Electronic cigarettes (e-cigarettes) are the most commonly used smoking cessation aid in England and have been endorsed by a range of organisations [1
]. Over 3 million adults in Britain currently use e-cigarettes; most are ex-smokers who use e-cigarettes to help them quit or remain abstinent [5
]. In the UK, e-cigarettes are available on general sale, with specialist ‘vape shops’ as the most popular source of products [1
]. There are currently in the region of 2000 vape shops in the UK [6
Vape shops provide easy access to a less harmful alternative to smoking [2
] and are able to respond to market developments quickly. Their customers are likely to be interested in quitting smoking or cutting down, and staff interactions with customers can provide opportunities to promote and maintain smoking cessation [7
]. This makes it particularly important to understand the role of vape shops in e-cigarette use and supporting quitters [7
]. However, relatively little is known about these shops’ customers, or the information vape shops provide, particularly outside of the USA, where the majority of existing studies have been conducted [8
]. A recent quantitative study of vape shops in the East Midlands region of England found that most vape shops customers were ex-smokers who were using e-cigarettes to quit or stay quit [16
]. The study also suggested that the majority of advice provided by vape shop staff was product—rather than cessation—focussed, but provided only limited insight into the interactions between staff and customers, or customers’ experiences of vaping and vape shops. A qualitative study investigating the role of the vape shop environment in supporting smoking abstinence in East Anglia, Kent and London found that traditional smoking cessation is not perceived as the main role of vape shops by either vapers or vape shop staff, but it is unclear whether its findings are representative of other settings [7
]. We now report a qualitative study of vape shop customers in the East Midlands, which aimed to understand vape shop customers’ experiences of vaping and vape shops and the need and potential for offering smoking cessation advice in a vape shop setting.
This study investigated the role of vape shops in vaping behaviour and the potential for vape shops to support smoking cessation from the perspective of vape shop customers. Our findings reveal that most respondents regarded e-cigarettes as a quitting tool, with several reporting having quit smoking as soon as they took up vaping; and that vape shops were central to their positive experiences of vaping in that they provided access to a wide variety of high-quality products and reliable product information and advice. Vape shops were identified as hubs of the vaping community which are staffed by trustworthy, knowledgeable individuals who take the time to give detailed product advice. The shop staff engendered a sense of loyalty in customers which, together with the community of other vapers, created a network which helped to support e-cigarette use. Vape shops were not, however, regarded as a setting in which to seek out cessation-specific advice, and participants reported not knowing where to go for this type of information. Vape shops were acknowledged as potentially appropriate places to provide quitting support, although some participants alluded to a potential conflict of interest vape shops in doing so.
Very little research has previously been undertaken in vape shops, and, in particular, very few studies have explicitly explored the role of vape shops in supporting smoking cessation. Our sample may be biased in favour of keen vapers and vapers who have quit smoking; however, we recruited customers directly within vape shops, which is likely to provide a more representative sample of vape shops customers than other recruitment methods such as social media. Our study was conducted in a single region of the UK, but its findings provide valuable insights for researchers and policy makers in other countries around the views and behaviours of vape shops customers and the role that vape shops play in supporting tobacco harm reduction.
Previous studies suggest that vape shop staff regard themselves as being able to educate customers about e-cigarette use and that access to staff is a key reason for people to use vape shops [15
]. E-cigarette products vary widely and require a level of technical knowledge and, as such, there is a ‘vaping learning curve’ to their use [20
]. Vape shops are therefore likely to be integral to supporting smoking cessation using e-cigarettes, as they can ensure that customers choose products that are most suitable to them and use them correctly—a process which is generally lacking in randomized trials of e-cigarettes for smoking cessation and where the type of device tested is likely to influence quit rates [21
]. Previous research has demonstrated that vape shops play an important role in providing product advice to smokers who are new to vaping, but also ongoing support to existing vapers [7
]. Furthermore, vape shop staff may provide product repairs and advice to smokers who have relapsed [7
]. These examples emphasize that short-term guidance alone may not be sufficient to maximise the role that vaping and vape shops can play in maintaining smoking abstinence.
Our findings are in line with existing studies which indicate that many vapers regard vaping as an enjoyable activity [20
], with the variety of available products contributing to its appeal. Given the limited range of vaping products available in other retailers (such as supermarkets), this further highlights the extent to which vape shops may be important in maintaining interest in vaping and supporting smoking abstinence.
While vape shops could have an important role to play in smoking cessation, this study echoes the findings of previous studies which found that smoking cessation is not a core aspect of the dialogue within vape shops [7
]. As such, some opportunities to support quit attempts among vape shop customers may be being missed. Many participants felt that inadequate support for using e-cigarettes in quit attempts was available, and that receiving cessation advice in vape shops, rather than product advice alone, would be useful. Some level of co-working between smoking cessation services and vape shops has been suggested previously [7
], and a model whereby shop staff are trained to deliver cessation advice may be most well-received [16
]. Previous studies have identified vapers who are resistant to the vaping culture and community [7
], and of whom some perceive vaping as a medical treatment rather than an enjoyable or sociable activity. It is also possible that some smokers are deterred from experimenting with e-cigarettes by the perceived vaping culture and might find an offer of more formal cessation advice, without forgoing the benefits of in-depth product advice, appealing. Any vape shop-based cessation intervention would, however, have to strike a balance between encouraging e-cigarette uptake in smokers who do not currently vape, and not deterring existing customers who may regard vape shops as an inappropriate setting for providing smoking cessation advice.
Many participants in our sample were happy to continue vaping in the future; to them, switching completely from tobacco to e-cigarette constituted ‘quitting’. However, others were concerned about continuing addiction and expressed a desire to give up vaping. While helping smokers to quit tobacco cigarettes is a clear benefit of e-cigarettes, these products are likely to be associated with some health risks (albeit that existing evidence indicates that these risks are likely to represent a very small fraction of the risks posed by smoking [2
]), and their use also imposes a financial burden. It is therefore important to develop services or strategies to help established vapers to quit vaping. Our participants drew many parallels between vaping and cigarette smoking, suggesting that some of the same behavioural cues that would need to be addressed would be similar.
While the vape shops in our study provided a significant amount of product information, and participants generally reported improvements in their health, several expressed uncertainties around the harms of e-cigarettes. Misperceptions about the harms of e-cigarettes are widespread [2
], and our findings illustrate that there is confusion in people who are currently vaping, not just in the general population. For example, in our sample, some participants expressed serious concerns about the health effects of vaping which do not reflect the existing evidence base. This underlines the importance of providing clear and reliable information on e-cigarettes. In particular, this requires that any information about the potential harms of e-cigarettes is presented in comparison to the risks posed by combustible tobacco use.
Overall, therefore, our study suggests that vape shops provide a valuable resource for smokers trying to cut down or quit tobacco use, but also represent an opportunity to deliver more extensive services aimed at long-term cessation of nicotine use as well as long-term substitution of tobacco with electronic cigarettes. Vape shops also offer a medium through which to deliver independent information on the relative risks of tobacco and e-cigarette use. Our study also indicates that vape shops could do more to appeal to smokers who have yet to try e-cigarettes, possibly by offering more formal pathways to quitting. Although doing so presents an apparent conflict of interest, our findings suggest that such an approach is most likely to interest individuals who are not currently vaping. Since the prevalence of e-cigarette use now appears to have plateaued in England [1
], this represents an opportunity to attract new customers and hence new business. A further commercial opportunity lies in marketing existing and new services to low income smokers, who as a group have in the past been slower to adopt electronic cigarettes than higher income smokers [26