An ethnographic observational study of advice given in vape shops to people wanting to use e-cigarettes to quit smoking

Dr Emma Ward, UEA, Dr Lynne Dawkins, LSBU, Professor Richard Holland,

Leicester Medical School, Dr Caitlin Notley, UEA.

1. Smoking Toolkit Study, UCL, Accessed smokinginengland.info. 2. Cheney, M., Gowin, M., & Wann, T. F. (2016) Vapor Store Owner Beliefs and Messages to Customers in Nicotine and Tobacco Research 18(5), pp694-699 . 3.Allem, J., Unger, J. Garcia, R. Baesconde-Garbanati, L., & Sussman, S. (2015) Tobacco Attitudes and Behaviors of Vape Shop Retailers in Los Angeles in American Journal of Health Behaviour 39(6) pp. 794-798. 4. Langley, T. & Bains, M. (2017) An insight into vape shops in the East Midlands, paper presentation given at Cancer Research UK E-Cigarette Research Forum, at the Royal College of Surgeons, London, 23rd May 2017. 5. Sussman, S. Garcia, R., Cruz, T., Caezconde-Garbanati, L. Pnetz, M., & Unger, J. (2014) Consumers’ perceptions of vape shops in Southern California: an analysis of online Yelp reviews in Tobacco Induced Diseases 28(1) pp22 6. Notley, C. Ward, E. Dawkins, L. Holland, R. (In progress) ECtra Study (E-cigarette Trajectories). Real world experiences of using e-cigarettes for avoiding relapse to smoking, www.ecigresearch.uea.ac.uk. 7. Polosa, R., Caponnetto, P., Cibella, F., Le-Houezec, J. (2015) Quit and Smoking Reduction Rates in Vape Shop Consumers: A Prospective 12-Month Survey in International Journal of Environmental Research and Public Health 12: 4, pp3428-3438

Method Total sample of 11 vape shops in an UK city.

Researchers asked shop assistants ‘what advice would you give me if I

was trying to give up smoking using an e-cigarette?’

Detailed field notes taken and collated.

FindingsDevice: All the shops recommended a second-generation device for quitters over third-

generation: easier to operate, able to use higher strength nicotine more comfortably, and

provided a ‘mouth to lung’ hit similar to smoking.

Flavour: Some shops encouraged tobacco as a first flavour to replicate the experience of

smoking. Other shops believed quitters had more success if they were encouraged to find a

flavour they enjoyed.

Nicotine strengths: Some shops had ‘rules of thumb’ e.g. 6mg strength liquid for smokers of

10 tobacco cigarettes a day or less. Other shops took an individual approach taking into

account the strength of throat hit customers desired.

Quitting strategies: Some shops suggested a period of dual use with tobacco use eventually

tapering off. Other shops suggested switching to e-cigarettes with no tobacco use.

Safety: Some shops provided battery safety leaflets and battery cases.

Study 1: Informal observations of the advice given to

customers wanting to quit smoking using an

e-cigarette

ecigresearch.uea.ac.uk

Study 2: Non-participant observations of vape shops exploring how the shop experience contributes to smoking cessation and relapse prevention

Method Three observations in vape shops purposefully sampled to include city location, a small rural

town, and a large seaside town.

A researcher sat in situ for around 3 hours per observational visit taking notes of customer/staff

interactions and conversations with staff.

Data across the three observations was analysed thematically using NVivo qualitative software:

Three key themes identified described below.

Consumer orientated respect• Confident and knowledgeable staff – willing to listen to customers.• Personalised service – remembering customers’ preferences for flavours and strengths.• Ongoing support – willing to change consumables and investigate malfunctions for free.• Sales based on customer needs rather than large profit.

Shared experience of flavour

Most customers were buying liquids and asking for particular brands they enjoyed.

The shops offered a range of new and exciting flavours to try in the shop.

Testing out flavours is an enjoyable shared sensory and social experience.

Relaxation

Many customers came into the shop to simply sit, drink coffee, and have a vape.

Conversation between staff and customers included ‘vaping talk’, but also general conversations

about customers’ lives and banter between staff and some customers.

The atmosphere was similar to a pub or café with staff greeting customers in a friendly inclusive

manner.

Findings

Conclusions Rather than smoking cessation medical advice, attempts were made by shops to understand customers’ smoking preferences in order that advice

could be tailored about the most appropriate product, strength and flavour of e liquid. Advice varied between shops.

Vape shops offer an ongoing point of contact and advice for continuing to vape, experimenting with devices and e liquids to suit individual needs,

troubleshooting problems, offering practical help and maintenance, and providing important safety advice.

Culture and social environment of shop offers an identity related aspect to vaping that may support long-term smoking abstinence. Shops need to

promote inclusivity.

In addition to the nicotine replacement and behavioural aspects of vaping, the enjoyment of flavours should be viewed as important in the

prevention of relapse back to smoking.

What’s next? Triangulate the observational data with the ECtra Study interview data on vapers’ perspectives of the effectiveness of shop advice and impact of

the shop environment. Recommendations about shop advice and their role in relapse prevention will be made.

Existing ways in which Stop Smoking Services are engaging with vape shops will be investigated. For example, Leicester Stop Smoking Service (UK)

have vape shop staff helping with volunteer outreach, and the service has set up a scheme working with a vape shop to offer discounts and other

services for homeless people.

Background E-cigarettes are the most popular method of help to give

up smoking in the UK and most e-cigarettes are bought

in specialist vape shops1.

Vape shops are the ‘front line’ of smoking cessation

advice for consumers who choose not to access formal

medical advice.

The advice given is not standardised, leading to concerns

about accuracy and quality of information2,3.

Vape shops vary in the extent their staff feel confident

giving smoking cessation advice and vary in their belief

that customers want in-store advice4.

Customers value advice relating to vaping products from

shops4,5, with some customers also wanting smoking

cessation advice4.

Some evidence that quitters’ interaction with vape shop

can reduce the risk of relapse back to smoking6,7.

The ECtra StudyThe observational data presented here is a part of a wider ongoing

qualitative study exploring in-depth participant perspectives of e-

cigarette use over time. Emergent findings show that quitters go

through a process of trial and error, often including relapses back to

smoking, before finding the e-cigarette set up that works. Therefore

getting the right advice relating to products is extremely important

in preventing relapse.

Tobacco quitters were asked about their experiences of vape shops,

emergent findings show that:

Most quitters experienced being overwhelmed by the range of

products in vape shops.

Positive experiences related to getting bespoke guidance about

products.

Negative experiences related to uninterested shop assistants

focused on selling or intimidating shop atmosphere catering for

the ‘hobbyist’ vaper.

I just found <the shop> to be incredibly helpful. I was a bit baffled by the array of devices that were on offer and really didn’t have

any idea what we were looking at, what strength liquid we needed or anything like that, so we were entirely guided by the lady there.

She asked us more about our smoking history that actually I got asked at the Smoking Cessation [Service]. (37 year old male vaper)

I still find <shops> a little bit intimidating. I think because the ones I go to, they also sell like all the heavily modded tanks and

batteries and stuff like that, so they are still a little bit kind of boys’ clubby to me. […] People who just want your basic set up,

they’re not interested in all the you know, bells and whistles. (38 year old female vaper)

Photos by ECtra Study participants of their devices