Social factors associated with the intention and use of e-cigarettes in Australia
Electronic cigarette (e-cigarette) use has grown quickly across many countries since their introduction, though growth in Australia has been slow relative to other high-income countries. There is limited evidence about why people start using e-cigarettes in Australia, and the social factors that may contribute to e-cigarette uptake. The aim of this thesis research was to explore the reasons why people start and stop using e-cigarettes in Australia, with a specific focus on social factors and social media influence.
To address this aim I undertook (1) a systematic review examining the influence of social factors on e-cigarette intention and use; (2) an interview-based study exploring the motivations of Australian e-cigarette users; (3) a survey measuring social acceptability factors and associations with e-cigarette intention and use relative to smoking status; and (4) a mixed-method study to understand how and where Australians access e-cigarette information relative to their e-cigarette use and smoking status, with a specific focus on social media.
The main findings from the systematic review were that few studies included Australian populations or focused on information on social media; most participants in the included studies were young and non-smokers; and studies that included smokers and non-smokers were typically not designed to examine differences in social factors between the two groups. Intervention studies only tested advertising, and results from these studies were generally consistent, showing that e-cigarette advertising increased e-cigarette intentions compared to a control. The results of the systematic review were then used to inform the design of the survey and interview studies, where differences between smokers and non-smokers were explored in more detail. The interview-based study included 14 e-cigarette users and revealed a range of social, health, and personal and access issues that participants mentioned as important to starting or stopping e-cigarettes. The survey-based study involved 185 participants and showed that current and past smokers were more likely to use e-cigarettes, and e-cigarette users were more likely to report social acceptability of e-cigarettes among colleagues in places of work and study. The results of the mixed methods study showed that more than half of the participants had seen e-cigarette information on social media, though e-cigarette information seeking on social media was more common among past and current e-cigarette users.
In Australia, where smoking rates are low, the findings from these studies suggest a need to understand the balance between the risks and benefits of using e-cigarettes as an intervention for smokers and the potential risks associated with socially-mediated uptake of e-cigarettes among non-smokers in an environment where vaping is more acceptable and common.
