generic” retailers may sell to tobacco, menthol and mint. Variety-seeking showed considerable variability with some participants using the same or very similar flavours throughout the study while others engaged in extensive variety-seeking, particularly during the first 12 weeks of ENDS uptake. Work currently underway is exploring the social practices that participants developed as they acquired or created flavours, consumed these, and communicated their experiences.

Work in progress is exploring ENDS devices as material objects with which participants associated or ceased associating with as they attempted to replace smoking with ENDS. Participants appear to move between three phases: catalysing, where they recognised ENDS could offer new and desirable functional capabilities; bridging, where they experienced affective reinforcement that they preferred to smoking, such as perceiving themselves to be cleaner; and bonding, where ENDS use had become integrated into other practices performed during their daily lives.

Future work will build on these earlier studies to explore whether and how participants navigated moving from smokers to becoming ENDS users. This work will probe nostalgia for smoking-related identity elements, how the novelty ENDS use allows enabled participants to forge new identity positions, and how they managed stigma and experiences of “othering”. The researchers are currently also developing short videos to expand traditional dissemination pathways and enhance communication of their findings.