The Culture of Vaping and Meaning of E-cigarettes

A study unpacking experiences and patterns in Norway

Rikke Tokle

Dissertation submitted for the degree of Philosophiae Doctor (PhD)

Department of Sociology and Human Geography

University of Oslo

March 2021
© Rikke Tokle, 2021

Series of dissertations submitted to the

Faculty of Social Sciences, University of Oslo
No. 853

ISSN 1564-3991

All rights reserved. No part of this publication may be

reproduced or transmitted, in any form or by any means, without permission.

Cover: Hanne Baadsgaard Utigard.

Print production: Reprosentralen, University of Oslo.
Acknowledgments

The pursuit of a PhD degree has proved transformative. Many people have contributed and deserve
to be acknowledged.
First, I want to thank the Dam Foundation for funding this PhD project, and the Norwegian Cancer
Society for providing the organizational backing for it. Thanks also to the Norwegian Institute of
Public Health (NIPH) for providing administrative support, interesting mandatory work and a first-
class team of excellent colleagues. In addition, to my director, Elisabeth Kvaavik – thank you for your
great support.

I also owe gratitude to my two supervisors, Karl Erik Lund and Willy Pedersen. Kalle, thank you for
providing me with the opportunity to undertake a PhD degree in the first place. Early on, you
understood the significance of the invention of e-cigarettes – both for smokers and for us as
researchers. Your expertise in the field of tobacco studies, paired with your ability to keep track of
the constant influx of studies, debates and innovations has been very inspiring and slightly
intimidating. Throughout the PhD process, I have benefitted greatly from the sources and extensive
knowledge you shared with me. Willy, your positivity has really meant much to me! Thank you for
providing insightful and helpful guidance along the way, for motivating me to stay on the sociological
track, and for being open-minded and supportive throughout the process.

Janne Scheffels deserves special thanks for years of encouragement, fruitful discussions and for being
a great travel companion, colleague and friend. I also want to express gratitude for the insight
provided by the rest of the fine group of tobacco behaviour researchers at NIPH, Gunnar, Tord,
Marianne and Ingeborg.

The high-quality ‘qualitative crew’ have been of the utmost importance for this work as well as for
my general well-being. Throughout the past four years, Kristin, Thomas Anton, Marit, Ola and Øystein
have served as intellectual and social supporters. I am most grateful for the discussions, feedback
and fun. TA, sharing an office with you (and Lars Vaular, ofc) has been a true pleasure! Kristin, thank
you for reading and providing valuable feedback with such apparent ease – and for simply making all
social contexts more entertaining and interesting. Solveig, thank you for your valuable support in the
final days of this project.

Participants, vapers and ‘MyLifers’ alike. Thank you for sharing your time, knowledge and
perceptions of the various aspects of vaping. Interviewing you was the finest and most enlightening
part of the project. To my friends and family, I look forward to hanging out post PhD (and Covid-19)!

Finally, the people ‘backstage’ deserve the spotlight: Sondre, Alma and Nor, my beautiful
distractions. I praise the three of you for providing the overall substantial meaning to life. Sondre,
you deserve a thousand special thanks for never being boring, always supportive, and loving. I am
lucky to have you. Alma and Nor, the two of you will forever be my greatest achievement. It makes
me proud to see how smart, creative and curious you are. Last, a little bow wow to Lise, who
deserves a salute for being a simple, soft, tail-wagging contrast to our complex society.

Rikke Tokle
Oslo, March 2021

3
4
Summary
Over the past several years, e-cigarettes – which are battery-powered devices that transforms
heated liquid into inhalable aerosol – have made the contemporary nicotine and tobacco landscape
more complex. The use of e-cigarettes, called vaping, was initially promoted to help people stop
smoking and was early on adopted by smokers. Vaping, however, is currently also associated with
alternative user motives and attractiveness to young people. Internationally, the contextual frame on
e-cigarettes is marked by split-risk approaches, divergent legislation and polarized views. In this
dissertation, I study the vaping phenomenon with an analytical focus on the culture of vaping and
social meaning of e-cigarettes in Norway. Based on three sources of data – personal interviews with
adult vapers, repeated interviews with adolescents and related longitudinal survey data, I show
processes of meaning making and user patterns among adult vapers who have experienced the
shifting status of smoking in society, and adolescents growing up in the post-smoking era. I make use
of a multiple-lens perspective to highlight various dimensions within the data, and thereby shed light
on the co-occurrence of various meanings and cultures. The key findings are presented in four
articles in peer-reviewed scientific journals.

The first article uses subculture theory, and concepts of identity and stigma to highlight an identified
variation within the sample of adult vapers, and the emergence of a subculture within the vaper
culture. As an analytical tool to show the range in practices and cultural positions, two ideal types of
vaper are constructed. The “cloud chaser” type was associated with the subculture. They were
dedicated vapers, many involved in vaping communities in which vaping occurred as a hobby,
involving tricks, customizing devices and self-advocacy. The “substitute” type was associated with the
more mainstream vaping culture. They were ex-smokers turned pragmatic vapers who used e-
cigarettes to stay off combustible cigarettes. These vapers described more mixed feelings relating to
their use and ranging from stigma, pleasure and addiction.

The second article highlights the similarities within the same adult sample through a focus on risk
perceptions- and negotiation of e-cigarette controversies. In terms of risk, e-cigarettes were
perceived as a harm reduction tool in relation to conventional cigarettes. Following this view, the
present Norwegian vaping regulation, which prohibits nicotine, was framed as increasing risk by
limiting current smokers’ availability to a safer alternative. In addition, the risk information on e-
cigarettes from health authorities and media was decoded as predominantly anti-vaping. The sum of
the identified divergence between vapers’ risk perceptions and how they experienced the public risk
communication and regulation, seem to contribute to diminish vapers trust in authority provided e-
cigarette information and increase their preference for lay expertise, typically available online. For
some, the split risk approaches also occurs as a driver for engaging in vaping-advocacy.

5
In article 3, based on a comparison of findings from repeated interviews with adolescents, I identify a
systematic pattern in which adolescents account for vaping as a time-limited trend. The gradual and
collective change in vaping practices and the social meaning of e-cigarettes occurs in three phases: In
the beginning of middle school, few had tried vaping, but several were curious because of the
multiple flavours and perceived novelty. Midway in, one in three pupils reported personal use –
however, mostly for flavour and without nicotine. Vaping was described as harmless, cool and
oppositional. By the end of middle school and in upper secondary school, vaping had lost its status,
was labelled childish, unpopular, and e-cigarettes were compared with trend-sensitive toys such as
the fidget-spinners. These findings highlight the important mechanism between symbolic meanings
and user practices in adolescence and may serve also to inform other substance use studies
conducted among youth.

Based on longitudinal questionnaire data, the final article provides further information on
adolescents’ use of e-cigarettes with and without nicotine. In contrast to expressed concerns that e-
cigarettes may lead to nicotine addiction among new generations of users, the majority of
adolescents in the sample who reported vaping used e-cigarettes without nicotine. Moreover, most
ever-users quit vaping – both with and without nicotine – during the observation period. Despite the
fact that use of e-cigarettes was temporary for most youth, findings indicate that nicotine vapers still
differed from both non-nicotine vapers and non-users in terms of personal characteristics. Nicotine
vapers were more likely to use other tobacco products, report more conduct problems and
symptoms of depression. Thus, monitoring use of nicotine e-cigarettes among adolescents can also
serve to highlight youth who have other internal and external problems.

The thesis provides new insight into the vaping phenomenon and nuances the current
understandings of e-cigarette use in adolescence. It shows that the current culture of vaping in
Norway is fragmented, with several co-existing vaping cultures, including a distinct vaper subculture,
a more mainstream culture associated with ex-smokers’ substitute use, and an independent youth
vaper culture marked by experimentation and temporal vaping patterns. Adult vapers and
adolescents draw on different repertoires of available meanings: While the adult vapers, through
comparison of differences and similarities, intrinsically linked vaping to smoking; Adolescents framed
e-cigarettes as a trend-sensitive consumer product and emphasized this by highlighting features such
as their novelty, flavours or sleek design. Findings illustrate the importance of avoiding a conformist
understanding of the meaning of e-cigarettes, and of acknowledging intra-vaper and intra-cultural
differences in empirical studies of use. It also provides support for undertaking a multiple lens
approach when investigating novel phenomena in order to illuminate a broad spectrum of
dimensions.

6
Table of Contents
1. Introduction and background ........................................................................................................ 11
Framing the issue: terminology, product and history ................................................................... 12
Approaching social meanings through controversies ................................................................... 14
Previous studies of vaping culture and vaper identities ............................................................... 17
Content of the Dissertation ........................................................................................................... 19
2. Theoretical Framework ................................................................................................................. 23
A reflexive cultural approach on vaping: Identity, Stigma and Risk .................................................. 23
Subculture theory: from urban groups to online (vaping) communities .......................................... 25
Conceptualizing the agency of technology and sociability in vaping ................................................ 27
Studying an unsettled phenomenon ................................................................................................. 28
3. Methodology ................................................................................................................................. 33
Source 1: Qualitative interview data with adult users of e-cigarettes.............................................. 35
Origin and Data collection: Exploring the vaping phenomenon online and bottom-up ............... 35
Ethical considerations ................................................................................................................... 38
Data Analysis and construction of concepts ................................................................................. 39
The MyLife study: the origin of source 2 & 3 .................................................................................... 41
Source 2: Qualitative longitudinal interview data with adolescents ................................................ 42
Research design and Data collection............................................................................................. 42
Thematic Data analysis .................................................................................................................. 45
Source 3: Quantitative longitudinal survey data with adolescents .................................................. 47
Research design and Data collection............................................................................................. 47
Identifying vaper groups and associated characteristics .............................................................. 48
Data analysis .................................................................................................................................. 51
Ethical considerations for longitudinal studies with adolescents ..................................................... 52
A pragmatic rationale for use of multiple methods .......................................................................... 53
4. Summary of the Research Articles ................................................................................................ 55
Article 1 ............................................................................................................................................. 55
Article 2 ............................................................................................................................................. 56
Article 3 ............................................................................................................................................. 57
Article 4 ............................................................................................................................................. 58
5. Discussion and Concluding Remarks ............................................................................................. 61
Implications and Directions for Future Research .......................................................................... 65
Conclusion ..................................................................................................................................... 67
References ............................................................................................................................................. 69

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List of Publications

Article I Tokle, R., & Pedersen, W. (2019). “Cloud chasers” and “substitutes”: e-cigarettes,
vaping subcultures and vaper identities. Sociology of health & illness, 41(5), 917-932.

Article II Tokle, R. (2020). Bottom-up meets top-down: exploring vapers’ accounts of risk in a
context of e-cigarette controversies. Health, Risk & Society, 1-18.

Article III Tokle, R. (2020). ‘Vaping and fidget-spinners’: A qualitative, longitudinal study of e-
cigarettes in adolescence. International Journal of Drug Policy, 82, 102791.

Article IV Tokle, R., Brunborg, G.S. & Vedøy, T. (Revised and resubmitted). Adolescents’ use of
Nicotine-free and Nicotine E-cigarettes: A longitudinal study of vaping transitions and
vaper characteristics. Submitted to Nicotine and Tobacco Research

8
Preface

Popular culture and smoking have been entangled for decades. What properties establish a
typological character more efficiently than a cigarette? The gangster villain, the deprived white trash,
the femme fatal, the tired worker, the stressed lonely mother, the rebel? The act of smoking is filled
with various and shifting meanings (Sæbø, Scheffels, & Tokle, 2017), spanning from smoking as a
symbol of opposition, feminism, coolness to addiction, deprivation and health issues (Collins, 2014;
Klein, 1995). In Western societies, the smoking practice has gradually gone from representing the
norm to being denormalized (Bell, Salmon, Bowers, Bell, & McCullough, 2010), followed by an
associated shift in the meaning of cigarettes from status to stigma (Lund, Lund, & Halkjelsvik, 2014;
Peretti-Watel, Legleye, Guignard, & Beck, 2014; Scheffels, 2009). Within this normative landscape, an
associated disruptive technology was launched just over a decade ago. Popular culture, through
movies such as The Tourist (2010), provided many with their first glimpse of an alternative ‘smoking’
ritual. In the above-mentioned movie, the main character, portrayed by Johnny Depp, is introduced
to the audience seated on board a European high-end train about to smoke. Before inhaling, he
excuses his ’smoking’ to the passenger next to him by explaining that the cigarette in his hand is in
fact not a combustible cigarette, but an electronic one. He inhales, a light on the end of the device
glows. He exhales, and we see something resembling smoke. A plastic cigarette with a blue light:
What a game changer! But what to make of it? What do others make of it?

9
10
 1. Introduction and background

The use of e-cigarettes is still a relatively novel phenomenon, and its symbolic meanings and
associated social practices have yet to be fully understood. Although a significant and growing body
of work that investigates vaping behaviour has emerged, particularly from the USA and the UK,
sociological studies of the social meaning- and culture of vaping remain sparse. Drawing from three
sources of data – personal interviews with adult vapers, repeated group- and individual interviews
with adolescents, and related longitudinal survey data from adolescents derived from the MyLife-
study (Brunborg et al., 2019) – I seek to enhance current knowledge about the vaping culture and
social meaning of e-cigarettes. The dissertation is guided by one overarching research question and
two sub-questions:

How can we understand the culture of vaping and social meaning of e-cigarettes?

1. How do adult users who have lived through the shifting status of smoking understand
vaping?
2. How do adolescents as part of the post-smoking era approach and perceive e-cigarettes?

Investigating the use of e-cigarettes among adults and adolescents provides a twofold perspective
essential to identify variations in user and group experiences, motives, patterns and identifications. I
rely on systematic analyses of data from personal interviews with 30 adult vapers, repeated
interviews with 118 adolescents, and related data from online questionnaires to examine the vaping
culture and the social meaning of e-cigarettes. By studying the vaping phenomenon from various
angles, I seek to contribute to and expand upon current knowledge of e-cigarettes and vaping. My
aim is to offer a broader understanding of how new inventions can entail multiple social meanings
and be approached differently by subgroups of users resulting in a variety of consumer cultures.

Several contextual factors, ranging from the product-related, situational and personal level ones, are
key for understanding the culture of vaping and meaning of e-cigarettes. Before I present the
following chapters, I will set the stage, starting with a brief overview of the terminology, products in
focus and a timeline to illustrate the development. This will be followed by an introduction of the
main controversies applicable for understanding the contemporary vaping context, and finally, a
short synopsis of recent significant and related contributions within the social sciences on vaping
behavior from which the thesis draws examples, but also seeks to extend.

11
Framing the issue: terminology, product and history
All innovations acquire a special nomenclature: throughout this thesis, I will mostly use the term ‘e-
cigarette’ to represent all vaping devices. Less frequently, the term ‘vaporizer’ is used for the same
purpose. ‘Vaping’ specifies the associated use of such devices, while the term ‘vapers’ denotes the
people using them. It is worth mentioning, however, that in the associated literature, scholars and
users refer to vaping devices with a multitude of terms, including electronic cigarette, e-cigarette,
vaporizers and ENDS (Electronic Nicotine Delivery Systems). Moreover, young people increasingly use
nonstandard terminology, such as vapes, e-cigs, Juuls and mods, to denote the products or to
describe subtypes of use (Morean, 2020). Although these terms overlap in the sense that they refer
to the same battery-powered products, their associated meanings may vary. The term e-cigarette,
for instance, can be associated with the original purpose of e-cigarettes as a smoking substitute,
while also carrying connotations to more stigmatized meanings associated with cigarettes (Barbeau,
Burda, & Siegel, 2013) – the most harmful legally available consumer product, and smoking – the
number one cause of preventable harm and death (WHO, 2008). When investigating meaning
making, the choice of words is important. When I choose most frequently to use the term e-
cigarette, despite its potentially problematic connotations, I do so based on how well established the
term is, and hence for the purpose of aligning the thesis with existing literature. I also acknowledge
that the term vaporizer can be useful when describing alternative user practices. In contrast, within
this dissertation, the term ENDS has limitations because it includes the presence of nicotine.

Next, a note on the products investigated in this thesis: e-cigarettes are battery-operated devices
that heats liquid into an aerosol that users can inhale and exhale (US DHHS, 2018). Usually, these
liquids contain propylene glycol, glycerine, nicotine, flavourings, additives, and differing amounts of
contaminants (Hajek, Etter, Benowitz, Eissenberg, & McRobbie, 2014). Nicotine is the addictive
substance found in conventional cigarettes and in other tobacco products, such as snus. Snus is a
low-nitrosamine smokeless tobacco product available and widely used in Norway and Sweden.
Despite e-cigarettes key unifying features, there are multiple variations of devices and e-liquids
available. Since they were first launched on the market, e-cigarettes have undergone a massive
evolution (Pepper & Brewer, 2014; Unger & Unger, 2018). At present, the product portfolio includes
four generations of devices, shown in figure 1 below.

12
Figure 1: Four generations of e-cigarettes

The first, are known as ‘cig-a-likes’ which resembles

traditional cigarettes, as they glow upon inhalation and
are disposed as the e-liquid is consumed (Levy et al.,
2019). The second, are the slightly larger and reusable
vape pens. The third, are often referred to as mods,
which are reusable open system devices that allow for
customization and come in a range of sizes and shapes
(Etter, 2016). Finally, there are the more recent pod-
versions, which are discrete as they resemble USB-sticks
Source: Mathur & Dempsey, 2018 (Huang et al., 2019).

Finally, a brief overview of the development in user configurations: Invented in China in 2003, the
first-generation e-cigarettes were designed to provide a safer alternative to inhaling nicotine from
combustible cigarettes (Hajek et al., 2014). In line with the original intention of the e-cigarettes as a
smoking substitute, adult smokers were the first user group to adopt these devices (McNeill et al.,
2015b). For smokers who wanted to quit, vaping not only offered nicotine, but also sensory
similarities to smoking through the practice of inhaling nicotine and exhaling vapour, paired with a
device to hold and fumble with (Farrimond, 2017).

However, additional and alternative e-cigarettes practices and user configurations gradually began to
emerge. Particularly in the US, youth vaping increased immensely from 2016 (Cullen et al., 2019),
where young people found the novel pod-types particularly appealing (Huang et al., 2019), including
non-smokers (Hajek et al., 2020). At present, e-cigarettes are the most commonly used tobacco
product among youth in the USA (Cullen et al., 2019). This development in user configurations among
vapers, from predominantly involving adult smokers to also including young people and non-
smokers, made US health officials highlight youth e-cigarette use as a major public health concern in
2016 (US DHHS, 2016).

With the e-cigarette or vaping-associated lung injury (EVALI) outbreak in 2019, yet another user
direction became evident in the form of vaping to administer cannabis. In the case of EVALI, e-
cigarettes were used to deliver unregulated THC-oil containing e-acetate (Hall, Gartner, & Bonevski,
2020), which resulted in a large number of lung injuries and deaths among American youths, (Layden
et al., 2020). The deaths and pulmonary illnesses associated with vaping were subject to massive
investigation, and together with the rice in youth vaping, e-cigarettes became subject to increased

13
scepticism (Dave, Dench, Kenkel, Mathios, & Wang, 2020). However, e-cigarettes were debated also
prior to EVALI and the rise in youth vaping in some countries (Bareham, Ahmadi, Elie, & Jones, 2016).
I will discuss this further below.

Approaching social meanings through controversies

Investigating aspects of the vaping culture and the social meaning of e-cigarettes is particularly
interesting because e-cigarettes have made the contemporary nicotine and tobacco landscapes so
much more complex. They entered the market at a time when smoker rates were declining and
smoking was increasingly denormalized in most of the Western World (Peretti-Watel et al., 2014;
WHO, 2018). Thus, the fear of a renormalization of smoking was expressed from the outset. Some
suggested that vaping could challenge tobacco control and the vision of a smoke-free society
because of its resemblance to smoking (Bell & Keane, 2012). At the same time, and despite of
decades of falling prevalence, the numbers of remaining smokers were, and remain, substantial
(Drope et al., 2018; Islami, Torre, & Jemal, 2015).

Against this backdrop, e-cigarettes have been approached on the one hand based on their potential
of health gain in smokers who replace combustible cigarettes with e-cigarettes (Siegel, Tanwar, &
Wood, 2011). On the other, based on the fear of renormalization of smoking, a potential increase in
nicotine addiction and health loss from vaping in groups of non-smokers (Bell & Keane, 2012;
Goniewicz, Gawron, Nadolska, Balwicki, & Sobczak, 2014; Vugrin et al., 2015). Hence, a split approach
on e-cigarettes and vaping occurred early in the research community and subsequently in
governmental regulations (Bareham et al., 2016; Bareham, Ahmadi, Elie, Jones, & McKee, 2018).
There seems to be a virtual consensus among scientists that e-cigarettes are not risk free but are
much less harmful relative to combustible cigarettes (COT, 2020; Stratton, Kwan, Eaton, 2018). The
balancing act between the interests of adult smokers versus adolescents has contributed to a field of
research marked by divergence (Carroll et al., 2021). Moreover, with the increase in vaping in global
markets, and vaping attracting young people in some countries (Huang et al., 2019), the
controversies and polarized views on e-cigarettes only seem to intensify (Britton, Arnott, McNeill &
Hopkinson, 2016).

Through the various approaches, the contours of a gap between a more pro-vaping harm reduction
approach (McNeill et al., 2015) and more anti-vaping positions (Dutra & Glantz, 2017) can be seen. In
table 1, I highlight some of the topics that are subject to debate within research communities, health
professionals and regulators.

14
Table 1. E-cigarettes topics were opposing sides are evident1

E-cigarette topics of divergence Anti-vaping Drivers Pro-vaping Drivers

Targeted groups Non-smokers and youth Smokers and people prone to smoking
Overall aim Tobacco-free Society Smoking related harm and mortality
reduction
Device innovation Precaution Principle Potential to outperform cigarettes
Nicotine addiction Undesirable Acceptable if health risks are low
Use of nicotine To be limited and reserved for Recreational use will exist
therapeutic use in smokers
Smoking cessation Efficiency uncertain. Might delay Offer smokers an alternative to switch.
cessation and increase relapse Value sensory similarities
Dual use of cigarettes Cementing addiction because of Transient phase, vaping will reduce
e-cigarettes high nicotine exposure cigarette smoking
Visibility Renormalize smoking Denormalize smoking
Risk Long-term risks unknown Considered low based on toxicological
and physiological testing
Risk communication Nicotine products are addictive Emphasis on relative risk to combustible
and never risk-free cigarettes
Contrasting risk Compare to non-use Compare to smoking
Nicotine-industry Cannot be trusted Can be willing to cooperate
Flavours To be restricted to demotivate Encourage to motivate smokers to switch
never-smokers
Use of e-cigarettes among non- The Gateway theory: Vaping will The Diversion approach: A less harmful
smokers lead to subsequent smoking alternative for people who otherwise
might have taken up smoking.

As the table illustrates, the divergence on e-cigarettes includes a large number of topics. Spanning
from their effectiveness in smoking cessation, dual use of e-cigarettes and cigarettes (Hartmann-
Boyce et al., 2020; McRobbie, Bullen, Hartmann-Boyce, & Hajek, 2014), how to measure
effectiveness in smoking cessation2 (not shown in table) (Polosa, 2015; McNeill et al., 2015), and
determining the risk and health impacts of use of e-cigarettes (Kalkhoran & Glantz, 2015). In

1
The table is inspired by a table presented in a conference lecture by Warner (2017).
2
A frequently held view is that randomized control trials (RCTs) symbolize the gold-standard method in
research for assessment of the efficacy of an intervention (Bauld, 2016). However, disagreement exists also
around the correctness of RCTs2 to ascertain data on efficacy of e-cigarettes (Bareham, Ahmadi et al. 2016;
Weier, 2018). Some claim RCTs do not measure e-cigarettes the way they are actually used and promote
studies of vaping from a more real world perspective, arguing that personal lifestyle statements and consumer
selection processes are not always under the researcher’s control (Fraser, Glover et al. 2018). Instead, use can
be influenced by such as product appeal, handiness, flavours, price, accessibility, device characteristics and risk
perceptions (Niaura, 2018; Weier, 2018).

15
addition, the generally mistrusted tobacco industry’s increasing involvement in the e-cigarette
market, through buying up brands and creating their own versions, serve as an additional
complicating factor (Branston & Sweanor, 2016; Kamerow, 2013).

Divergence are also evident in the interpretations of adolescents’ vaping trajectories. A key
dimension in the discussion is whether e-cigarettes represent a gateway to smoking or a diversion
from it. A gateway exists to the extent that prior vaping is a cause of subsequent smoking (Bell &
Keane, 2014). Some conclude that the use of e-cigarettes is in fact a gateway to smoking (Dutra &
Glantz, 2017). Others have voiced concern over the likelihood of vaping being a gateway to smoking
(Chatterjee, Alzghoul, Innabi, & Meena, 2016; Kinnunen et al., 2020). Yet others object to the
gateway thesis by pointing to common liabilities in these users. Liability refers to the shared
underlying characteristics of vapers and smokers that can make them more likely to engage in both
practices. Liability explanations thus suggests that the statistical associations between vaping and
smoking initiation are more likely to be associative than causal (Chapman, Bareham, & Maziak,
2019). In contrast to the gateway thesis, the diversion hypothesis proposes that vaping can be a
diversion from smoking. Following this view, if e-cigarettes were unavailable, youth prone to risk-
taking behaviour would be more likely to use combustible tobacco products due to the absence of
suitable non-combustible tobacco substitutes (Etter, 2017; Kozlowski and Warner, 2017).

The objective of this overview is not to take sides, but to show how these novel products can be
negotiated within a divergent context depending on how they are framed. The situational factor of
ongoing e-cigarette controversies in scientific environments have implications for processes of
meaning making. When scientists take opposing sides, as in the case of e-cigarettes, it can leave the
audience; including regulators, laymen and users, more confused (Carroll et al., 2021; Niaura, 2018).
In addition, it can lead them to search for alternative sources of information. The quote below, cut
and translated from a page of a Norwegian vaper forum, illustrates the challenges that risk
communication related to vaping is subject to.

An article is circulating: “Scientists warn: E-cigarettes are ten times more likely to cause cancer
compared to ordinary tobacco. Dramatic findings in new report”. It strongly warns against vaping. Of
course, there is a researcher behind the warning. Unfortunately, I am a smoker, but I hope to be able
to quit by switching to e-cigarettes in the end. So, are these findings valid? It would be nice to have
some counterarguments from people who actually know these things. (Retrieved, January 2018).

Thus, the ongoing divergence is found to have created a gap between some vapers and the orthodox
part of the pro-tobacco control society. Interlinked, the scientific community have been accused of
having taken a one-sided view of either the potential for e-cigarettes to addict another generation to

16
nicotine or the potential for smokers to stop smoking (Carroll et al., 2021). In interviews, adult vapers
recruited from online communities have reported that they feel misrepresented by researchers and
that they lack trust in research, deeming it as predominantly ‘anti-vaping’ (Annechino & Antin, 2016).
The divergence has also complicated regulation based on scientific evidence. E-cigarettes have
proven to be a regulatory challenge for policymakers and governments, resulting in various
outcomes. At present, they are banned in around 30 countries. Others, including Norway, permit the
sale of devices for uptake of e-liquid, but at the same time have banned the sale of e-liquid
containing nicotine. Most countries, however, have a regulated market of e-cigarettes (both with and
without nicotine) under tobacco control policies (Drope et al., 2018; Kennedy, Awopegba, De León, &
Cohen, 2017)3. Hence, the split-approaches not only impact the social meaning of e-cigarettes, but
also have policy and regulatory implications of relevance for both adult smokers and adolescents. For
instance, in terms of access and availability. Insight into the context of controversies is there for
relevant for the current thesis in order to better understand the way e-cigarette-related information
and topics can be understood, negotiated and contested when approached bottom-up.

Previous studies of vaping culture and vaper identities

Tobacco products in general and cigarettes in particular have a long history as bearers of various, and
conflicting meanings. From connoting stigma, addiction, poor health, on the one hand, and coolness,
pleasure and opposition on the other (Collins, 2014; Klein, 1995). As such, both the use of tobacco-
and snus products are regarded as means by which to express identity (Scheffels, 2009; Scheffels &
Lund, 2017; Scheffels & Tokle, 2017; Sæbø et al., 2017). However, neither tobacco cigarettes nor
snus have received the volume of attention from a collective group of consumer advocates as that
witnessed with e-cigarettes.

Not long after e-cigarettes were launched on the global market, groups of early adopters embraced
the invention. The majority of these were identified as former smokers, who by switching to e-
cigarettes found a way to substitute their use of tobacco cigarettes (Siegel et al., 2011). However,
early on, some developed a particularly strong interest in the commercial technology, related
research and policy aspects, resulting in the occurrence of social networks of vapers (Barbeau et al.,
2013). As a result of these early adopters’ unusual willingness to promote e-cigarettes (Bell & Keane,
2012; Rogers, 2010), the early diffusion of vaping is largely seen as consumer driven (Rahman, Hann,
Wilson, & Worrall-Carter, 2014). Pro-vapers have referred to the development as a bottom-up health

3
In most of Europe, e-cigarettes are regulated as a tobacco product under the EU’s Tobacco Products Directive
(TDP). The TDP-regulation involve restrictions on types of vaporizers, refill bottles, juices and levels of nicotine
in the e-liquid.

17
revolution, as it evolved on the side of the anti-tobacco movement and government control
(Stimson, 2016).

Virtual communities (e.g. Facebook, Twitter etc.) are important in this development by facilitating a
tool with which vapers can interact, exchange experiences and provide support across borders (Li, ur
Réhman, & Li, 2011). Thus, the development of vaping communities (Annechino and Antin, 2016) can
be seen as largely rooted in internet forums and chatrooms (Bell & Keane, 2012; Farrimond, 2017).
Moreover, such consumer-based chat rooms and online communities devoted to e-cigarettes, paired
with evolving commercial technology, vaping stores, events, competitions and conferences, have
contributed to what we can deem a distinct ‘vaping culture’ (Bell & Keane, 2012). Vapers partaking in
this side of the vaping culture reportedly valued the social identity of being a vaper (Barbeau et al.,
2013; Farrimond, 2017). However, having a strong vaper identity is not necessarily a feature shared
by all vapers. Based on differing beliefs, user motives and political interest, some are also identified
as indifferent to such an identity and others are found to actively reject it (Farrimond, 2017).
Identification of oneself as a ‘vaper’ is associated with several factors, including the role of
pleasure/enjoyment, the acceptance of a medical model of nicotine addiction, the acceptability of
long-term use, and political interest in vaping rights (Farrimond, 2017; Notley & Colllins, 2018).
Moreover, notions of stigma can be contributing factors in these processes, as the vaping
experiences of adults are typically interwoven with previous or ongoing smoking experiences (Notley
& Colllins, 2018; Thirlway, 2016).

In addition, the massive changes in the tobacco landscape during recent decades have created a
different social context for the youth of today than that of adult smokers. Therefore, the thesis
applies a twofold approach. While adult vapers have experienced the shifting status of smoking,
today’s adolescents are part of a post-smoking era that establishes a different situational frame for
their use and perceptions of e-cigarettes. Particularly, the interrelated social meanings between
combustible cigarettes and e-cigarettes may be less obvious to young people. Recent figures from
the USA demonstrate that 4.7% of middle school and 19.6% of upper secondary school students
were using e-cigarettes (Wang et al., 2020). Data from the UK shows that 16% of adolescents have
tried e-cigarettes (ASH, 2019). Adolescents’ vaping, however, has been associated with more
experimental user patterns (ASH, 2019). Among the minority (1.6%) of adolescents in the UK that
reported regular use, most were already smokers (McNeill, Brose, Calder, Bauld, & Robson, 2019). In
contrast to these, among adolescents who report use of e-cigarettes without prior tobacco
experience (Chapman & Wu, 2014; Hajek et al., 2020), e-cigarettes can seem to represent a more
independent consumer product unrelated to smoking (Hardcastle et al., 2014; Measham, O’Brien, &
Turnbull, 2016).

18
An early study on vaping behaviour, showed how vapers highlighted the novelty and attractiveness
associated with using a new product, and noted how vaping served as a good conversation starter
and interaction device for social network building (Li et al., 2011). As a social context, adolescence is
a formative period, characterized by change and development, where social acceptance and peer
relationships are found to gain increased importance (Forehand & Wierson, 1993; Vartanian, 2000).
Thus, adolescent vapers’ experiences can also be interpreted as part of their identity projects.
Choices of e-cigarettes and flavours may serve as means to show individuality or to enhance one’s
image as ‘cool’ (Hardcastle et al., 2014). Relatedly, young people report having vaped for the sake of
‘having the experience’ (Hardcastle et al., 2014), and for the performative aspects of it (Measham et
al., 2016).

In summary, e-cigarettes, in terms of devices and technology, and vaping, in terms of motives,
practices and associated identities, have been subject to innovations and change over the last 15
years. Originally intended to target smokers, but with time also used for other motives and among
additional groups. In Norway, vaping has been monitored since 2013. In the adult population, it is
estimated that approximately 150 000 Norwegians are currently using e-cigarettes (Vedøy & Tokle,
2019). Further, e-cigarette use emerged in a situation where the sale of devices was permitted, while
sale of nicotine e-liquid was banned. Consequently, 80 per cent of the e-liquid and 60 per cent of the
vaporisers are imported over the internet or purchased from retailers abroad (Vedøy & Lund, 2017).

Content of the dissertation

My study enters this field of research on a theoretical and methodological level. I see e-cigarettes as
bearers of symbolic and social meanings and vaping as not only entailing various user patterns within
various user groups, but also as leading to distinct vaping cultures. At the same time, the research
field on e-cigarette use is often polarized in studies of either adult vapers or vaping in the younger
age segment (Carroll et al., 2021). In this thesis, I empirically address both groups, which is less
common. I do so in order to provide a wider frame when investigating and discussing the vaping
culture and the social meanings of e-cigarettes. I use data derived from qualitative interviews and
surveys to shed light on how adult vapers and adolescents experience and use e-cigarettes in
Norway. In addition, I offer a broad theoretical take on e-cigarettes and the evolving and various
vaping cultures witnessed in contemporary society by discussing e-cigarettes and the vaping
phenomenon against perspectives from that of Subculture-, Interaction Ritual- and Actor-Network-
Theory. I also rely on empirical work from a number of recent contributions in e-cigarette-related
research, including those outlined in this chapter. The findings from this study appear in four articles,
of which three have been published in sociological journals, and one has been submitted in a journal
focusing on nicotine and tobacco research. At time of writing, this paper has received an invitation to

19
be revised and resubmitted for further consideration for publication. Together with this introduction
chapter, these articles form the dissertation.

In chapter 2, I elaborate on the theoretical perspectives and concepts that I draw on to address the
dissertation’s research questions. In the published papers, I have provided space for theoretical
discussions. In this chapter, I will show how these multiple theoretical contributions can offer
complementary perspectives. I begin by demonstrating how the overarching aim of this study places
this thesis within the tradition of cultural sociology. This leads to a brief outline of key concepts such
as identity and stigma, before I offer some more background on subculture theory particularly
relevant for analysing the evolving vaping cultures. This is followed by a discussion of Interaction
Rituals and Actor-Network-theory, both of which, by being fundamentally different in their
respective focus, can contribute to a theoretical openness useful to unpack a new phenomenon such
as vaping.

In chapter 3, I describe and discuss the methodological approaches and analytical work undertaken
in the dissertation. I begin by providing an overview of the three sources of data and a table that
constitute the empirical foundation of the dissertation. I then seize the opportunity to provide an
extended elaboration and discussion of matters related to the respective data sources, such as
ethical considerations, which were restricted within the journal articles because of word limits.
Finally, I will discuss how the multiple data sources can help to support the thesis’s twofold approach
on adolescents’ vapers’ and adolescents’ experiences of e-cigarettes.

In chapter 4, I provide a summary of the four journal articles. The first article makes broad use of
interview data with 30 adults with extensive vaping experiences. The article investigates user
motives, their self-identity as vapers and involvement in vaping subcultures. The second article
explores vapers risk perceptions and accounts of the risk communication and regulation of e-
cigarettes in a Norwegian context. Article three, explores the evolving meaning of e-cigarettes and
vaping among adolescents from 2014-2019 based on an extensive qualitative longitudinal material.
While the fourth and final article makes use of prospective survey data to examine: the prevalence of
nicotine and non-nicotine vaping in a nationwide sample of Norwegian adolescents, assess
differences in personal characteristics between groups of e-cigarette users, and to identify transition
between these groups.

In chapter five, I offer my concluding remarks on how the key findings of the four papers align with
the aim of unpacking the culture of vaping and meaning of e-cigarettes. Finally, I suggest some
implications of the overall findings for our current understanding of the vaping phenomenon and
propose a few possible directions for future research.

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21
22
 2. Theoretical Framework

In this chapter, I outline and discuss the central theories and concepts drawn upon to examine the
issues at hand. The overarching focus and theoretical approach of this thesis belong within the field
of cultural sociology. However, I make use of multiple lenses to investigate the vaping phenomenon
from several angles. In what follows, I present the cultural foundation of the thesis and briefly
introduce the concepts of identity, stigma and risk in relation to vaping. This is followed by an
introduction of the framework of subculture. I then discuss how employing several and even
seemingly conflicting perspectives can help to acquire new understandings of vaping cultures and the
meaning of e-cigarettes, with emphasis on Actor Network Theory (ANT) and Interaction Rituals (IR).
Finally, by drawing on examples from the journal articles that constitute the main part of this thesis, I
discuss how these multiple theoretical lenses can be employed to capture different aspects of vaping
cultures and meaning of e-cigarettes among both adult vapers and adolescents.

A reflexive cultural approach on vaping: identity, stigma and risk

Culture in this thesis refers to processes of meaning making, and culture – or processes of meaning
making – are seen as apparent in all sorts of social practices (Spillman, 2002, p. 7). The cultural
approach is thus similar to the perspective emphasized by symbolic interactionists who also examine
meaning making in fluid interactional processes (Spillman, 2002). Moreover, understanding culture
as ongoing processes involves the acknowledgement that cultures are fragmented. Meanings, norms,
values and practices are not necessarily obvious or unambiguous, nor universally shared, coherent,
or consistent within groups or in society. Rather, people or social groups draw on the available
repertoires of symbolic meanings in their context (Spillman, 2002). This can mean, for instance, that
being a former adult smoker versus being a non-smoker growing up in the post-smoking era provides
different points of departure when engaging in meaning-making processes related to e-cigarettes.

In line with the current understanding of culture, identity is understood as something essentially
social and reflexive (Jenkins, 2014). According to Jenkins (2014), people derive their perception of
identity largely from identification and comparison of similarities and differences between other
persons or things (p. 2). In this context, one way to understand various vaper identities can be
through comparison with the smoker identity. Relevant as the majority of adult vapers report being
former smokers (Delnevo et al., 2016; Schoenborn & Gindi, 2015). Smoking is the most important
cause of preventable morbidity and death in the Nordic countries, as well as a contributing factor in
maintaining social inequality in health (Grøtvedt, Kvalvik, Grøholt, Akerkar, & Egeland, 2017; Lund,
2016; Vedøy, 2014). Awareness of health risks associated with smoking and the decline in the

23
numbers of smokers have contributed to a general devaluation of smoking in recent decades.
Subsequently, the identity of being a smoker has become a matter of moral judgement and
stigmatization (Farrimond & Joffe, 2006; Farrimond, Joffe, & Stenner, 2010; Lund et al., 2014).

According to Goffman (2009), stigma is a feature that is socially discrediting in a specific way and
serves to label stigmatized persons with a set of unwanted characteristics. Stigma thus affect
interactions between “normal” and stigmatized people (Ritzer, 2000, p. 367). Consequently, persons
who experience external stigma may feel shame, loss of self-esteem and may turn to self-stigma. The
latter refers to the process of inflicting stigma on oneself from a negatively viewed personal attribute
that, according to Goffman, can create a gap between a virtual and actual social identity – and lead
to what he deems a ‘spoiled identity’ (Goffman, 2009). Returning to the example of smokers turned
vapers: negotiating a “new” vaper identify might not be straightforward for everyone. Some may
struggle against letting go of their smoker identity, or against accepting or rejecting external
identification between smoking and vaping by either transferring the stigma or through boundary
work to distinguish these practices. However, as illustrated with the changing cultural position of
smoking in society, what constitutes stigma or stigmatized attributes is reflexive, and thus subject to
change and related to specific social contexts (Goffman, 2009). This entails that what is perceived as
a stigma for some can be used as an emblem by others, or in Goffman words; "An attribute that
stigmatizes one type of possessor can confirm the usualness of another, and therefore is neither
credible nor discreditable as a thing in itself" (Goffman, 2009 p. 6). Thus, other vapers can perhaps be
indifferent to previous smoker stigma, or proudly take a vaper identity based on the comparison
between vaping and the severe risk factors associated with smoking (see for instance Farrimond,
2017).

Against this backdrop, and the previously mentioned divergence associated with the use of e-
cigarettes, it can be of value to bear in mind that what constitutes risk is similarly subject to
negotiation and bound to sociocultural contexts (Lupton, 2013, p. 44). For example, there is general
consensus about the health advantages for smokers who switch to e-cigarettes; at the same time,
there is an often-voiced fear that e-cigarettes carry the risk of increased e-cigarette use among non-
smoking adolescents (Gilreath et al., 2016). Risk perspectives and risk understandings are integrated
in larger cultural processes of meaning making (Lupton, 2013). For instance, adopting the harm
reduction perspective involves an emphasis on relative risk. From this perspective, it seems rational
that smokers who are unable or unwilling to stop should be encouraged to switch to a lower health
risk alternative. At the same time, accepting the precautionary principle would involve emphasizing
that the history of e-cigarettes is short and that the evidence base on risk of health effects from long-
term vaping is limited. Thus, accepting the precautionary principle of risk is likely interlinked with

24
being more in favour of strict restrictions in general, and for the sake of avoiding potential use in
unintended groups in particular (Drope et al., 2018; Hartmann-Boyce et al., 2020).

In sum, the reflexive understanding of the concepts of identity, risk and stigma highlight the
importance of the broader social context. Moreover, the social context may be different for
individuals and groups. For instance, concepts such as stigma and harm reduction might not be
equally useful for investigating vaping among adolescents without previous smoking experiences.
Thus, investigating the meaning making of the use of e-cigarettes implies an awareness of the
contextual drivers within various social groups. Therefore, rather than searching for one explicit
vaping culture, this approach can be applied to investigate several vaping cultures and subcategories
of use, including those involving more distinct user practices typically associated with subcultures.

Subculture theory: from urban groups to online (vaping) communities

Subcultures have always been seen in terms of their relationship to and function within broader
society. They can be defined as: “(…) groups of people that are in some way represented as non-
normative and/or marginal through their particular interest and practices, through what they are,
what they do and where they do it.” (Gelder, 2005, p. 1). Subculture theory derives from a long
tradition of subcultural research, originated at the Chicago school of Sociology in the USA during the
1920s and 1930s, and later developed by the Birmingham Centre of Contemporary Cultural Studies
(CCCS) in England during the 1970s. Within these subculture traditions, the emphasis was on atypical
and often deviant groups. The participants in subcultures were portrayed as relatively homogenous,
and subcultural groups were often regarded as cultural responses to socially marginalized positions
(Gelder, 2005).

From the Chicago school, the earliest subculture studies were carried out as empirical fieldworks.
These provided insight into how groups of people can create alternative sets of norms and values to
those of mainstream society and how, by creating their own systems of social meanings, they could
legitimize behaviour deemed deviant or delinquent (Cressey, 2008; Park, 1915; Whyte, 2012).
Initially, urban locations were in focus. The city was framed as a laboratory in which human nature
and social processes could be conveniently studied (Park, 1915, p. 612). Later on, subcultures were
also understood as more institutional and as occurring like ‘worlds within the world’ (Gordon, 1947).

With the tradition of the Birmingham School of Cultural Studies, the subcultural approach was
broadened with an increased focus on popular culture and class tension. Subcultures were seen as
emerging through resistance with mainstream culture and the dominant middle-class culture on the
one hand, and the working-class culture on the other (Gelder, 2005). In addition, descriptions of the
process whereby objects are made to mean and mean again as ‘style’ were given extended focus

25
(Hebdige, 1979). As an example, Willis’s famous study on working-class boys’ path to working class
jobs showed how identification and symbolic resistance to a ‘conformist’ culture marked by middle-
class values were expressed through consumer goods such as cigarettes, alcohol and clothes (Willis,
1977). Willis shed light on mechanisms (identification, resistance, negotiated practises) that in ways
correlate with drivers in the emerging vaping subcultures that I will return to later. Thus, the
traditional subcultural perspectives outlined here, provide ways to investigate alternative
expressions, but have also been criticized for shortcomings in term of describing more contemporary
subcultures in a fragmented culture (Clarke, 1982; Gelder, 2005; Sandberg, 2013).

As a response to more postmodern forms of sociability, subcultures over recent decades have
increasingly been treated more as a result of the heterogenic nature of social contemporary life
(Gelder, 2005, p. 183). The more contemporary understandings also devoted more space to identity
(Fine & Kleinman, 1979; Sandberg, 2013). Fine and Kleinman (1979) relatively early on provided a less
rigid understanding of subcultures as culturally bounded networks of people who share ideas,
material objects and practices. Their conception offers an understanding of how cultural consumer
elements, such as e-cigarettes, can be widespread in a population but also hold various meanings
within various groups. They acknowledge the existence of local variations in cultural content through
interactional negotiation in group settings, as well as the dynamics of subcultural change (Fine &
Kleinman, 1979, p. 17). Such a reflexive understanding of subculture is of value when exploring
emerging vaping subcultures within the broader fragmented vaping culture, as it suggests emphasis
on how (otherwise heterogeneous) individuals subscribe to shared interests and beliefs (Gelder,
2005 p.12).

In addition, the internet a new resource for the affiliation and expression of subcultural identity
(McArthur, 2009). The rapid development of the internet has contributed to the emergence of new
subcultures in contemporary society (see for instance; Kahn & Kellner, 2004; Williams, 2006;
McArthur, 2009). Dimensions creating tension can still be important subcultural drivers, such as
opposition and resistance to stigma or dominant risk approaches. However, in contrast to previous
subcultures bound to face-to-face environments, the internet has facilitated a new borderless
medium for subcultural existence (Williams, 2006). Through online forums and social media (SOME)
networks, individuals who otherwise might not have participated in a subculture are provided
platforms on which to respond, interact, share, and as such, develop subcultural identities (Williams,
2006). This online development thus opens for new understandings of present-day subcultures, with
an emphasis on how online arenas enable the expression of subcultural identity detached from
physical space and geography (Kahn & Kellner, 2004; McArthur, 2009).

26
Conceptualizing the agency of technology and sociability in vaping
The e-cigarette has undergone development and, as previously mentioned, it has been subject to
massive innovation. To consider this dimension, an alternative approach to the novel vaping
phenomenon might be to describe the actual invention and its technological progress; namely, to
focus on e-cigarettes as technical objects holding certain features that allow for several practices to
emerge. In the USA, where youth vaping has been most prevalent, the increased interest has been
associated with the arrival of the discrete pod versions on the market (Huang et al., 2019). The newer
versions bear little resemblance to the prototype invented by Hon Lik in China in 2003, which was
designed to resemble a traditional cigarette (Bareham et al., 2016). Thus, when addressing use in the
contemporary new nicotine market, a more relativist theory such as Actor-Network-Theory (ANT),
with a preference for descriptions and inscriptions of objects (actants) over meaning, can offer a
supplementary lens (Latour, 1996).

According to the ANT perspective, agency can be found in both human and nonhuman objects
(actants). Hence, the ANT perspective focuses attention on how nonhuman objects such as the e-
cigarette act on users, engage in practices and operate in networks (assemblages) (Latour, 2005, p.
68). The ANT concepts of inscriptions and translations can be of relevance in a study of vaping.
Inscriptions refer to the specific features of an object (actant), and how an object – in this case an e-
cigarette – creates a user pattern by way of how the object facilitates its own use (Latour, 1987). For
instance, the e-cigarette is made for inhalation through a mouthpiece. It come in a size which makes
(most of) them easy to carry around. At the same time, they are heavier than the conventional
cigarette, so that many will hold them differently. In contrast to cigarettes they are not guided by the
time frame starting from lighting the cigarette at one end and ending with reaching the filter;
instead, they are more flexible, as they leave it up to the consumer to decide when the practice
starts and ends. An object with a strong inscription will automatically force the object to be used in a
given way, whilst a weak inscription allows alternative user patterns than those originally intended
by the creator.

In ANT terms, conventional cigarettes can be seen as having a strong inscription, while e-cigarettes in
comparison have a weak inscription. The ever-expanding product portfolio, the increasing number of
youth vapers found in the USA (Cullen et al., 2019), or the use of e-cigarettes to deliver alternative
substances might serve other indications than that e-cigarettes have weak inscriptions, given their
original conception as a smoking substitute. The term translations refer to creating an inscription in
order to align the object (or the assemblage) in a particular way (Latour, 1994, pp. 32-41). For
instance, the changes in user configurations in the USA have been directly associated with the e-
cigarette JUUL’s arrival on the market. Translations in this case refers to the novel and discreet shape

27
of these pod-devices, which resemble sleek USB sticks. These translations of the original inscription
seem to facilitate use in youth settings, such as school environments (Ramamurthi, Chau, & Jackler,
2019). In response to this development, another form of translation of the inscription of e-cigarettes
could be to increase standardization of vaping products or to alter vaping regulations. Thus, as I have
tried to illustrate above, the strong point of ANT is making objects co-participants in the
development of action (Latour, 2005 p.70). The Interaction Rituals (IR) perspective on the other
hand, can offer a complementary lens to investigate the sociability and ritual aspects of vaping.

Collins’ theory of interaction ritual chains (2004) builds on Durkheim's theory of rituals, Weber’s
conflict theory and the microsociology founded by Goffman. According to Collins an, IR “is the
process in which participants develop a mutual focus of attentions and become entrained in each
other's bodily micro-rhythms and emotions” (Collins, 2004, p. 47). In ways similar to the constructivist
understanding of identity outlined above, IRs are seen as creating symbols of group membership, and
to represent boundaries of inclusion and exclusion (Collins, 2004, p. 297). Collins (2004) can also be
seen as partly meeting Latour (2005) by acknowledging the importance of objects in IRs. Membership
symbols is the concept Collins uses for items subject to a group’s attention during such rituals (2004,
p. 150). An application of the IR lens can thus provide an additional theoretical tool to highlight the
various levels of solidarity and commitment to e-cigarettes as membership symbols in social groups
and situations. It can also be employed to explain how external conditions can shift the symbolic
meaning of a given product and thus the strength of the social ritual (Collins, 2004). Collins himself
used the shifting position of smoking in society as an example to show how interlinked social
meanings of rituals are with social context, by illustrating how the smoking ritual went from being
associated with social elites to representing outsider positions (Collins, 2004). Applying the same
lenses to vaping can thus provide supplementary ways to grasp vaping cultures and the meaning of
e-cigarettes among different social groups. This is for instance illustrated by Yule and Tinson (2017),
who identified vaping as a low-intensity ritual based on varying levels of formality and process, and
linked it to mechanisms for misbehaviour among young people.

Studying an unsettled phenomenon

The short market history for e-cigarettes means that the full picture in terms of vaping cultures and
the social meaning of e-cigarettes can be challenging to ascertain. For instance, an online search
using the terms e-cigarettes or vaping will quickly illuminate what could be deemed the narrower,
but at the same time, perhaps most visible, sites of the vaping culture in the form of numerous blogs,
forums and tutorials devoted to vaping. The content varies between platforms, but can typically
range between emphasizing vape tricks, equipment, engaging in self-advocacy, consumer support
groups and so on. Despite the split approaches on e-cigarettes – or maybe because of it, e-cigarettes

28
are used in remarkably bold and visible ways (See for instance Annechino & Antin, 2016; Farrimond,
2017). At the same time, e-cigarettes have also gained a position in the more mainstream culture.
They have found their way into the popular culture, as seen on monitors in prize-winning series such
as Euphoria (released on HBO, 2019) and Billions (released on Netflix, 2016). More importantly, they
are used as an alternative to conventional cigarettes by millions of people worldwide (Euromonitor,
2021) and have gained the attention of young people (Cullen et al., 2019). The various theoretical
lenses outlined above, both reflect and contribute towards investigating the unsettled phenomenon
at hand by providing various ways to understand the fragmented culture of vaping and the various
meanings e-cigarettes can hold within different groups such as adult vapers and adolescents.

In the three first articles, meaning making processes are investigated on the ground, at the subjective
level (Spillman, 2002, p. 7). The two first, elicited through interviews with adults with lived
experience of vaping, and the third based on longitudinal interview data with adolescents. In these
articles, I make use of different theoretical lenses, such as identity, subculture, ANT or IR, in order to
situate these meanings or experiences within the broader social context. The first article (Tokle &
Pedersen, 2019) explores the subcultural dimension of vaping cultures and makes use of the
concepts of identity and stigma (see Jenkins, 2014 & Goffman, 2009) to illuminate differences and
similarities within a group of adult vapers.

A relevant example for understanding the vaping subculture approach can be found in Thornton’s
study (1995) of young British clubbers. Thornton describes subcultures as ideological communities,
which are used to show distinctive character and affirm that members are not part of an
undifferentiated mass (Thornton, 1995 p.185). By launching the term ‘subcultural capital’, Thornton
integrates the work of Bourdieu (1984) into her subcultural studies of clubbers who desire to be hip
over mainstream. Similar to Goffman’s notion of the reflexivity of stigma (Goffman, 2009),
subcultural capital “confers status on its owner in the eyes of the relevant beholder” (Thornton, 1995,
p. 186), and is hence, in some ways similar to Bourdieu’s cultural capital, but without the strict class-
dimension (see Bourdieu, 1984). Following Thornton, subcultural capital can be objectified through,
for instance, having the right haircut – or the most advanced mod [type of vaporizer], if to transfer it
on to the vaping subculture. It can also be embodied, in the form of ‘being in the know’, displayed by
using the right terminology or acting like a natural when performing the latest practices of value.
Subcultural capital is used in contrast to those deemed less relevant, mainstream and unhip, and is
achieved through being perceived as ‘in the know’ by relevant others (Thornton, 1995). This is also
similar to the process of constructing a social identity through similarities and differences (Jenkins,
2014). In this article (Article 1), various identified characteristics related to vaping led to the
construction of two different vaper identities, one of which included vapers sharing characteristics

29
that suggested a vaping subculture, as the social meaning of vaping could be seen as extending far
beyond that of being solely a smoking substitute. Moreover, those labelled with this vaper identity
were ‘in the know’ on vaping-related matters, to use the term coined by Thornton (1995).
Subcultural capital could be linked with feats such as customization of devices, performing tricks or
steeping of e-liquids for various flavours. However, stigma and resistance are also contributing key
concepts, as the emerging of a vaping subculture can be seen as a tension or a response to stigma,
following the denormalization of smoking in the Western world during recent decades (Peretti-Watel
et al., 2014; Sæbø, 2017). Thus, identity and subculture theory can be particularly useful in the
present thesis to delineate differences within groups of vapers (Article 1).

Shifting the focus to the concept of risk and risk knowledge, on the other hand, can serve to highlight
similarities within the same group (Article 2). E-cigarette aerosol generally contains fewer toxic
chemicals than conventional cigarette smoke (Stratton, Kwan, Eaton, 2018). However, vaping is not
harmless; it can expose users to substances known to have adverse health effects, including ultra-
fine particles, heavy metals, and other unpredictable and potentially harmful ingredients (COT, 2020;
Stratton, Kwan, Eaton, 2018; US DHHS, 2016). Thus, vaping conveys health risks when compared to
not using any inhaled recreational drugs, particularly for ‘unintended groups’ such as children and
non-smokers (WHO, 2014). The reflexive understanding of risk (see Lupton, 2013) offers ways to
investigate how this ambiguity is negotiated among vapers who used to smoke (Article 2). Moreover,
ascertaining vapers’ understandings of risk contributes towards an understanding of emerging vaping
communities in contemporary society and the meaning of online platforms.

Subculture theory (Article 1), together with concepts such as stigma and risk (Article 2) are useful
analytical perspectives when investigating the position of dedicated vapers engaging in such as
vaping policy, and self-advocacy. The perspective of IR on the other hand, can offer a way to highlight
the sociability of vaping in less distinct groups and in the broader youth culture (Article 3). Article
three also illustrates how an ANT-inspired approach can offer a sensitivity to the novelty and the
technical sides of the e-cigarette invention. Looking at the vaping phenomenon through the lenses of
ANT provides the possibility to zoom out on the device, to investigate how the product facilitates the
practices at hand, and to maintain this focus throughout the analysis. Is choice of products a
coincidence, a mod, a vape pen, a sleek pod version? The flavours, delivery of nicotine? Price and
availability?

While the theoretical perspective of IR, can provide a tool to zoom in and investigate how these
devices integrate in social rituals, and thus capture the sociability of vaping, as well as drivers in and
out of use. Collins’ (2004) notion of ‘membership symbols’, for instance, is useful for grasping the

30
product’s social status, and thus the contributing mechanisms such as experimentation, peer
pressure or disapproval (article 3). Separately, the ANT perspective offers a sensibility to the material
aspects of e-cigarettes, while IR can be used as an analytical tool to attend to the social features of
the practice. Applied together, these perspectives can combine to demonstrate how the synthesis of
the materiality and technology of the e-cigarette (ANT) are entangled in the collective dimension of
vaping (IR).

In addition to the three qualitative articles mentioned, which in various ways make use of the above
outlined theories and concepts, the thesis comprises a fourth quantitative paper. In this paper
(article 4), rather than investigating meaning-making processes, the aim was to investigate vaping
prevalence, transitions in vaping behaviour and to consider whether there were any differences in
personal characteristics between adolescents who reported use of e-cigarettes and those who did
not. Approaching behavioural aspects – such as vaping – based on an understanding that such
actions can be associated with personal characteristics is common in psychology, and particularly in
the psychobiological paradigm (Zuckerman, 2011). Within substance use studies, the
psychobiological terms sensation-seeking and depressions are among some of the frequently used
sources by which to assess whether there are personality and individual differences (Brunborg et al.,
2019; Jessor & Jessor, 1977). While these terms contrast with the overarching reflexive cultural
approach, they can be combined with the more psychosocial perspective of problem behaviour to
maintain an awareness of the social environment in which such use takes place (Jessor, 1987). (More
information on sensation seeking, depression and problem behaviour is provided in the method
section, source 3).

In sum, I have suggested that several theoretical tools can be utilized to unpack sides of the complex
vaping phenomenon and its various social meanings, user practices and patterns. Although many of
the outlined theoretical perspectives or concepts separately could have served as the main
theoretical focus, my aim has been to illuminate how shifting perspectives can be used to capture a
broader range of dimensions associated with e-cigarettes and vaping cultures. In my view, applying a
multiple lenses approach provides an important reflexivity of value because of the novelty and
unsettled nature of the subject in focus.

31
32
 3. Methodology

In this chapter, I present and discuss the methodological aspects of the dissertation, which consists
of three sources of data presented in four papers (Table 2). The guiding aim of this section is to
elaborate on some of the methodological aspects and challenges not covered in the four journal
articles.

Table 2. Sources of data

S Paper Aim to capture Study designed to capture Data Sample (N)

1 1. & The voices of adult Insight into how a Qualitative semi- 30 adult vapers.

2. vapers. Examine various heterogeneous sample of structured personal

motivations for use, adult vapers experience using interviews.
identities, vaper (sub) e-cigarettes in Norway where
cultures and risk the practice is regulated
perceptions.

2 3. The voices of adolescents Trajectories in adolescent Qualitative longitudinal The baseline (T1)
providing the evolving substance use. semi-structured group- sample consisted
meaning of vaping and e- and personal of 118 12–13-
cigarettes in a Norwegian The Monitoring Young interviews. year-olds from six
youth culture context. Lifestyles (MyLife) study was Four data collections 8th grade classes
initiated as an integrated from 2015-2019. from six schools.
quantitative and qualitative 50 group- and 175 At T4, they were
prospective investigation of individual interviews. 16–17-year-old
correlates, causes, and and in high
consequences of adolescent’ school.

3 4. Adolescents’ use of e-cigarette, tobacco and Quantitative 2,975 8th, 9th

nicotine and nicotine-free substance use and other longitudinal survey and 10th graders
e-cigarettes in Norway. addictive behaviour in data. Three data from 33 middle
Contrasting related Norway. collections: 2017, 2018 schools Of whom
characteristics and vaping and 2019. 2018 completed
patterns over time. all three
questionnaires.

As shown (Table 2), this thesis makes use of data derived from multiple methods, which is a
pragmatic approach useful to illuminate a multifaceted topic (Tashakkori, Teddlie, & Teddlie, 1998).
Pragmatism in this context involves making methodological choices based on what fits best with the
research question(s) at hand (Zhang & Creswell, 2013). In general, qualitative methods are well
suited to address broad questions and provide insight into the broader social contexts in which

33
individuals’ meanings are situated and their practices developed (Creswell, 2007). Corresponding
with the cultural approach outlined in the previous theory chapter, the overarching research
paradigm, or the “… basic set of beliefs that guide action” (Guba, 1990, p. 17), of the qualitative
studies aligns with that of social constructivism. Because interpreting meanings and how they are
made require that I both acknowledge the interviewees’ subjective and varied understandings of
experiences and objects, and that I look for complexity in their views (Creswell, 2007, pp. 20-21).
Quantitative methods, on the other hand, are fit to investigate proportions, patterns and user
characteristics in larger samples. Together the multiple method data provides an empirical
foundation for investigating various sides of the culture of vaping and meaning of e-cigarettes in
Norway. In what follows, I describe and discuss the origin of each source. I begin with source 1, the
qualitative explorative study with adult vapers and follow up with source 2, the qualitative,
longitudinal study with adolescents; finally, I examine the third and related source, the quantitative,
longitudinal study with adolescents.

34
Source 1: Qualitative interview data with adult users of e-cigarettes
Source 1 data consist of 30 qualitative personal interviews with adult vapers, carried out in two
phases.

Exploring the vaping phenomenon online and bottom-up

Working at the Norwegian Institute of Alcohol and Drug Research (SIRUS), I was given the
opportunity in 2014 to investigate – the at that time and for me new phenomenon – use of e-
cigarettes. The initial objective was to explore how users experience and perceive e-cigarettes. With
the general foundation of social science literature being limited on the subject, and users’
experiences with e-cigarettes not previously having been investigated in Norway, I had no initial
hypothesis to investigate. Hence, my pathway into the field was highly inductive. The explorative
study design aligns with the constructivist grounded theory (CGT) as positioned by Charmaz (2014).
CGT has its origin in grounded theory (GT) (Glaser & Strauss, 1967) and follows several of the GT
strategies for qualitative research, such as employing an inductive, emergent, open-ended, and
iterative sampling and analysis approach (Denzin and Lincoln, 2008). CGT does, however, offer more
pragmatic and flexible guidelines to the fixed methodical rules of GT (Charmaz, 2014; Charmaz &
Belgrave, 2007). In addition, CGT differs from the more positivist epistemology of early GT, by
perceiving data as a co-construct between the researcher and the interviewee, rather than as an
objective truth revealed by the researcher (Charmaz, 2017).

Personal interviews are suitable for exploring novel phenomenon by enabling investigation of
individuals’ own understandings, experiences and practices. To access the field, I searched for
information on e-cigarettes online. This directed me to a Norwegian forum devoted to vaping and an
associated Facebook (FB) group, which revealed numerous users sharing knowledge, support,
enthusiasm and frustration. I decided to join the FB group, which at that time (2014) had 6000
members. After having observed the high activity on these pages for a period, I requested permission
from the administrators to publish a post where I presented the project and myself, in order to ask if
any of the associated members would be willing to meet in person for an interview. As permission
was granted and the interview request was published, I was also invited by some of the forum
members to a physical vape meeting in Oslo. This meeting enabled me to pose questions, observe
practices, equipment, and listen to eight vapers discuss e-cigarette-related topics for three hours.
Simultaneously, several e-cigarette users had reached out on FB. I had found an entrance.

35
The sampling criteria were broadly defined as adult men and women with lived experience of e-
cigarette use in Norway. In total, 16 interviews were conducted in the first phase in 20144. I
interviewed seven participants recruited through the vaping group on Facebook (5) and the physical
vape meeting (2). It was obvious to assume that these vapers, with ties to the same forum devoted
to e-cigarettes, might have assimilated shared stories and similar perspectives through the online
community interaction. However, the high activity online and the numerous members participating
on these vaping platforms made it expedient to include representatives in a study investigating user
experiences and meaning making. At the same time – and in line with CGT design – it became
important to investigate whether experiences associated with use of e-cigarettes were different for
users without possibly biased knowledge or ties to established vaper communities. As a measure, I
began actively recruiting broadly outside the forum setting, through extended network and nightlife
venues. This resulted in nine additional participants.

Having received PhD funding, I was given the opportunity beginning in autumn 2016 to explore the
social and cultural determinants associated with vaping and e-cigarettes more extensively. I wanted
to include the first phase data since the Norwegian legislative status on e-cigarettes had not
changed, and I knew that there were several dimensions present within the material that deserved
more unpacking. However, to ensure that the interviews were not dated, I started comparing the
most recent acquired findings with the existing interviews. Because I found the new interviewees to
largely echo former participants, both in terms of their experiences and perspectives, I felt assured
that the findings were still valid. In addition, I also found it necessary to conduct additional interviews
– in GT term called theoretical sampling, throughout the period as new topics became evident in data
or interviews (Glaser & Strauss, 1967).

In line with the explorative objective of this study, participants in the second phase were also
recruited from various locations for the purpose of variation. This included vape shops, nightlife
venues and a festival. The former chosen purposely to see if I could seek out young urban adults and
to investigate the position of e-cigarettes in these environments, as a possible contrast to vape-
platforms. On that note, when conducting qualitative research, the goal is rarely to generalize, but
rather to provide a rich, contextualized understanding of some aspects of a particular phenomenon
(Ayres, Kavanaugh, & Knafl, 2003). Thus, the process of recruiting in different arenas reflected the
inductive design. A level of sample diversity allowed me to further investigate uncertainties and
highlight diversity and different perspectives in the data (Creswell, 2007, pp. 240-241). Sampling for
variation also involved trying to reach the less visible vapers. To do this, I used a chain-referral

4
Some of the findings from the first 16 interviews are presented in a SIRUS-report (Tokle, 2014).

36
strategy whereby I recruited through extended networks and snowball sampling (Biernacki &
Waldorf, 1981). Additionally, this strategy was used to actively recruit more women, as I wanted a
certain level of gender balance. In total, the sample consisted of 13 women and 17 men. Issues
specifically addressing gender, however, were rarely brought up during interviews. I acknowledge
that this could have been a self-energizing effect related to an absence of focused questions on
gender implications associated with use of e-cigarettes in the research guide. Despite my lack of a
gender focus – which can be seen as a limitation – some did describe the vaping culture as being
somewhat stereotypically masculine (mentioned in article 1), which might suggest that applying a
more focused gender perspective on vaping might have been of value.

The interview guide was structured around broad topics associated with e-cigarettes, spanning from
initial experience, smoking history, user motives and vaping patterns, to identification with other
vapers. I conducted all interviews in person, and although guided by a list of themes, the interviews
were open-ended and flexible enough to allow me to adjust and add questions as information arose.
In this way, face-to-face interviewing requires both the interviewer and the interviewee to be active
participants (Gubrium & Holstein, 2003). The flexible approach also guided the overall recruitment
process. Locations were decided based on the interviewees’ preferences. I encouraged them to
suggest a place, but also provided them the option of my office or some specific cafés. They opted
for different alternatives, ranging from their own offices, my office, the outdoors, bars and quieter
cafés. I also preferred to offer interviewees something to drink, a coffee or a soda before starting the
interview. I found these small gestures created an atmosphere for informal chatting, which I felt
helped to establish a friendly ambience. My aim throughout was to make the interviewees feel
comfortable. In addition, all interviewees received 300 NOK (approximately £30) to compensate for
their time. For me it felt good to be able to offer something beyond merely something to drink and
verbal gratitude in return for their time. The interviews lasted on average between 1-2 hours, and
the honorarium may have indirectly contributed to the length and richness of data, as it made me
more relaxed and less apologetic about keeping them occupied.

Interviews continued until saturation was met for the main study purpose, which was not
straightforward in this explorative study. Saturation means that additional interviews would not add
any additional meaningful information (Merriam & Tisdell, 2015). I reached 25 interviews before
experiencing that the most recent interviews added nothing substantial to my understanding. In line
with the principle of saturation, I felt determined after completing 30 interviews that the research
findings were reliable and valid for further investigation of adults’ meaning making of e-cigarettes.
One that note, the youngest adult interviewee - and the only one without a previous history with
smoking – described experiences that indicated that youth vaping could involve additional social

37
meanings. However, with the current sampling criteria being adult vapers, unpacking dimensions
associated with youth vaping would involve additional sampling of young vapers which extended the
scope of the current study. For an overview over sample characteristics, please see tables in article 1
and 2.

Ethical considerations
The first phase data collection (2014), which was carried out at SIRUS, was cleared with NSD
(Norwegian Centre for Research Data) and evaluated again in 2016, prior to the additional data
collection by the Privacy Protection Committee at NIPH. In line with their ethical guidelines, all
interviewees were fully informed about the study, its purposes and funding prior to participation.
They were given information about the project upon recruitment (i.e., in the FB post, by text
message or email when contacted through extended network or snowballing) as well as formalized in
writing prior to each interview. In addition to giving them time to read, I repeated the most crucial
information in conversation. I particularly stressed that study participation was optional and that
they had a right to withdraw their consent and associated data at any time if they should later come
to regret participating. I also ensured anonymity. This involved taking measures such as verbal rather
than written consent and avoiding asking for sensitive or identifying information, such a name or
place of birth, as I was recording. Recordings were deleted after they were transcribed, and
pseudonyms were assigned in the transcripts. In cases where potentially identifying information
occurred, i.e. workplace or specific geographic locations, I systematically altered or excluded this
from the transcripts.

In addition to these standard measures in qualitative studies, the constructivist approach also means
acknowledging that research itself is a construction occurring under specific conditions (Charmaz,
2014). The specific conditions in this context, which I was made aware of early on and was somewhat
naively surprised by – involved, for instance, the lack of trust in me and my intentions that some
expressed based on the fact that I was a government-funded employee. This made me aware of the
perceived discrepancy between many vapers’ perceptions of e-cigarettes and their perceptions of
the more public approach on e-cigarettes. In addition, it made me reflect over my own researcher
positionality and the interviewees’ agenda. In practice, this involved me stressing that I conducted
independent research without preconceived ideas of what is morally right or wrong, that there was
no such thing as correct or incorrect answers to my questions and that my aim was insight into their
experiences and perspectives. I also mirrored their terminology and avoided referring to the use of e-
cigarettes as smoking. In terms of interviewees with an agenda, I acknowledge that the most
dedicated vapers saw the interview as an opportunity to highlight the benefits of vaping. However,

38
this is in itself interesting, and provided relevant and valuable data. In addition, by strategically
recruiting less visible users, I felt assured that I was able to avoid an one-biased sample.

Data analysis and construction of concepts

Having conducted all the interviews myself yielded the benefit of closeness to data. In the inductive
coding process, transcripts were imported and coded in the qualitative coding software
HyperResearch. In this coding process, codes were developed based on grouped excerpts or phrases
from the interviews with similar meanings (Tjora, 2012). The data collection and the initial analysis
processes were also in ways interlinked. As outlined above, interviewees could introduce new
themes, or additional dimensions became evident as I coded transcripts or reread coded data. In
some cases, this caused me to conduct additional interviews. During the writing process, the
complete set of coded data was subject to systematic comparison within and across codes to
illuminate patterns, themes and the more hidden processes at play (Charmaz, 2014). Findings are
also presented with an awareness of the relevant social contexts in which they are situated
(Charmaz, 2014).

The first article focuses on the interviewees’ different approaches to vaping, ranging from those of
the proud ‘public’ vapers to the more reserved and reluctant ones. Through sorting and comparing
codes indicating motives, identifications and user patterns, the ambiguity and variation between the
interviewees’ positions were systematically illuminated. This led to the construction of concepts in
the form of two vaper identities (‘Cloud chasers’ and ‘substitutes’, article 1). Similar to Weber’s term
ideal types, these constructed groups function as tools to explain and highlight distinguishing
characteristics of the social phenomenon of vaping. Importantly, however, such ideal types are not
expected to be found in their pure form in social reality, but are useful in differentiating various types
of vapers. In this context for instance, these constructed vaper types are used to illuminate a vaper
subculture within the broader vaper culture. Generating constructed concepts to specify
relationships and unpack a phenomenon can somehow align with the purpose of GT to theorize from
empirical findings. However, I do not imply the creation of formal theory. These constructed vaper
types can perhaps be understood as a form of middle-range theory building, which in CGT simply
refers to abstract representations of specific social phenomena that are grounded in data (Charmaz,
2014, P. 18). In addition, conceptual generalization is an aim in GT, which means to provide concepts
that have relevance beyond the specific data source (Tjora 212, p. 215). Since the article was
published, the constructed vaper concepts have been applied on findings from related studies
situated in different social contexts, see i.e.: (McCausland et al., 2020; Smets, Baeyens, Chaumont,
Adriaens, & Van Gucht, 2019), which might suggest a level of conceptual generalizability and
transferability (Ayres et al., 2003).

39
Results from the 30 semi-structured personal interviews with adult vapers that constitute source 1,
are presented in the two first articles in this dissertation. The first paper was written on the notion of
variation. The second paper pursues the more unifying dimension within the sample. In addition,
source 1 provides data on adults’ vapers perceptions of youth vaping (Article 2), but also illuminates
the need for additional data to investigate e-cigarettes’ position within the youth culture, which
leads to the next sources.

40
The MyLife study: the origin of source 2 & 3
As I started working on my PhD in autumn 2016, the social context surrounding vaping had begun to
involve an increased focus on the use of e-cigarettes among young people. The backdrop was the
identified rise in numbers of youth vapers in the USA from 2014 (King, Patel, Nguyen, & Dube, 2015;
McMillen, Gottlieb, Shaefer, Winickoff, & Klein, 2015). Numbers that were found to escalate even
more in the USA as of 2016 (Cullen et al., 2019; FDA, 2018). Whether a similar trend could be
witnessed in Norway was however uncertain. We lacked studies at the time that could provide
insight into the status of vaping and use of e-cigarettes among Norwegian adolescents. In line with
the original explorative approach of the thesis, I found it important to include the dimension of
adolescents in the overarching aim. Not only were these evolving new user configurations important
independently, but they also had implications for the broader social context and meaning of vaping.

The large Norwegian multi-method, longitudinal youth study Monitoring Young Lifestyles (MyLife)
provided an ideal opportunity to investigate Norwegian adolescents’ e-cigarette use. The MyLife
study was originally designed to examine a wide range of research questions from diverse fields such
as sociology, psychology and epidemiology. The study employs both quantitative and qualitative
methodologies and facilitates the study of developmental issues, life transitions, and risk and
protective factors relevant to young people’s health and youth cultures in general, and underage
substance use in particular. Since I had been involved and contributed in this study from the onset, I
knew questions about e-cigarettes had been included from baseline in both the qualitative and
quantitative arm of the MyLife project. In the current thesis, the qualitative data represent source 2
and the quantitative data source 3.5

5
Additional details and more general information about the MyLife study can be found in Brunborg et al.
(2019) and on the following website: https://www.fhi.no/studier/mittliv/om-mittliv/ (Accessed, 08.02.2021).

41
Source 2: Qualitative longitudinal interview data with adolescents
Source 2 consists of 50 focus group and 175 individual interviews with a large sample of Norwegian
adolescents (N = 118 at T1). Data are from the above-mentioned MyLife study. Interviews have been
completed in four stages (T1-T4), beginning when the students were 12–13 years in 2015 until 16–17
years in 2019.

The purpose of the qualitative longitudinal design is to collect responses that can be read against
each other (Yates & McLeod, 2007). As such, the strategy provides an invaluable opportunity to
analyse how perceptions and experiences can change and evolve over time (Saldaña, 2003). In the
current thesis, source 2 is used to explore the evolving social meaning of e-cigarettes and vaping. In
what follows, I provide an overview of the timeline and key information from the data collection,
reflections on the process of analysis and some of the ethical considerations.

Research design and data collection

When designing the study, it was decided early on to recruit participants at class level as this would
ensure inclusion of both genders, a level of heterogeneity and make the recruitment process more
manageable since we could cooperate with the respective teachers in each class. The next step of the
main study sampling procedures involved selection of geographical areas. Six schools located in the
north, the south and the east of Norway were included. Further, to ensure both urban and rural
representation within each region, one school class from the largest city and one from a rural
municipality within a two hours’ drive from each city were selected. The aim was to enrol one entire
eighth grade class/cohort per school. The sampling procedures ensured geographical and sample
diversity, which make these data particularly suited to investigate the position of vaping within the
broader Norwegian youth culture.

A pilot was carried out to test recruitment strategies and to inform the main study decisions
concerning the timing and balance of individual and group interviews, group sizes and composition.
One of two pilot classes continued to participate and was included in the core sample, although
baseline was completed one year ahead of the main study schedule (see table 3 below). These
interviews continued to advise the main data collection. In the description of procedures hereafter,
the pilot class is integrated unless otherwise stated.

42
Table 3. Timeline and overview over qualitative longitudinal study

Time Point (T) 1 Time Point (T) 2 Time Point (T) 3 Time Point (T) 4
N = 118 N = 85 N = 95 N = 80
58 boys & 60 girls
Pilot study Fall 2014 *Pilot not included Spring 2017 Autumn 2018
1 class N = 13

Main study Fall 2015 Fall 2017 Spring 2018 Spring 2019
5 classes N = 105
Interview Group interviews Group interviews Personal interviews Personal interviews
form (26) (24) (95) (80)
Cohort Middle school Middle school Middle school Upper secondary school
10th grade 10th grade 10th grade 1st year
Age 12-13 years 14-15 years 15-16 years 16-17 years

* T2 data from the pilot class (n = 13) were not comparable to T2 main study and were therefore not included in
the overall dataset. The first pilot follow-up was carried out with the participants at a younger age, and as
personal interviews rather than group interviews.

Combining group- and personal interviews

As shown in table 3, the baseline data collection (T1) and the first follow-up (T2) were conducted as
focus group interviews (table 3). Group interviews came out as facilitating the most beneficial
interview setting on substance issues because of the respondent’s young age (12-13) at study onset.
The first rounds of interviews largely revolved around perceptions because few had personal
experience with vaping or other substances at this point. Group interviews were repeated at time
two also based on the argument of comparison from T1 to T2. The size of each group ranged from
three to six students. Focus groups are particularly suited to explore participants’ perceptions and
experiences in an interactive format (Lambert & Loiselle, 2008), and hence the collective
understanding of the social meaning associated with e-cigarettes and vaping (article 3). The teachers
assisted us with the composition of groups within each class to ensure that the interviewees would
feel comfortable in the interview setting. For instance, this could involve separating students who
were likely to have more experience with substance use from those with less experience, and/or
keeping friends together to encourage natural interactions. As the students reached the end of
middle school (for both pilot and main study) we needed to strengthen the personal ties between
interviewer and participants. This was important as future follow-ups would demand one-on-one
interviews because the study would no longer be carried out in a shared school context. Individual
interviews also facilitate a more private context for talking about sensitive themes and behaviour,
such as the young people’s own use of substances. Thus, the second (T3) and third (T4) follow-up

43
were conducted as personal interviews. In practice, this also allowed for an increased emphasis on
personal experiences and meanings (Lambert & Loiselle, 2008; Morse, 2003).

The combination of group and personal interviews may have contributed towards exploring specific
opinions and experiences in more depth (Lambert & Loiselle, 2008). Or as noted by Lambert and
Loiselle (2008, p. 235), “When performed rigorously, the integration of individual interview and focus
group data is a productive strategy that leads to an enhanced description of the phenomenon’s
structure and its essential characteristics”. The strategy has the advantage of first identifying a range
of experiences, perceptions and perspectives, and then drawing from that pool to add more depth
where needed (Lambert & Loiselle, 2008). During the data collection, for example, this involved a
systematic review of the data collected in the group interviews when making the interview guide for
the individual interviews in order to develop new questions with a view to increasing our
understanding.

Interview guide, semi-structured interviews and offer of payment

Apart from the baseline main study, I administrated the ongoing qualitative data collections, and,
together with colleagues, conducted interviews and wrote field notes at all time points. This enabled
me to stress the importance of maintaining focus on the use of e-cigarettes during the continuous
rounds of interviews when out in the field. Although the interviews were semi-structured, an
interview guide were used to align the interviews. This was vital to ensure that the range of
questions about e-cigarettes and vaping, in addition to other questions on tobacco products, alcohol
and drugs, were asked in each interview. During the interviews, interviewees were also
systematically asked questions that could provide context to their answers about e-cigarettes and
other substances, such as their use of social media, leisure activities, relationships with friends and
parents.

After having completed one round of interviews, new themes or associated dimensions often arose.
As a measure, the interview guide was adjusted before each follow-up to ensure that we could
further address and unpack relevant subthemes. In practice, this involved including additional
questions on items such as e-cigarette flavours and places for purchasing vape products. In general,
this procedure allowed for a thorough, yet flexible investigation of how Norwegian adolescents
situated themselves in relation to these devices and associated practices at any given time. The
overarching focus on substances, including e-cigarettes also remained the same throughout. Another
unchanged feature during the course of the data collection was the emphasis on the use of open
questions and empathic reactions. This was considered important for two reasons: First, we wanted
all participating students to have a positive interview experience, which is vital in itself, but also can

44
serve to prevent avoidable attrition (for more information on the attrition, see article 3). Second, the
consistent use of open-ended questions helped to produce ‘thick descriptions’ of the interviewees’
experiences (Geertz, 1973).

A shared honorarium of 2000 NOK (approximately £200) was given to each of the six participating
classes upon each round of interviews during middle school, regardless of whether some adolescents
declined to participate. After the adolescents transitioned from middle school to upper secondary
school, participants were compensated individually with a gift card containing 300 NOK. Similar to
my experiences from interviewing adult vapers, the effect of being able to offer symbolic payment to
both schools and later to the participants individually, was valuable. During data collection when the
adolescents were in middle school, this compensation seemed to make the school staff more willing
to take part as the classes received something in return. When the participants were in upper
secondary school, re-recruiting became more complicated as each needed to be contacted
individually. In addition, many had moved, and all had changed schools. In this case, the individual
honorarium is likely to have contributed towards maintaining the relatively low attrition rate at T4
(80 of 95 completed interviews). In general, being able to acknowledge the importance of their
continuous participation and give participants something in return for their time and effort, had a
positive effect on the interview setting.

In sum, the repeated interviews with adolescents provided data well suited to map and describe the
complex social and cultural processes of meaning making associated with a novel phenomenon.
Moreover, the combination of the longitudinal design and the sizeable and heterogeneous sample,
make this a unique source for presenting an overview of how the vaping phenomenon is situated
within the broader youth culture context in Norway.

Thematic data analysis

All interviews were recorded and later transcribed verbatim. Participants were given pseudonyms
and identifying details were removed from transcripts to ensure confidentiality. The next step
involved systematically coding the transcripts. The data corpus from the four rounds of interviews is
coded using the qualitative research software, HyperResearch. This process involved categorization
of data into several groups of codes that reflected themes within the interviews. Each group of codes
involved several subcodes that reflected the stories presented by the adolescents. In addition to the
coded transcripts, field notes, written after each interview contributed to the analysis by providing
context to each interview, and provided an overview of the individual changes over time.

I have made particular use of the e-cigarette associated codes from the data body of source 2,
involving items such as “own experience with e-cigarettes”, “typical users”, “risk perceptions” and

45
“reasons for use” (presented in article 3). I used thematic analysis to further search across these
codes within the data set to find repeated patterns of meaning and identify additional themes at
each time point (T1, T2, T3, and T4) (Braun & Clarke, 2006). The social meaning and status of e-
cigarettes (transgression, cool/uncool) and the participants’ way of addressing aspects of e-cigarettes
as objects (flavours, novel thing/old toy) occurred as patterned themes of importance. Both the
social and the more product-related aspect seemed to capture something vital about the data
relevant to each specific time. Next, I analysed how these themes evolved from early to older
adolescence, by comparing how participants’ e-cigarette perceptions, attitudes and experiences
varied between time points. The theoretical framework of ANT and IR were used in the final analysis
of selected extracts and for the refinement of specific themes upon presentation (Braun & Clarke,
2006, p. 87). In article 3 of this thesis, I decided to present the analysed data chronologically to
highlight the longitudinal aspect of the analysis and the evolving meaning of e-cigarettes. I also
decided to include the voices of different participants rather than individual trajectories to show the
overarching social meaning of e-cigarettes in the contemporary Norwegian youth culture.

I will return to the more formal ethical considerations of source 2 after I have presented the final
source of data. As both the outlined source and the next origin from the same overarching (MyLife)
study, the associated formal ethical considerations largely overlap. The connection between these
datasets was also an important driver for inclusion of the next source, as the qualitative data
illuminated aspects to adolescents’ use of e-cigarettes, such as temporality and use of e-cigarettes
without nicotine, which could be investigated further in the related quantitative data.

46
Source 3: Quantitative longitudinal survey data with adolescents
Source 3 consists of data from 2975 adolescents who participated in the quantitative arm of the
previously mentioned MyLife study. Of these, 2018 completed online questionnaires at all three time
points: 2017 (T1), 2018 (T2) and 2019 (T3) (mean age: 14.2, 15 and 16.2).

Research design and data collection

The multi-cohort prospective quantitative arm was designed to investigate adolescents within their
social contexts (i.e., families, schools) and with particular emphasis on examining mechanisms
underlying developmental changes and transitions in substance use (Brunborg et al., 2019; Chassin,
Sher, Hussong, & Curran, 2013; Ennett et al., 2008). The sampling strategy was developed to ensure a
nationwide heterogeneous sample of adolescents. For geographical heterogeneity, one county in
each of Norway’s five geographical regions was selected for study inclusion (one from the north,
middle, west, south, and east, respectively). In addition, and similar to the qualitative design, both
urban and rural areas were included from each county. To ensure heterogeneity in standard of living,
low, medium, and high SLI communities were selected based on the benchmark Standard of Living
Index (SLI) from Statistics Norway. This index reflected community-level characteristics ranging from
social security, single parent and disability payments to mortality and unemployment rates. These
strategies ensured a sample that was both diverse and sizeable, which is a strength as it enables
more precise estimates.

Baseline and follow-ups

T1: After ensuring parents and participants’ consent (outlined under ethical considerations below),
the first data collection was carried out autumn 2017. Teachers provided information and assisted
the students during class. Participants were given access to the online questionnaires by typing in a
Uniform Resource Locator (URL) in their web browsers. Of the 3512 enrolled students from 32
schools, 2975 completed the baseline assessment. The response rate for eighth, ninth and tenth
graders was 88%, 81% and 85%, respectively (Brunborg et al., 2019). A contact person at each middle
school also received 1000 Norwegian Kroner (approximately £100) as compensation for assisting
with the data collection. In addition, each participating class received the same amount deposited
into their class’ savings account regardless of the individual response rates.

T2: The first follow-up (T2) was carried out by the 2018 autumn semester. For students who were still
in middle school (n=2515), the data collection procedure remained the same as at baseline, with the
exception that the teachers handed out notes with a preassigned PIN-code to enter in the
questionnaire. Participants who had started upper secondary school were sent individual e-mail
invitations with a link to the questionnaire. Three reminders were sent to non-responders via email

47
and text message during the autumn of 2018. For the 8th and 9th grade students who responded in
the school setting, the response rate was 85.4% and 84.4%, respectively. For the first-year upper
secondary students, the response rate was 72.3%. The first follow-up (T2) was completed by 2857
adolescents (81% of the cohort). Participants who continued to participate in upper secondary school
were compensated individually with a 200 Norwegian Kroner gift card (approximately £20) each after
completing the survey questionnaire.

T3: The second follow up (T3) was conducted during autumn 2019 and followed the same procedures
as the previous year; Students in middle school completed the online questionnaire during school
hours. Students who had graduated middle school (10th grade) were contacted individually and
completed the questionnaire on their own time. A total of 2651 (75%) students completed the T3
questionnaire.

Identifying vaper groups and associated characteristics

The questionnaire addressed a wide range of topics, with a particular focus on family background,
leisure time activities, personal characteristics, and substance use. An overview of the baseline
questionnaire is available in Brunborg et.al. (2019). In this context, I was predominantly interested in
topics from the questionnaire associated with use of e-cigarettes, and particularly the adolescents’
use of e-cigarettes with or without nicotine. In addition, the aim was also to investigate whether
those who reported use of e-cigarettes in general, and with nicotine in particular, differed from
others concerning tobacco use and personal and behavioural characteristics. Based on this aim, the
following strategic set of variables were included: age, gender, use of e-cigarettes (with or without
nicotine), use of tobacco products (snus and cigarettes), sensation-seeking, depression and conduct
problems (presented in article 4).

Age was an obvious variable, given the longitudinal design. In addition, the developmental phase of
adolescence, characterized by physical, mental and psychosocial changes is generally an important
period in terms of initiation of substance use (Forehand & Wierson, 1993). Gender and tobacco use
were also deemed important in the context of vaping. In the ongoing debates over e-cigarettes as
either a potential gateway to smoking or a diversion from smoking, these practices are commonly
interlinked. Moreover, previous studies have found that boys try e-cigarettes more often than girls
do, and adolescents with prior smoking experience more frequently use e-cigarettes compared to
their non-smoking peers (Lundberg, Kvaavik, & Tokle, 2018; Treur, Rozema, Mathijssen, van Oers, &
Vink, 2018). In addition to smoking, snus (moist smokeless tobacco) is available on the Norwegian
market, and also currently the most popular nicotine product among Norwegian adolescents (ESPAD,

48
2020), which made inclusion of variables on use of snus particularly relevant when investigating
vaping with and without nicotine in the Norwegian context.

To see if there are certain personal traits associated with adolescents who use e-cigarettes in the
sample, the two variables, sensation seeking and depression, associated with the psychobiological
approach, were selected. Sensation seeking is a trait that has been linked repeatedly to youth risk
behavior, including cigarette smoking (Vallone, Allen, Clayton, & Xiao, 2007). A qualitative study has
also found that adolescents report personal vaping in order to show opposition, which suggests that
the use of e-cigarettes can serve as a marker of risk or transgression (Yule & Tinson, 2017). In some
ways, this motive bears a resemblance to the sensation seeking trait, which is “expressed in the
generalized tendency to seek varied, novel, complex, and intense sensations and experiences and the
willingness to take risks for the sake of such experiences” (Zuckerman, 2010, p. 1). In the
questionnaire, sensation seeking was measured based on the following four statements from the
Brief Sensation Seeking Scale (BSSS-4): “I would like to explore strange places”; “I like to do
frightening things”; “I like new and exciting experiences, even if I have to break the rules”; and “I
prefer friends who are exciting and unpredictable” (Stephenson, Hoyle, Palmgreen, & Slater, 2003).
Thus, because the BSSS-4 was previously found to be useful for identifying youth at risk for smoking
(Vallone et al., 2007), we wanted to investigate whether this trait is also associated with vaping.

Similarly, variables measuring depression were included because smoking is found to be more
widespread among people with depression and mental illnesses (Tjora et al., 2014; Smith et al.,
2020). In addition, it can be of value for targeted prevention to investigate whether persons who
suffer internal problems, such as depression, more frequently use e-cigarettes as well. Depression
outcome was measured with the nine-item depression module from the Patient Health
Questionnaire (PHQ-9) below (Spitzer, Kroenke & Williams, 1999).

49
Patient Health Questionnaire (PHQ-9)

Source: Spitzer, Kroenke & Williams, 1999.

Last but not least, early conduct problems have been identified as an important risk factor for
substance use among young people (Jessor, Donovan, & Costa, 1994; Pedersen & Wichstroem,
1995). Conduct- or behaviour problems are commonly understood as deviating social norms shaped
by the joint role of environmental forces, such as exposure to deviant peers, together with individual
forces such as anti-social behaviour (Jessor et al., 1994, pp. 99-126). Substance use, including
cigarette smoking and drinking alcohol, have previously been interlinked in the broader pattern of
conduct problems among young people (Jessor, 1987). In this case, the aim was to investigate
whether the use of e-cigarettes similarly occurs more frequently among adolescents who report
behavior problems. In the questionnaire, behavior problems were measured based on the following
7 items: destruction of property, lying, fighting, sneaking out of home, stealing, being loud and
belligerent, and bullying others in the past 12 months. Reponses were structured by a four-point
scale ranging from “Never” (coded 0) to “5 or more times” (coded 3).

In sum, the overarching aim for including the above variables was to enhance our knowledge about
adolescents’ use of e-cigarettes with or without nicotine and to investigate user characteristics of
adolescents who try e-cigarettes. For instance, we wanted to look at whether or not traits such as
sensation seeking and depression, or engaging in problem behavior, play a role as additional
explanatory factors for the use of e-cigarettes. The inclusion of the above-mentioned variables,

50
however, does not mean that I deem other variables unimportant, or that I believe the included ones
provide a complete picture of youth vaping and vapers.

Data analysis
The statistical analyses were conducted by the first co-author Geir Scott Brunborg, PhD. As outlined
in article 4, cross-sectional data were used to show the stability of prevalence estimates in the
sample (table 1, paper 4). Chi2 tests and one-way analysis were used to show variance and to assess
group differences associated with vaping in the sample at baseline (T1). The sample was divided into
four main user groups: vaping with nicotine; without nicotine, unaware of nicotine content; and non-
user. These tests were followed by a set of regression models to compare how the different e-
cigarettes status groups differed in use of tobacco products (snus and cigarettes) and individual
characteristics (gender, age, sensation seeking, conduct problems and depression. For continuous
variables (age, sensation-seeking, conduct problems and depression) across e-cigarette use status,
linear predictions (margins) were calculated from four bivariate linear regression models. For
categorical variables (gender, snus use status and smoking status), marginal mean probabilities were
compared from a bivariate logistic regression model, and two bivariate multinomial logistic
regression models, using Bonferroni correction to rule out false discoveries.

Longitudinal individual-level data are used in this context to show individual transitions in vaping
pattern during the observation period. To address individual level patterns of e-cigarette use, the
data analysis was restricted to the total of 2018 of the 2975 adolescent participants who had
completed all three assessments (T1, T2, T3). These transitions were visualized by the second co-
author, Tord Finne Vedøy, PhD, in a Sankey diagram by using the SankeyMATIC tool 38. Cohen’s
kappa was used to assess stability in the distribution of individuals over the four vaping categories.

As also shown in article 4, along with the associated tables and appendix, 957 of the 2975
participants were not available for follow-up. The missing data sample included more males (OR =
1.44, p < 0.001), persons with lower average level of depression (b = -0.55, p = 0.010) and they were
more likely to have tried cigarettes (OR = 1.60, p = 0.004) compared to the remaining sample. In
terms of age, sensation seeking, conduct problems, and snus use, they did not differ from the study
sample.

The missing data can serve as a limitation of the data, although it is difficult to ascertain in what way.
In addition, the sample was not drawn at random and data are not necessarily representative of the
general population of adolescents. The survey data are also based on self-reports, which may lead to
known biases such as selective recall and socially desirable responses, especially among young
participants (Del Boca & Darkes, 2003). In addition, a significant number of adolescents did not

51
participate in the study because they did not return their parental consent forms. This also entailed
that no information on them was obtained to inform as to how their non-participation may have
affected the outcome. The importance of informed consent is further outlined in the next section.

Ethical considerations for longitudinal studies with adolescents

Sources 2 and 3, as part of the MyLife-project, received the approval of the Norwegian Data
Protection Authority (DPA) (reference no.: 15/01495), after ethical evaluation by The National
Committee for Research Ethics in the Social Sciences and the Humanities (reference no.: 2016/137).
A general procedure was followed for both the quantitative and qualitative study to ensure that
informed consent and participation was voluntary (NESH, 2016). Because of the respondents’ young
age (12-13) at study onset, and the follow-ups during middle school, informed parental consent was
necessary before the adolescents could be asked to participate. The schools were given information
packages containing a printed booklet describing the project in plain language, explicit consent form
and a secure return envelope. Teachers at the various schools assisted by sharing information and
handling consent forms. Student were asked to return completed consent forms in sealed envelopes
to their teachers by a set date. Those with parental consent were then asked to consent to own
participation immediately preceding the data collection (Brunborg et al., 2019). Participants 16 years
of age and older were free to give their consent without informing their parents.

In terms of guaranteeing confidentiality for participants in the quantitative study, this was ensured
by assigning them numbers. For the adolescents participating in the qualitative interviews, the
persons transcribing anonymized the names pf students, schools and locations as the recordings
were transcribed. Recordings were also deleted after being transcribed. Moreover, information that
could be sensitive and identifiable were also consequently left out of transcripts. The sizeable sample
and longitudinal design of both studies, however, require that we maintain some vital information in
order to contact participants again after finishing middle school and to link and compare individual
data from time to time. These documents are safely stored at The Service for Sensitive Data (TSD)
platform, in compliance with the Norwegian regulation regarding individual’s privacy (TSD, 2016).
The anonymized transcripts and fieldnotes are also only available to a small number of researchers
involved in the MyLife-study.

52
A pragmatic rationale for use of multiple methods
As described, I have employed three different data collection methods in this thesis. Johnson,
Onwuegbuzie, and Turner (2007) offer the following definition of mixed methods research as the
type of research that “combines elements of qualitative and quantitative research approaches (e.g.
qualitative and quantitative viewpoints and data collection) for the purpose of breadth and depth of
understanding and corroboration” (p. 123). In the associated literature, the most common rationale
for applying multiple-methods or mixed-methods approaches is a pragmatic one based on the
questions that researchers seek to answer (Tashakkori & Teddlie, 2010; Tashakkori et al., 1998). In
other words, the pragmatic justification for multiple-methods research can simply rely on an
argument of utility of research means for research ends (Tashakkori & Teddlie, 2010, p. 96). In line
with the above pragmatic orientation, I have employed the outlined sources as tools to investigate
aspects of the vaping culture and social meaning of e-cigarettes. I have used qualitative methods to
address how adult users who have lived through the shifting status of smoking understand vaping,
guided by an aim to provide insights into the larger socio-cultural contexts of individuals (source 1). I
have also used longitudinal qualitative methods to illuminate how adolescents as part of the post-
smoking era perceive the meaning of e-cigarettes, and how these social meanings develop and
progress over time (source 2). Finally, the longitudinal survey data have been used to investigate
characteristics and patterns associated with use of e-cigarettes among adolescents (source 3).

In sum, the results from the integrated sources offer both depth and breadth in the understanding of
the social meaning of e-cigarettes and the development of vaping cultures. The use of multiple
methods within this thesis, however, does not mean that I have integrated the various data sources
within the different articles. To the extent that this may be of value to future research, I will next
offer a short summary of the main findings in the outlined sources.

53
54
 4. Summary of the Research Articles

Chapter four provides a summary of the study findings, and highlights the thread of continuity in the
thesis, which is a broad methodological and theoretical investigation of aspects of the vaping culture
and the meaning of e-cigarette use. These findings occur in four journal articles. Article 1 and 2, offer
insight into how adult users who have lived through the shifting status of smoking understand
vaping. Article 3 and 4 contribute knowledge about how adolescents, as part of an all-time-low
smoking generation, approach and apprehend e-cigarettes. In the following, I highlight each of the
paper’s original contribution to the field. In sum, these findings shed light on how adult vapers and
adolescents currently negotiate and apprehend the social meaning of e-cigarettes in Norway. It also
shows how the current thesis contribute with a multifaceted understanding of the culture of vaping.

Article 1
Tokle, R., & Pedersen, W. (2019). “Cloud chasers” and “substitutes”: e-cigarettes, vaping subcultures
and vaper identities. Sociology of health & illness, 41(5), 917-932.

The focus is in the first article is on vaping cultures and vaper identities. The article is written against
the backdrop of vaping as a new activity, which entails dealing with symbolic meanings and
associated social practices that are still subject to negotiation. Findings are from Source 1 data, the
semi-structured interviews with 30 adult e-cigarette users. In the study, the co-author and I
investigate user motives, vapers’ self-identity and involvement in vaping subcultures. We analyse the
data according to subculture theory and the concepts of identity and stigma. We identify differing
motivations of current e-cigarette users in Norway and find traces of a vaping subculture. In addition,
we identify how vapers, through their differing motivations, hold different positions towards this
subculture.

In order to highlight the variations and the associated dimensions, we constructed two ideal types
that we labelled “cloud chasers” and “substitutes”. Within the cloud chaser group, the social
meaning of e-cigarettes had evolved from a smoking-cessation practice to a more complex lifestyle
product. The vapers who identified with the emerging vaping subculture were generally enthusiastic
and dedicated; they shared accounts of vaping as a pleasurable hobby, were often engaged in
vaping-related activities on social media and had a sense of belonging to the vaping community.
Based on opposition to current vaping policies, many were also politically engaged with a view to
improving vaping regulation regimes. In contrast, within the substitute group, e-cigarettes were
primarily used for smoking cessation in a more pragmatic and defensive manner, typically in order to

55
avoid health risks, to escape the stigma of smoking and to manage nicotine addiction. In this group,
self-identity as a vaper was generally lacking and ambivalence was more often present. The latter
occurred as a “split vision” of health and stigma in their perceptions: On the one hand, they would
emphasize positive aspects such as improved health, successful smoking cessation and the pleasures
of vaping. On the other, they commonly described vaping as an activity intrinsically linked to their
nicotine addiction and as such, symbolically linked to the stigmatized smoker identity they wanted to
escape. This was reflected in their user patterns. For instance, they preferred to hide their vaping and
use discrete e-cigarettes. Interviewees placed within the substitute group also described the
emerging vaping subculture, but in more negative terms. In contrast to the cloud chaser group, this
group generally did not want to be identified with it. Thus, our findings suggest that the existing
vaper subculture has played a positive and significant role for some vapers, but a negative one for
others in terms of affecting their social meaning of vaping. Particularly the aesthetic and
performance part of the subculture seems to have little mainstream appeal. Ultimately, Article 1
adds to the sparse literature on the culture of vaping and extends earlier studies as we unpack
variations within vapers, social meanings of vaping, and we identify a vaping subculture.

Article 2
Tokle, R. (2020). Bottom-up meets top-down: exploring vapers’ accounts of risk in a context of e-
cigarette controversies. Health, Risk & Society, 1-18.

In Article 2, I use the same interview data to further investigate aspects of the “split vision” of
health and stigma associated with vaping identified in Article 1. While the first paper addresses
the differences in the sample, this study focuses on the evident unifying themes within these
interviews. One relevant (and unintended) feature of the sample was that 29 of the 30 adult vapers
were previous smokers. The relationship between vaping and smoking was brought up in all
interviews and negotiated in various ways. In terms of risk perceptions and their view of the public
risk communication and regulation of e-cigarettes, however, I identified a large overlap in their
accounts. I decided to analyse the data according to a theoretical understanding of risk as a
negotiated construct and against the broader context of e-cigarette divergence in society.
Predominantly, three dimensions resonated across the data and user identities: first, they framed
vaping as harm reduction, because the alternative for most of them was combustible cigarettes.
Second, the interviewees commonly perceived health authorities and the Norwegian regulation as
anti-vaping because of the current ban of nicotine in e-cigarettes. Third, and interlinked, they
generally perceived lay expertise on the part of other vapers as more trustworthy than what they
described as the disproportionately negative ‘top down’ risk communication from health authorities

56
and the media. The findings thus reveal that vapers experience a dissonance between their risk
perceptions and the current regulation and more public risk-communication on use of e-cigarettes.
Among these adult vapers, the use of e-cigarettes was compared to the relative risk of smoking and
was thus construed as harm reduction, while the present regulations were seen as preventing access
to a safer alternative to combustible cigarettes. Moreover, in contrast to the vapers’ perception of e-
cigarettes as a positive contribution to their health, they perceived the public risk communication as
anti-vaping with an emphasis on risks and uncertainty. These dimensions that contributed to the
outlined dissonance offer an understanding of the motives, including reactance, frustration and
mistrust, which seem to drive some vapers to engage in self-advocacy, bottom-up movements and
peer assistance. Finally, Article 2 illustrates how the mixed public approaches on e-cigarettes is a
challenge in risk communication on vaping. In creating uncertainty, it can indirectly drive lay people
to seek information from alternative sources, including biased echo chambers rather than health
professionals.

Article 3
Tokle, R. (2020). ‘Vaping and fidget-spinners’: A qualitative, longitudinal study of e-cigarettes in
adolescence. International Journal of Drug Policy, 82, 102791.

The third article explores the vaping phenomenon in the adolescent segment of the population.
International studies have identified increasing use of e-cigarettes among young people. Against this
backdrop, the aim of the study was to gain more knowledge on vaping among Norwegian
adolescents. The study represents the first extensive qualitative, longitudinal study of adolescents’
vaping in a context were e-cigarettes containing nicotine are banned. The article contributes to new
understandings of the evolving meaning of vaping devices and usage among young people.

Based on a total of 50 group interviews and 175 individual interviews with 12–17-year-old
boys and girls over four years, gradual and collective shifts in both vaping practices and the symbolic
meaning of vaping were observed. The longitudinal findings were thematically analysed in the light of
Actor-Network and interaction ritual theory. Three phases became evident: First, the 12–13-year-
olds’ accounts were marked by distance to the vaping phenomenon. Few had tried, although some
were curious about the novel invention, flavours and practice. In the second phase, as the
interviewees had turned 14–15, the distance was replaced by perceptions of vaping as a cool and
established practice. One-third of the sample now reported having used vaping devices themselves;
however, none reported vaping for nicotine. Instead, experimentation with vaping was driven by
peer perceptions of novelty, status, emphasized harmlessness, performance, exposure and
accessibility online. A third phase became evident at T3, where vaping had suddenly lost status and

57
was perceived by the currently 15–16-year-old participants as a childish and marginal activity. At T4
(16–17-year-olds), the collectively negotiated meaning framing vaping as an uncool, out-group
practice was further established. E-cigarettes were compared with the trend-sensitive fidget-spinners
and were associated with either kids or addicted adult smokers. The findings are presented with an
awareness of the transitional social context, the sociability of vaping and the shifting meaning of e-
cigarettes, inspired by the logic of IR and ANT. In summary, the study unpacked a systematic pattern
whereby adolescents account for vaping as a time-limited trend. E-cigarettes, and the use of them,
were devalued from novelty and transgression to childish and uninteresting within the same sample
during a four-year period. While the most novel contribution from Article 3 was that vaping within
the sample represented fashionable experimentation rather than steady user patterns, the study also
raised awareness about use of e-cigarettes without nicotine in this age segment. This dimension of
youth vaping called for additional systematic investigation of the proportion of adolescents using e-
cigarettes with and without nicotine.

Article 4
Tokle, R., Brunborg, G.S. & Vedøy, T. (Revise and resubmit). Adolescents’ use of Nicotine-free and
Nicotine E-cigarettes: A longitudinal study of vaping transitions and vaper characteristics. Submitted
to Nicotine and Tobacco Research Dec. 2020.
Data from the qualitative study presented in Article 3 raised some important questions relating to
the use of nicotine in e-cigarettes among adolescents. The increase in youth vaping, particularly in
the USA, has raised concerns about prolonged nicotine addiction in generations growing up in the
post-smoking era. However, few studies differentiate between the use of e-cigarettes with and
without nicotine, which is an important distinction when examining nicotine addiction. In Article 4,
my co-authors and I, examine proportions, transitions and user characteristics in adolescents’ vaping
with and without nicotine using the Source 3 longitudinal survey data.

We found that while the overall prevalence of vaping was stable throughout the observation period,
with an increase in nicotine vaping and a decrease in nicotine-free vaping, individual vaping patterns,
both with and without nicotine, were transitional and marked by temporality. Furthermore, a large
proportion of adolescent vapers used e-cigarettes without nicotine: Of the 15.6% of the participants
who reported ever use of e-cigarettes at baseline (T1), 9.9% reported using without nicotine, with
3.2% reporting use with nicotine, and 2.5% to be unaware of nicotine content. In terms of the
mentioned temporality: Within the group of nicotine vapers, 74.4% had quit vaping at T3. Within
nicotine-free vapers, 69% had quit vaping, while 17% had become nicotine vapers at T3. Hence, in
our paper, we also find that the majority of nicotine vapers became abstainers during the period.

58
In terms of characteristics we identified that compared to non-vapers, lifetime vapers – regardless of
nicotine use – were more often males and were noted to have higher scores on sensation seeking,
conduct problems and depression. When compared to non-nicotine vapers, nicotine vapers were
more likely to use other tobacco products and had higher scores on sensation seeking, conduct
problems and depression. Our findings show that while the majority of nicotine vapers also turn into
non-users, these adolescents are still characterized by having more conduct problems, poorer mental
health and more frequently use other tobacco products.

These findings show that that use of e-cigarettes seems to represent experimentation rather than
steady user patterns in the sample. However, they also identify a difference between what can be
interpreted as childish, light-transgressive and temporal use of e-cigarettes without nicotine, and the
more problematic use of e-cigarettes with nicotine among adolescents, who seem to be more
sensation seeking and to have more internalizing and externalizing problems to begin with.

59
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 5. Concluding Remarks

In my dissertation, I have offered a contribution to the growing body of social science literature on
vaping behaviour. Applying a twofold focus on adults and adolescents, I have provided new empirical
knowledge on vaping experiences and practices in Norway. The overarching research question has
been how can we understand the culture of vaping and social meaning of e-cigarettes? Against the
previous chapters and the four articles, the simplified answer is that we can understand the culture
as fragmented, through the co-existence of a youth vaping culture, the visible vaping subculture and
the more mainstream, pragmatic switcher culture. The exact social meaning and function of e-
cigarettes will be determined by the subgroup of vapers we study. Experiences, motives, status and
perceptions vary both within groups of adult vapers and between adults and adolescents. These
distinctions are important: Former smokers’ who currently vape emphasize the health benefit by
switching. Adolescents instead describe vaping as a hype and seem to use e-cigarettes for
experimentation, out of curiosity and as means by which to express status or opposition. This implies
a need for nuanced understandings of the use of e-cigarettes, with room for parallel narratives.

In this concluding chapter, I discuss some plausible explanations for the cultural variation in vaping
practices and their associated social meanings. Moreover, I reflect upon implications from my
observations and offer some recommendations for future research.

Previous smokers versus a non-smoking generation

The consumer commitment to e-cigarettes represents something new and previously not seen in the
tobacco landscape (Bell & Keane, 2012). In the thesis, I have made use of the cultural approach of
meaning making and the subculture perspective to show this dimension, as well as to show that it is
not unanimous (Gelder, 2005; Spillman, 2002). Identification, known as the basic mechanism by
which to understand oneself in relation to others (Jenkins, 2014 p.14), is key for socialization into a
group or a subculture and subsequent contributions to it (Fine and Kleinmain, 1979).

The vaper subculture in this context is a term referring to a distinct set of features such as visible
enthusiasm, feelings of community, vaping practices with hobby dimensions – but also reactance,
frustration and opposition towards what some vapers have deemed the more anti-vaping
establishment. I argue that, depending on affiliation, the subculture can serve as both a driver and a
barrier to vaping (Article 1, 2). This was evident in the way some adult vapers embraced the
subcultural dimensions, such as the advanced practices, the community feeling, and displayed their
“subcultural savvy” through extensive knowledge and field-specific argot (Thornton, 1995). While
others in contrast, perceived the associated aesthetic as masculine, tacky, and subsequently

61
expressed fear that their vaping might make others associate them with it. Their lack of subcultural
identification also tended to intersect with a preference for discrete use and products (Article 1).

In the interview data from adolescents, identification with e-cigarettes was a similarly important
theme, but in relation to peers in this age segment. Experimenting with e-cigarettes occurred as a
small part of a larger identity project. For a limited period, e-cigarettes carried the status of a valued
symbol of membership at the centre of the adolescents’ social attention (Collins, 2004). In early
adolescence, for a young person to have tried the then cool and novel invention could be one way to
express their “in the know” to peers (Thornton, 1995). In later adolescence, when e-cigarettes had
been subject to a symbolic turnaround and labelled childish and untrendy, continuous vaping
expressed the opposite. The process of devaluation serves to show how e-cigarettes lost their ritual
value in parallel with their novel appeal (Collins, 2004). E-cigarettes were relegated to “the others”,
typically the younger adolescents or addicted smokers that aligns with Goffman’s understanding of
(discrediting) behaviour or attributes as essentially reflexive and socially constructed (2009).
Moreover, it illuminates e-cigarettes position as independent consumer products relative to
cigarettes in this age segment. Adolescents not only compared them to trend-sensitive gadgets and
fresh toys (fidget spinners, yo-yos, new mobile phone); they also treated them as such by discarding
them when the hype passed (Article 3). These findings indicate that aesthetic and novel features can
be strong factors making e-cigarettes more acceptable and appealing to young people regardless of
their smoking status (Lee, Lin, Seo, & Lohrmann, 2017).

The link to smoking – or lack of it, in the case of the adolescents – thus seems to affect meanings,
user practices and motives. The connection between e-cigarettes and smoking was rarely present in
the adolescents’ accounts and few reported personal smoking experience (Article 3). This mirrors the
situational frame of growing up in a post-smoking era (ESPAD, 2020). However, the way vaping was
described as means for light transgression in early adolescence bears resemblance to meanings
previously identified with youth smoking (see for instance, Scheffels 2009; Willis, 1977). Yet, the
adolescents themselves seemed unaware of the association between these two practices (Article 3).
In the adult sample, in contrast, vaping was inevitably interlinked with smoking. All but one turned
out to be former smokers (Article 1, 2). This was made evident through a comparison of similarities
and differences between the e-cigarettes/cigarettes and smoking/vaping. For example, my use of the
term ‘e-cigarette’ was frequently contested during interviews because of its connotation to
cigarettes. To distance themselves from cigarettes and smoking, interviewees preferred labels such
as vaporizer, vape-pen or a mod. Often paired with the repeated mantra: “This is not smoking, its
vaping”. Simultaneously and in ways contradictory, harm reduction and replacing smoking were
important motives for many. In the latter accounts, the similarities between these practices were

62
underlined, the strong point being that vaping enabled them to continue the ritual of inhaling
nicotine, exhaling vapour and having a device to fumble with.

Emphasis on differences between smoking and vaping, as witnessed in the group of adult vapers, can
be interpreted as boundary work driven by previous experiences of stigma (Copes, Hochstetler, &
Williams, 2008). Vaping seems to offer the former smokers not only nicotine and pleasure, but also
alternative identities, which at least some described as more culturally and socially acceptable
(Farrimond, 2017; Notley & Colllins, 2018). Despite e-cigarettes being the focal point during the
interviews with adult vapers, the “deeply discrediting” stigma attached to smoking (Goffman, 2009,
p. 3), was frequently brought up. Experiences of the shifting status of smoking occurred integrated in
the adults’ repertoires of available meanings. Moreover, their portrayal of being a smoker in current
society echoed studies that place smoking in the socioeconomic margins of society (Graham, 2012).
Although some vapers in the more pragmatic substitute user group described transferring the stigma
associated with smoking onto vaping, viewing e-cigarettes as a stigmatized symbol of their nicotine
addiction. The subcultural participants, on the contrary, emphasized the independent features of
vaping and stood forward as proud vapers.

The subcultural participants’ rejection of stigma and framing of vaping as a phenomenon that is
misunderstood by ‘mainstream society’, echoes classical subcultural motives (Hall & Jefferson, 1993;
Willis, 1977). Willis write, “A pool of styles, meanings and possibilities are continuously reproduced
and always available for those who turn in some way from the formalised and official accounts of
their position” (Willis [1977] in Gelder 2005 p. 113). Willis’ (1977) portrayal of oppositional working-
class boys can be transferred to a contemporary analysis of vaping subculture as it show how
resistance can be expressed by refusing to adopt to the norms and values appreciated by mainstream
society. Thus, experiences of stigma associated with conventional smoking may explain some of the
rejection, reactance and tension evident in the accounts of participants in vaping subcultures.

Split-risk approaches: a factor stimulating polarization?

Another contributing factor highlighted in this dissertation is understandings of the split-risk
approach on the use of e-cigarettes between positive health effect vs stigma/harms. The complexity
identified in vapers’ social identities, where vaping is embraced or rejected by some while others are
indifferent to it (Farrimond, 2017), can be seen as mirroring e-cigarettes’ position within the general
field of nicotine and tobacco science. In research, the polarization occurs when there is either a one-
sided focus on e-cigarettes’ potential to reduce morbidity and mortality in smokers unable or
unwilling to quit; or the potential for e-cigarettes to addict a new generation to nicotine (Carroll et
al., 2021). In the public, the experience of a mixed scientific approach can result in confusion (Carrol

63
et al., 2021; Niaura, 2018). In vapers, divergent risk understandings seem to be a stimulating factor
for vapers self-advocacy and involvement in vaping communities.

Split-risk approaches was a theme addressed by many of the adult vapers, were the divergence occur
as factors stimulating polarization. Particularly, the scientific concern over use by non-smokers and
adolescents was often simplistically deemed ‘anti-vaping’. In this group, vaping represented several
things, but above all harm reduction (Article 2). Refusal to accept the narrative of e-cigarettes as a
health risk can be directly related to their proclaimed fear of the potential regulatory outcomes from
a focus on e-cigarettes as a threat to public health (Article 1, 2). Several of these vapers shed light on
peer assistance in online vaper platforms and the preference for user experiences over scientific
knowledge. Some, for instance, described vaper forums as the place to go for answers to e-cigarette
related questions. Others said that they felt obliged to help current smokers by publishing vapers’
stories of improved health on vaper forums and to counter negative arguments (Article2). The
findings show that internet has been vital to the vaper community by virtue of its ability to provide
vapers easy access to networks of fellow vapers on global platforms, and echo studies of self-
advocacy carried out in other countries (Annechino & Antin, 2016; Farrimond, 2016; Hagan &
Donovan, 2013). Importantly, such community forums can further reinforce the polarization by
occurring as echo chambers promoting and supporting certain views, which are bolstered when
others repeat the same views.

For adolescents who are part of the nearly non-smoking generation (ESPAD, 2020), vaping has been
subject to discredit for potential subsequent nicotine addiction, or for being a potential gateway to
smoking (Chatterjee et al., 2016; Kinnunen et al., 2020). However, the adolescents in the current
sample – despite being the social group at the core of much of the expressed concern, appeared to
remain largely indifferent to the current regulation and unaware of the divergent positions on e-
cigarettes (Carrol et al., 2021). This also reflects how vaping at the time of the study had a marginal
appeal within the Norwegian youth culture. They typically described experimenting with e-cigarettes
as ‘tricks and fun’ and using simple second-generation devices containing exotic, sweet flavours, but
rarely nicotine.

The study thus shed light on a previously overlooked phenomenon concerning the use of e-cigarettes
among adolescents, by identifying a segment of non-nicotine users among young vapers (Article 3,
4). This might provide a nuance to current understandings of youth vaping as related with
subsequent nicotine addiction. Moreover, few adolescents in this study engage in stable vaping
patterns. The absence of products containing nicotine – and hence subsequent addiction – might
explain the instability in the user pattern. The fact that a majority of the adolescents who reported

64
vaping with nicotine also stopped using e-cigarettes during the observation period, can however be
an indication that other factors, such as peer-negotiated social meanings can be of importance
(Article 3, 4). The survey data also show that adolescents’ use of e-cigarettes was associated with
more frequent use of other tobacco products. Moreover, they shed light on how those who had tried
vaping differed from never-users in terms of personal traits. These adolescents scored higher on
sensation seeking and reported more internal and external problems. This might imply that e-
cigarettes can be particularly appealing to “high-risk” youth with a disposition for risk-taking
behaviour (e.g., impulsive personality, novelty-seeking tendency) in general, who also are susceptible
to smoking initiation (Kozlowski & Warner, 2017; Vallone et al., 2007). It is however important to
bear in mind the legal ban on e-liquids containing nicotine in Norway at the time of the study. The
current regulation has likely limited the adolescents’ access and exposure to for instance pod devices
delivering nicotine which are found to appeal to young people in the USA (Huang et al., 2019).
Nicotine use and vaping trajectories among Norwegian adolescents would perhaps have played out
differently in a situation with better access. In addition, the Norwegian context is different from most
other countries (except Sweden) in that snus is widely available and popular in this age segment
(ESPAD, 2020).

Implications and Directions for Future Research

The identified variety marking the cultures and meaning of vaping, and the importance of factors
such as age, peer influence, former smoker status and personal dispositions, are suitable to inform
current understandings. The outlined findings above all suggest awareness of the variations in vaping
approaches among adult vapers – as illustrated through the constructed cloud chaser and substitute
identities – and between former smokers and adolescents. The understanding of the nuanced
differences in the social meaning of e-cigarettes in various user groups may have implications for
future research designs, for instance in how to adjust the study according to specific groups. Insight
in various practices associated with different social groups can also inform more targeted
intervention strategies in the field of tobacco control. Despite the decrease in smoking prevalence,
smoking remains a significant health issue, particularly among older people with low socio-economic
status (Grøtvedt et al., 2017; Lund, 2016).

The current findings may also contribute to inform future e-cigarette-related communication and
policy. For risk information to be accepted, the target group must trust the credibility of the
messenger, and credibility can be achieved through insight (Mayer, Davis, & Schoorman, 1995). The
current findings suggest that adjusted communication could be of value to accommodate specific
groups, rather than a single-track approach towards all users of e-cigarettes. This may mean, for
example, that smokers should be made aware of the relative risk between smoking and vaping, while

65
adolescents should be informed of the risk of vaping based on comparison with non-use. Moreover,
based on the EVALI-experience, adolescents should perhaps also be subject to targeted information
about the risk from purchasing THC-oils for vaping of the black market (Hall, Gartner & Bonevski,
2020).

Essentially, these findings – the range in meanings, vaper identities, user motives, practices and user
patterns – are rooted in a specific social context, at a specific time and within specific groups. To be
exact, the current PhD study is situated and carried out in Norway. During this period (2014-2019),
the vaping prevalence, both among adults and adolescents has remained relatively low. This may be
related to the current ban on nicotine e-cigarettes in domestic shops, but also to the availability and
widespread use of snus in Norway. Like e-cigarettes, snus can provide a safer alternative for nicotine
intake compared to combustible cigarettes (Lund & Vedoy, 2019). And in contrast to e-cigarettes,
snus is a more discrete, standardized nicotine product, currently popular and well established in the
market (Lund & Vedoy, 2019). Additional studies investigating the culture of vaping and social
meaning within social groups situated in different contexts, is vital to further inform the issues at
hand. Several interesting and important dimensions related to e-cigarettes also extended the scope
and the associated data of this thesis. The novelty and the unsettled nature of the phenomenon in
focus, together with forthcoming regulatory changes in Norway, make it reasonable to anticipate
further changes. Continuous investigation and monitoring of e-cigarette use within various groups in
Norway is therefore also vital. Below, I outline some proposals for future research based on
acknowledgement of certain shortcomings of the present thesis and some of the current research
gaps in Norway.

x Gender

Use of e-cigarettes from a gender perspective could provide additional insight. Despite having
attempted to balance gender representation in the samples, the issue of gender has not been given
focused attention in this thesis. The findings imply that gender differences occur within the vaping
phenomenon. More boys than girls report use of e-cigarettes (Article 4). Some rejected the vaping
subculture as stereotypically masculine (Article 1). Future research could consider more focused
questions on gender in interviews or include separate gender analyses to increase insight into
pertinent differences in use, patterns and perceptions.

66
 x Vaping for THC or other substances

Vaping behaviour involves smoking cessation, vaping for tricks and flavours alone, but can also serve
as means to inhale THC-oil (Barrington-Trimis & Leventhal, 2018; Hall et al., 2020; Hardcastle et al.,
2014; Knapp et al., 2019; Measham et al., 2016; Pepper, Farrelly, & Watson, 2018; Pepper et al.,
2017). There is a need to further investigate alternative vaping behaviour and motives including
vaping to consume cannabis and other drugs. Assuming the phenomenon has low prevalence, this
may require targeted samples.

x Vaping for smoking cessation among current smokers

There is a large degree of consensus about the health advantages for smokers who switch to e-
cigarettes (Gilreath et al., 2016); however, we lack individual data that investigate such transitions
over time in Norway. Longitudinal studies, both quantitative and qualitative, could be of value to
enhance insight into cessation trajectories and evolving experiences and meaning-making processes
among smokers switching to e-cigarettes.

x Use of e-cigarettes among adolescents and adults in Norway after TPD implementation

The expected implementation of TPD in Norway will lift the current ban on nicotine and subsequently
make internationally popular nicotine pods such as the JUUL accessible on the domestic marked. This
should make it a priority to provide knowledge about how the altered legislation impact smokers,
vapers and current non-users in terms of prevalence, practices and social meanings of e-cigarettes
should.

Conclusion
In taking a cultural and sociological approach, and by using a range of theoretical perspectives
(Collins, 2014; Gelder, 2005; Latour, 2005; Lupton, 1999; Spillman, 2002), this thesis provides support
for undertaking a multiple-lens approach when investigating novel phenomena in order to illuminate
a broader spectrum of dimensions. It also highlights the importance of avoiding conformist
understandings of the meaning of e-cigarettes and acknowledging intra-vaper and intra-cultural
differences in empirical studies on usage. By studying adults with lived experience and a broader
adolescent sample over time, and from various angles, this study adds nuances to the current
understanding of e-cigarette use. In particular, I reveal the importance of variables such as age,
previous smoker status and social context in terms of meaning making processes and vaping
practices. For adults, vaping implies harm reduction, but also additional and more advanced vaper
practices. For adolescents, vaping can involve both seemingly innocent consumer practices marked
by temporality and be associated with other internal and external problems. In sum, the outcome is
the coexistence of several and sometimes-contradictory social meanings of e-cigarettes. Currently

67
they represent both harm reduction and risk; are interlinked with cigarettes and independent
consumer products; used regularly or for experimentation, with, and without nicotine. Insight into
these co-occurring meanings – both within and between various vaper cultures – can contribute to
inform future research and prevention policies.

68
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I
Sociology of Health & Illness Vol. 41 No. 5 2019 ISSN 0141-9889, pp. 917–932
doi: 10.1111/1467-9566.12854

“Cloud chasers” and “substitutes”: e-cigarettes, vaping

subcultures and vaper identities
Rikke Tokle1 and Willy Pedersen2
1
Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo,
Norway
2
Department of Sociology and Human Geography, University of Oslo, Oslo, Norway

Abstract The use of e-cigarettes is increasing, a practice denoted as vaping. We explore

user motives, self-identity as vapers and involvement in vaping subcultures,
drawing on sociological theory of stigma, subcultures and symbolic boundaries.
Based on analyses of semi-structured interviews with 30 Norwegian vapers, we
find that there is a vaping subculture in Norway. We identify two dominant vaper
identities. The first is labelled cloud chasers. These were dedicated vapers who
identified with symbols and values in the subculture. Many were politically
engaged in improving vaping regulation regimes and felt a sense of belonging to a
vaping community. The second group is labelled substitutes. These were former
daily smokers who used e-cigarettes for smoking cessation in a more pragmatic
and defensive manner, to avoid health risks, to escape the stigma of smoking and
to manage nicotine addiction. In this group, self-identity as a vaper was generally
lacking. Vaping was often symbolically linked to the stigmatised smoker identity
they wanted to escape, and was restricted to private contexts. The perceived
symbolic meaning of e-cigarettes varies: for some, they are a symbol of pleasure
and community. For others, they connote the stigmatised status of the addicted
smoker seeking an alternative to cigarettes.

Keywords: e-cigarettes, identity, smoking, subculture, symbolic boundaries, vaping

Introduction

E-cigarettes are handheld electronic devices that vaporise a flavoured liquid, which the
users inhale (WHO 2014). E-cigarettes were initially developed as a less health-damaging
practice to cope with nicotine addiction (Hajek et al. 2014). However, vaping soon moved
beyond a cessation-only practice (Weier 2018), and started to serve social, recreational and
sensory expectancies (Pokhrel et al. 2015) and to provide new rituals and social practices
(Keane et al. 2017). The e-cigarettes market has at the same time evolved from early
brands highlighting advantages over traditional cigarettes to present products with multiple
flavours and product versatility (Zhu et al. 2014). E-cigarettes come in a range of models,
along with a wide variety of e-liquids and levels of nicotine (Goniewicz et al. 2014, Soule
et al. 2016).

© 2019 Foundation for the Sociology of Health & Illness

Published by John Wiley & Sons Ltd., 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA
918 Rikke Tokle and Willy Pedersen

Smoking, vaping and subcultures

As cigarette smoking has moved to the socioeconomic margins of society, its stigma has
increased (Graham 2012). In Norway and many other countries, there has been a dramatic
decline in smoking over recent decades. Simultaneously, a policy of denormalisation of smok-
ing has been favoured by health authorities, redefining tobacco use as socially unacceptable
(Peretti-Watel et al. 2014, Saebo 2016). Current smoker identities reflect such redefinitions
(Bell et al. 2010). In Scheffels’ (2009) study of young Norwegian smokers, discourses of
smoking as stigmatised and immoral dominated, despite some stories reflecting classical posi-
tive meanings of smoking as a symbol of freedom. Evans-Polce et al. (2015) identified the
process from external stigmatisation to self-stigma with consequences such as guilt, loss of
self-esteem and defensiveness. Smoker-related stigmatisation has also been driven by possible
health consequences of second-hand smoke and company policies against hiring smokers (Stu-
ber, Galea, & Link, 2008). Patients with diseases such as lung cancer may feel particularly
stigmatised as the diagnosis is so strongly linked to smoking (Chapple et al. 2004).
E-cigarettes are marketed as less harmful alternatives to smoking (Farsalinos and Polosa
2014). However, Lucherini et al. (2017), drawing on a sample of young adult Scottish smok-
ers with disadvantaged backgrounds, observed a more complex picture. First, vaping was per-
ceived as more addictive and less controllable than smoking, due to the lack of ending point
and the possibility of vaping indoors. Second, vaping could not replace the social and cultural
importance smoking had in these participants’ lives. Thirlway’s (2016) ethnographic research
in a working class area in the UK revealed how different e-cigarette practices had developed:
older men constructed e-cigarette use as functional rather than pleasurable, drawing on a narra-
tive of family responsibility. Younger men more often constructed e-cigarettes as a legitimate
alternative to smoking cessation that could otherwise conflict with their masculine ethic of
working class hedonism (Thirlway 2016). Hoek et al. (2017) found some of their participants
replicating the smoking rituals, valuing ‘cigalikes’ for the similarity. Others missed attributes
connected with conventional smoking such as combustion and the dense smoke. Others again
developed new and unique vaping rituals. Farrimond (2017) also identified differing motiva-
tions for use of, and varying political engagement in, vaping regimes among UK vapers. She
constructed three main typologies: vaping for pleasure, vaping as medical treatment and
ambivalent e-cigarette use, suggesting that the motives of vaping may be linked to different
social identities. Some studies have pointed to the importance of online forums, blogs,
YouTube videos (Luo et al. 2014) and Facebook groups in this process (Dai and Hao 2017,
Pepper et al. 2017). These findings suggest that vapers as a group are diverse. One may
hypothesise that parts of the vaper culture, such as those who develop rituals for vaping (Hoek
et al. 2017) and those who vape for pleasure (Farrimond 2017), may have characteristics
typically associated with visible and often self-confident subcultures.
A traditional perspective of subcultures is presented by Ken Gelder (2005: 4), defining them
as groups of people that are “non-normative and/or marginal through their particular interests
and practices”. Groups may represent themselves in this manner, but may also be classified in
this manner by others. Such a perspective, focusing on atypical and sometimes deviant groups,
was typical in both the Chicago school (Colosi 2010) and the Birmingham school, where these
groups were often regarded as cultural responses to socially marginalised positions (Griffin
2011, Rojek and Turner 2000). However, such perspectives have been criticised, as many may
simultaneously participate in several subcultures. Moreover, such research may have over-
looked the more ordinary everyday lives of larger groups who are influenced by such subcul-
tures (Bennett and Kahn-Harris 2004). Fine and Kleinman (1979) earlier offered a less rigid
understanding, conceptualising subcultures as culturally bounded networks of people who
share ideas, material objects, and practices. Following them, subcultures can be interpreted as
© 2019 Foundation for the Sociology of Health & Illness
 Cloud chasers and substitutes 919

clusters of cultural elements and forms of distinctions that do not necessarily dominate peo-
ple’s lives. Thus, they may engage in subcultural practices without identifying as subcultural
participants (Thornton 1997).
Vaping is a new activity and its symbolic meanings and associated social practices are con-
stantly being negotiated (Lucherini et al. 2018). In this process, subtle distinctions or symbolic
boundaries may be important, as they function to establish personal and collective identities
(Williams and Copes 2005). According to Lamont and Molnar (2002: 168), symbolic bound-
aries reflect the struggle over definitions of reality. Drawing symbolic boundaries, we can dis-
tinguish “us” from “them”, and separate people into groups that feel similarity, unity and
group membership. In this respect, the use of symbolic boundaries also offers people who
engage in a certain behaviour the ability to distance themselves from those defined as stigma-
tised. Similar sociocultural processes have been observed with, for example, occasional smok-
ers: In Scheffels and Tokle’s (2017: 373) study, this group anticipated identities as “someone
who smoke, but is not a smoker”. Similarly Hoek et al. (2012), revealed how social smokers
simultaneously devaluated smoking, framed themselves as ‘better’ than smokers and yet con-
tinued to smoke to maintain membership of a social network. Generally, such developments
illustrate the importance of shared narratives, symbols and rituals for substance use. Heavy
alcohol use has, for example, been found to symbolise the embodiment of hegemonic mas-
culinities (Peralta 2007), while cannabis has been linked to political opposition, androgyny and
subcultural identification (Sandberg 2013). The data we present in this study show how indi-
viduals sharing the same activity – vaping – may, in a similar vein, create and negotiate such
subcultural boundaries.

Methods

The Norwegian context

It is estimated that one per cent of the Norwegian population are daily vapers, while 2.5 per
cent vape occasionally (Vedøy 2016). The health authorities have been reluctant to view e-
cigarettes as an adequate tool in a harm-reduction-oriented tobacco policy (Lund 2016). At the
time of the data collection, Norway permitted the sale of devices but banned the sale of nico-
tine e-liquid, resulting in 80 per cent of the e-liquid and 60 per cent of the vaporisers being
purchased from foreign retailers online or abroad (Vedøy and Lund 2017). However, these
products are to be given market access from 2019. Snus and conventional cigarettes are the
most frequently used nicotine products, with a prevalence of 12 per cent for daily use of snus
and 11 per cent for daily smoking (SSB 2018).

Sample and procedure

Thirty semi-structured interviews with vapers were conducted by the first author in Oslo, Nor-
way between February 2014 and April 2018. The sample consists of 17 males and 13 females,
age range 19–52 (mean age 35) (See appendix table A1. for more details on participant charac-
teristics). They represent a heterogeneous group in terms of socioeconomic status, ranging
from senior positions in academia and the private sector to unemployed on welfare support.
All but one were former smokers. As an inductive, explorative study of the use of e-cigarettes,
sampling and analysis followed the structure of grounded theory (Denzin and Lincoln 2008).
In the early stages of the purposive recruitment, we observed a variety of users. Some seemed
to be proud “public” vapers; others were more reserved and reluctant. To address this hypothe-
sised diversity, we conducted theoretically based sampling from various locations in order to
highlight gaps and uncertainties in the existing data and explore different perspectives
© 2019 Foundation for the Sociology of Health & Illness
920 Rikke Tokle and Willy Pedersen

(Creswell 2007: 240–1). The first author attended vape meetings and visited vape shops in
Oslo to recruit established vapers. Festivals and venues in the nightlife economy were visited
in order to investigate use among young adults and the capital’s frontrunners. Some were
recruited through a post on the Facebook wall for vapers. In order to reach the “less visible”
vapers, half the sample was recruited using a chain-referral strategy and extended personal net-
works. Interviews were informal, even if an interview guide was used to cover key themes.
We talked about perceived stigma related to smoking and the use of e-cigarettes, nicotine
addiction, trajectories of vaping, perceptions of groups of vapers, experiences of vaping at
work and at parties, and online forums and chat groups. Each interview lasted between 1 and
2 hours and was audiotaped.
Participants were paid a NOK 300 fee (approximately GBP 30). The Privacy Protection
Committee at the Norwegian Institute of Public Health gave ethical approval for the study,
and the study was conducted in accordance with their ethical guidelines. All interviewees gave
informed and active consent for participation. To ensure anonymity, names of participants and
all identifying details have been changed.

Analysis
The recordings were transcribed by the first author and two qualified research assistants, and
imported to the qualitative analysis software HyperRESEARCH. In line with grounded theory,
the analysis started immediately, and continued in parallel with data collection (Sbaraini et al.
2011). The HyperRESEARCH software was used as an organisational tool in the coding pro-
cess. First, codes were labelled close to the wording of the vapers themselves (Glaser et al.
1968). Both authors then took part in the development of broader and theoretically motivated
coding categories (Denzin and Lincoln 2008), such as vaping versus smoking, addiction,
health, stigma, community feeling, and vaper identity, drawing on literature on stigma, subcul-
tures and symbolic boundaries. This work led to the construction of our two main categories
“cloud chasers” and “substitutes”.

Findings

First, we present two contrasting perspectives on the vaping subculture, followed by the identi-
fication of the two dominant vaper identities. We then outline the key dimensions of these
vaper identities. Finally, we discuss our findings in relation to theory on subculture and
stigma.

Two perspectives on vaping subculture

Users of e-cigarettes agreed that one can indeed talk about a vaping subculture in Norway, but
they differed in the degree of identification with its symbols and values. Roger (44) and Axel
(29) represented opposite positions in this respect. Roger, a former daily smoker, valued the
vaping subculture and praised e-cigarettes:

Cigarettes and e-cigarettes are like beer and wine. Beer is just that pint, right. With wine,
it’s so much more. You can learn; it’s about quality. You become a connoisseur. That is
how it is with e-cigarettes as well. It’s just so much more than smoking.
For Roger, e-cigarettes were a symbol of high-quality enjoyment. E-cigarettes had given him
pleasure in a more complex and sophisticated manner than ordinary cigarettes. Axel took a
completely different position. He had smoked since he was 13 years old, and had managed to
© 2019 Foundation for the Sociology of Health & Illness
 Cloud chasers and substitutes 921

quit smoking for half a year by switching to e-cigarettes. However, at the time of the inter-
view, he had gone back to “the deadly ones”, sardonically referring to ordinary cigarettes,
smoking a pack a day. Axel’s explanation was that he had taken an “aesthetic evaluation”, in
the same manner as Roger, but with the opposite conclusion:

You become part of a subculture totally involuntarily, one you don’t identify with at all . . .
I was terrified that I would be identified with those people on YouTube if I continued.
Axel described the vaping scene as a “masculine, street-car-aesthetic with bikini-women and
bad music”. He said the use of e-cigarettes unintentionally made him part of this vaping sub-
culture, which he disliked. He used rich metaphors:

I skate, you know. Skaters do not like longboard. It represents something wrong. For me, e-
cigarettes are the longboard, while fags are the skateboard.
In this manner, Axel constructed symbolic boundaries to separate smoking from vaping (Copes
2016, Lamont and Molnar 2002). His metaphors pointed to “the edge” of skateboards, com-
pared to the more “inauthentic” longboards. Skateboards and smoking were seen as “the real
stuff”, echoing how smoking was once perceived as a classical symbol of freedom and indi-
viduality (Scheffels 2009). Vaping, like the longboard, was used to appear cool or to fit in. It
was, however, done in a manner that has been associated with “pretenders” or “wannabees”
(Driver 2011, Fox 1987).
However, the common denominator in these two stories is how both talked about an emerg-
ing vaping subculture, albeit from completely different positions. Both referred to vape forums
on the internet, championships and vape festivals. Both agreed that traditional cigarettes and e-
cigarettes hold different symbolic meanings, describing cigarettes as simple and straightforward
and e-cigarettes as more advanced. However, Roger eagerly outlined the possibilities for cus-
tomisation of e-cigarettes, the range of flavours and the attractive subculture. Axel’s negative
perception of the vaping subculture as “wrong” and unappealing conversely made him quit.
These differing approaches to the vaper subculture were echoed in the rest of our data mate-
rial. Two dominant vaper identities became evident; we labelled them “cloud chasers” and
“substitutes”.

Cloud chasers
In the Urban Dictionary (nineX, 2015), a cloud chaser is defined as: “a person who, using a
personal vaporiser expels large amounts of vapor from their lungs as a spectacle to behold.
“Cloud chasers” display their skills at cloud chasing competitions.” Hence, the term is partly
defined by the practice of vaping, partly by participation in certain public events. Previous
research has linked the term “cloud chasing” to performing demanding “tricks” with vapour
(Measham et al. 2016). Here, we use the term in a wider, more symbolic sense. As such, the
cloud-chaser identity is based on the stories told us by dedicated vapers, those who identified
with a vaping subculture. Of 30 interviewees, 12 shared perceptions connecting them to such a
subculture. In addition to (i) the visibility of the performance of vaping and the vapour
exhaled, we identified and included three other dimensions to the cloud-chaser identity, (ii)
vaping as performance and hobby, (iii) a community dimension and (iv) publicly advocating
the vape cause.

Vaping as performance and hobby

Kenneth (34) was an articulate representative of the cloud chasers and expressed how many
were well aware of the variations in vaper identities:
© 2019 Foundation for the Sociology of Health & Illness
922 Rikke Tokle and Willy Pedersen

There are two groups of vapers: those who have a technical interest, you may call us nerds,
where vaping has turned into a hobby, and who are likely to be members of a range of for-
ums. The other group, I believe, are the typical smokers who want to stay off cigarettes.
They use simpler equipment and are happy with that.
The cloud chasers shared a general notion of e-cigarettes as a health-improving tool to stop
smoking. However, importantly, e-cigarettes also offered social and symbolic functions not
provided by ordinary cigarettes or snus. Some of the younger adult vapers, for example,
described vaping as a tool for gaining attention. Nils (28), a dedicated vaper, described it like
this:

One of the aspects of it [vaping] is that it’s new and exciting and that you don’t really mind
having the role as the person with the new, cool gadget.
Particularly in night-life settings, vaping could create positive feed-back. The novelty aspect of
vaping may change when vaping diffuses. However, in the Norwegian context, public vaping
is still quite rare. Edward (25) described his motives for vaping in a similar manner:

It’s new and exciting; we can be early adopters, that’s a driving force. It makes it more fun.
I vape in a manner that I hope people will notice and ask ‘what do you think you are
doing?’ So I can use the arguments I have prepared: that this is vapour not smoke.
Edward had an oppositional attitude and highlighted the dedicated vapers’ visible, proud use
of vaporisers. Some decades ago, smoking among youth was similarly linked to sociocultural
opposition (Pedersen 1998, Willis 1977). Statements such as those from Edward indicate that
today, in some contexts, e-cigarettes may serve as a similar symbol of opposition. At the same
time, vaping was clearly distinguished from cigarette smoking. These participants consciously
separated the two products; many described vaping as a lifestyle, and used vaporisers with lit-
tle resemblance to ordinary cigarettes.
Embracing the vaping subculture, cloud chasers described vaping as a hobby, with pleasure,
performance and knowledge as important elements. Andre (45) said:

For me it [vaping] has become a hobby. Smoking never was. I want to build my own e-
cigarettes – or personal vaporisers to call them by the right term. It’s all about advanced
equipment to get the best experience possible in terms of taste and clouds.
These vapers often talked about personal customisation of vaporisers, liquids and the “unlim-
ited amounts of flavours” (Barbeau et al. 2013, McQueen et al. 2011). Critics have argued that
sweet flavours such as fruit and candy are designed to encourage vaping in under-age groups
(Bonhomme et al. 2016). In our study, the range of flavours was in fact part of the appeal.
Trying to explain this phenomenon to us as outsiders, they compared vaping to wine connois-
seurs and professional baristas. Such unambiguous descriptions of enjoyment are not typical in
the substance-use discourse (Duff 2008), due to the dominance of the medical model for
accessing health harms, with little room for accounts of pleasure (Moore, 2008).
Many of the cloud-chasers described vaping as a time-consuming hobby. Mikael (19) said:
“[Vaping] is something to tamper with for hours. There are so many models and so much to
get your head around. I use YouTube tutorials to boost my understanding.” Like Mikael, sev-
eral used YouTube tutorials to learn relevant skills, in a manner described as typical of the so-
called “YouTube generation” (Morris and Anderson, 2015). Several described how they per-
formed “sick tricks” with the vapour and ranked this as a key attraction (see also: Measham
et al. 2016: 229). Other used social media platforms to share images, video footage and
© 2019 Foundation for the Sociology of Health & Illness
 Cloud chasers and substitutes 923

tutorials. Some considered cloud chasing to be a sport and referred to competitions with more
or less professional vapers (Mosbergen 2017). The majority of the cloud chasers in our study
also invested much time keeping up-to-date on vaping-related topics. Ola (32) said:

Part of the hobby is to be up-to-date on what’s happening out there, like: “Have you seen
the newest one? Have you read that piece? Have you checked out this?
Martin (41) spent much time on vape-related activities – managing a blog, keeping abreast of
product development, research and regulations. ‘Being in the know’, to use the concept coined
by Thornton (1997), came out as an important part of this hobby. Most cloud chasers had a
high level of knowledge and used numerous vape-related-references. Many used English termi-
nology despite the interviews being conducted in Norwegian, illustrating insider competence.
As observed in other substance-using subcultures (Johnson et al. 2006), they used complex
argot such as “dripping”, “steeping”, “throat hit” for communication within the vaper subcul-
ture. The dynamic use of such argot constitutes a flexible communication system that is also
hidden from mainstream culture.

A community and policy dimension

In addition to “being in the know”, several of these interviewees were politically engaged with
regard to the legislation of e-cigarettes and were often dedicated to the “vaping cause”, reflect-
ing how polarised regulatory responses are in this area (Caponnetto et al. 2015). They told us
how they fought for better regulations and aimed to educate others by spreading vape-related
information on forums, blogs and Facebook. Rita (34) called this activity “measures in the
fight for the vaping cause”. The most active vapers echoed Rita and used the word “cause”
when discussing their involvement. Their opponents in these stories were often the public
health authorities as well as “Big Tobacco”.

The enormous potential e-cigarettes have to save lives is heavily limited by the [Norwegian]
sales restrictions. I will go so far as to say that it’s completely unethical and irresponsible of
the Ministry of Health.
Several cloud chasers expressed frustration with existing regulations on e-cigarettes and the
way health authorities communicated information related to vaping. Interestingly, as they dis-
tinguished between vaping and smoking when describing their motives, their social commit-
ment seemed motivated by their enthusiasm for the product as a health-improving smoking
substitute. Emma (27) stated:

The Norwegian government always says no straight away. It doesn’t matter that e-cigarettes
are a well-functioning alternative to getting cancer. It is only “NO!” It’s difficult to take
them seriously, but we have to try to make them understand for the sake of other smokers.
Many argued that the government should help smokers to switch from conventional cigarettes
to e-cigarettes. In addition, many wanted vaping to be acknowledged in its own right – as a
product for pleasure (McQueen et al. 2011). The strict legislation may have inspired vapers to
unite in a form of shared resistance, reflecting the classical motive of the subculture (Hall and
Jefferson 2006).
These vapers often talked about a fellowship of vapers. In Norway, vapers have formed
their own organisation, Norwegian Vaping Society, with over 13 000 Facebook members. Sev-
eral cloud chasers followed this group. Their political engagement reinforced the dedicated
vapers’ feeling of community. Martin (41) said:
© 2019 Foundation for the Sociology of Health & Illness
924 Rikke Tokle and Willy Pedersen

It is extremely important for us who have taken vaping to the next level to find a culture or
a hobby that unites everyone. People come from different backgrounds – cultures, gender,
race, and they immediately have something in common.
The vaping subculture was described as inclusive, inviting trust, affective friendships and
social networks, echoing earlier research on substance-using subcultures (Foster and Spen-
cer 2013). However, the in-real-life-subculture was described as a small “much above the
average dedicated group” and most claimed that the better part of it was taking place
online. Their stories underlined the importance of online communities and national or
international vaping forums. The dedicated cloud chasers described themselves as a
minority in numbers among users of e-cigarettes, and shared the perception of the major-
ity being former smokers using e-cigarettes to substitute their addiction to conventional
smoking.

The substitutes
The majority of our interviewees could be classified in the constructed vaper identity we have
labelled the substitutes. They were former daily smokers who talked about their vaping in a
pragmatic and sometimes defensive manner. The substitutes often echoed a medical model of
smoking, solidified by the development of medical treatments to quit smoking (Farrimond
et al. 2010). They expressed little or no identification with the subcultural dimension of vap-
ing. They were, however, well aware of the existence of more enthusiastic vapers. As Tone
(49) said: “It is a hobby for some, but I believe the majority just use it to substitute smoking”.
Isak (49), in a similar vein, stated, “I am not interested in building mods. I just want it to
work. It’s just a smoking substitute I use to get nicotine”.
We identified three dimensions of the typical substitute’s identity: (i) e-cigarettes were per-
ceived as a health-improving smoking substitute; (ii) several in this group struggled with
stigma related to smoking; and (iii) they used e-cigarettes to cope with nicotine addiction in an
often smoking-hostile context.

Improving health
The vapers holding the substitutes identity typically had a long history as addicted smokers.
For this group, e-cigarettes were a smoking substitute and they often still struggled with nico-
tine addiction and an identity as smokers. Their stories evolved around ambivalence and prob-
lems related to numerous efforts to quit, reflecting the “ambivalent e-cigarette user” identity
(Farrimond (2017). They reported benefits of e-cigarettes, but strongly rejected a vaper identity
and took no interest in online forums. Laila’s (40) motivation for vaping was a desire to
improve health and at the same time maintain her smoking habit, which was associated with
highly ambiguous feelings:

There are those who want to quit smoking and those who don’t want to quit smoking. I am
in both categories. I wanted to quit smoking because it is so harmful; you can get cancer,
COPD, claudication, you name it. Then there is a part of you that really enjoys it. I like
vaping because of that; that it tastes good and is vapoury – like cigarettes.
For Laila, vaping filled the deeply felt void after cigarettes. She was well aware of the adverse
health consequences of smoking. However, at the same time, smoking held a positive quality
for her, in the same manner as described by Richard Klein (2012) in his exploration of the
sublime appeal of cigarettes. In this manner, Laila emphasised both similarities and differences
between smoking and vaping. Along the same lines, Ingrid (41) said:

© 2019 Foundation for the Sociology of Health & Illness

 Cloud chasers and substitutes 925

E-cigarettes are for people who don’t want to quit smoking, but who should quit. This
[referring to her e-cigarettes] is smoking. Chewing gum is not smoking; using a nicotine
bandage is not smoking. This is the only way you can give up smoking if you don’t want
to quit smoking.
Thus, in an apparent paradox, she said she simultaneously quit smoking and continued to
smoke. All participants in our study preferred e-cigarettes to traditional nicotine replacement
therapy (NRT). Statements such as “I was chewing myself to death on disgusting gums” to
“Champix [a cessation medication] made me suicidal” were common in the stories on how
vaping was superior to NRT products. The success formula was that e-cigarettes combined the
intake of nicotine and the pleasure of smoking. Other cessation methods – abstinence, NRT or
medication-assisted withdrawal – operate under the idea that the user has to give up rituals
and habits linked to smoking (Weier 2018). Isak (49) had used e-cigarettes regularly for three
and half years. He had tried to quit smoking several times, with deep depressions as a result,
reflecting research suggesting that unsuccessful smoking cessation may increase mental health
problems (Capron et al. 2014). He praised the e-cigarettes as they gave him his “much needed
nicotine in a safer manner”. He continued:

I have decided to never stop smoking again. I am addicted to nicotine and I am going to
stay addicted for the rest of my life. I am not putting myself through another 3 months of
depression.
Interestingly, Isak also displayed his smoker identity in that he insisted on calling his use of e-
cigarettes smoking, explaining that vaping meant “healthier smoking” to him.

Avoiding stigma
Another important motive for using e-cigarettes among the substitutes was the strain of feeling
stigmatised as a smoker, reflecting the increasing negative normative climate related to smok-
ing (Saebo 2016). Isak (49) talked about incipient COPD. We asked whether he switched due
to such harmful effects. He replied:

Yes, but equally important was the social stigma. My girlfriend was a doctor and in that
environment, it is so extremely stigmatising to show your addiction; to go out on the bal-
cony to smoke in a dinner party. I really am an old radical and tried not to give a fuck, but
it just became too incriminating.
Carl echoed this motive: “I got concerned by health, but most of all bothered by the stigma”.
Surprisingly, these pragmatic users of e-cigarettes often transferred their perception of stigma
on to their use of e-cigarettes. Marco (42), a former heavy smoker, talked about how he
avoided vaping in public because of the reactions from bystanders:

Many people have given me these weird looks when I’m using one of these (showing his
vaporiser). They are probably wondering what it is, right. And it isn’t particularly cool. I
don’t think vaping is cool.
Marco, like several of the interviewees in the substitutes group, preferred to vape in private,
despite the good sensory feeling he got when using e-cigarettes. For many in this group, e-
cigarettes became a visible symbol of their addiction. Previous research on smokers in cessa-
tion services has reported that a narrative of continued nicotine use is seen as a threat to basic
goals of getting nicotine-free as well as smoke-free (Rooke et al. 2016), and this was also
shown in our data. Noelle (31) explained that she never vaped and preferred to smoke when
© 2019 Foundation for the Sociology of Health & Illness
926 Rikke Tokle and Willy Pedersen

she was at work, explaining that: “ . . . e-cigarettes show them how addicted I really am to
smoking”. Thus, vaping could undergo a symbolic reversal from a health-improving product
to one that displays your addiction. For some of the substitutes, it was impossible to escape
their internalised feelings of smoking-related stigma. Their hypersensitivity to being perceived
as addicted to smoking was transferred to their use of e-cigarettes, resulting in their avoidance
of vaping in public.
Thus, e-cigarettes occupy a complex position between pleasure and smoking cessation, sub-
ject to perceptions partly originating outside the medical/pharmaceutical sphere, resulting in
their controversial status within public health (Stimson et al. 2014). This may also be one of
the reasons for the complex strategies witnessed among the substitutes. They were insecure
about the basic status of e-cigarettes, in much the same manner as observed within the medical
profession itself (Cummins et al. 2016).

Managing addiction
As opposed to the cloud chasers, most substitutes shared a preference for discreet equipment
and vaping in private. A key reason for vaping was that it enabled them to cope with their
occasionally deep nicotine addiction. E-cigarettes were also presented as a solution to public
and personal smoking restrictions (Keane et al. 2017). Carl (34) really enjoyed smoking and
described himself as someone “who would love to smoke all day”. By means of e-cigarettes,
he was able to function throughout the day, despite his craving for nicotine. Carl appreciated
the convenience of vaping, notably that: “e-cigarettes do not burn out, smell or pollute the sur-
roundings”. The fact that e-cigarettes smell less than ordinary cigarettes increases the range of
settings in which they may be used (McKeganey et al. 2018). At the same time, Carl stressed
that, ideally, vaping would be something no one noticed. Camilla (36) agreed:

I want it to be as simple as possible and as similar to smoking as possible. I don’t want to

think about it or have others thinking about it.
The majority of the substitutes preferred neutral second-generation devices over customised
mods, due to their sensitivity to the possible stigma of their nicotine addiction. Some talked
about how they wished the smoke were invisible; they disliked the attention from bystanders
and used strategies to avoid it, such as using their sleeve to hide their e-cigarette and swallow-
ing the vapour to avoid the appearance of smoking. These strategies allowed them to vape in
places where smoking was not an option. In this way, they managed their use of e-cigarettes
in a discreet manner without identifying as vapers. These vapers differ from the proud, plea-
sure-seeking vapers who hold more of a cloud-chaser identity. However, in the same manner
as reported by Farrimond (2017), we also observed a more subtle dimension of “pleasure” in
this group: they felt healthier and reported having improved their life quality due to their use
of e-cigarettes.

Discussion

This study suggests that we are witnessing the contours of a new vaping subculture in Nor-
way. Key characteristics of the vapers centre around two dominant identities, labelled cloud
chasers and substitutes. They differ in their motivations for vaping and hold different positions
towards this subculture. Findings are summarised in Table 1 and extend earlier studies by
identifying how the symbolic meaning of vaping and vaping subcultures are developed and
perceived differently by these two main categories of e-cigarette users.
© 2019 Foundation for the Sociology of Health & Illness
 Cloud chasers and substitutes 927

Table 1 Defining codes for constructing two vaper identities

Cloud chasers’ characteristics Substitutes’ characteristics

Subcultural participants Harm reduction

Holding a vaper identity Vaping primarily as a smoking substitute
Vaping as a hobby Discrete use of e-cigarettes
Part of a vaping community Managing nicotine addiction
Engaged in the “vape cause” Managing stigma
“In the know” on vape-related issues Perceptions of vaping as stigmatised
Flavours Negative perceptions of vaping versus smoking
Product customisation Discreet vaporisers
The pleasure of vaping The pleasure of holding on to a smoking ritual

As shown in Table 1, those holding the cloud-chaser identity are embedded in the vaping
subculture in line with Fine and Kleinman’s (1979) understanding of subcultures as culturally
bounded networks of people who share ideas, material objects and practices. They engage in
vaping-related activities on social media, feel belonging to a vaping community and are
engaged in the “vape cause”. The performance and the policy aspects of the vaping subculture
can often be seen as a reaction towards what they perceive as a repressive health policy and
the lack of a harm-reduction oriented approach. Among these vapers, a devaluated smoker
identity (Evans-Polce et al. 2015, Scheffels 2009) has often been transformed into a proud
vaping identity, which reflects the classical motive of the subculture (see e.g. Hall and Jeffer-
son 2006), expressing resistance and opposition. The policy dimension is marked by a bottom-
up structure with the aim of impacting regulations. This grass-roots movement distinguishes
this group of vapers from other users of e-cigarettes, in a similar manner as has been wit-
nessed in the cannabis policy field (Matthews 2003). Hence, such subcultures may represent
organised responses to powerful institutions that do not value their activities (Willis 1977).
The substitutes perceive the vaping subculture more as a barrier to the use of e-cigarettes.
They neither identify, nor want to be associated, with this subculture. As shown in Table 1,
they have a pragmatic perspective and regard vaping as an efficient harm reduction tool and
vape as a smoking substitute. Through discreet use, they manage nicotine addiction as well as
stigma. Thus, they emphasise improved health, the pleasures of vaping and successful smoking
cessation. At the same time, they are defensive and often ambivalent regarding the symbolic
meaning and their use of e-cigarettes, often drawing symbolic boundaries (Copes 2016) by dis-
tinguishing and distancing their use of e-cigarettes from “performance” vaping and the aes-
thetic of the vaper subculture. Our study yields new evidence of the importance of the ritual
aspects of vaping (Barbeau et al. 2013, Hoek et al. 2017). Several substitutes described the
paradox that e-cigarettes enabled them “to quit smoking without quitting”; letting them con-
tinue with the often-valued practice of “smoking”, albeit in a completely different manner and
with potential for less damage to health (Barbeau et al. 2013). However, among the substi-
tutes, the perceptions of vaping as an activity intrinsically linked to their nicotine addiction
(Hoek et al. 2017) come with a price in terms of transferring stigma. As such, vaping is linked
to the same smoking-related stigma they are trying to escape.
Our study echoes research pointing to the symbolic meaning and identity aspects of other
types of substance use as well, such as cigarettes (Scheffels 2009; Scheffels and Tokle 2017;
Hoek et al. 2012), alcohol (Peralta 2007) and cannabis (Sandberg 2013), in addition to previ-
ous studies investigating e-cigarettes from such a perspective (Barbeau et al. 2013, Farrimond
© 2019 Foundation for the Sociology of Health & Illness
928 Rikke Tokle and Willy Pedersen

2017, Hoek et al. 2017, Measham et al. 2016, Thirlway 2016). New in our study were the
complex perceptions among the users, as some embraced the emerging vaping subculture,
while others avoided it. Thus, the subculture may possibly serve as both an efficient tool and a
barrier for a successful switch from ordinary cigarettes to e-cigarettes.
Moreover, our findings point to how vaping and vaper identities are still linked to and inter-
woven with the symbols and practices of cigarette smoking. As smoking has gradually disap-
peared in high SES groups, remaining smokers are highly stigmatised (Stuber, Galea, & Link,
2008). Previous smokers make up the majority of vapers (Dockrell et al. 2013). This is coher-
ent with the purpose of the invented product: e-cigarettes were designed to substitute smoking
(Hajek et al. 2014). From a diffusion perspective (Rogers 2010), early adopters of new inven-
tions hold top positions in the social hierarchy. However, in the case of vaping, this might not
necessarily be the case, since adult vaper groups largely consist of former smokers. Admit-
tedly, e-cigarette users appear to have higher socioeconomic status than ordinary smokers
(Brown et al. 2014). In our data, the substitutes’ stories reflect processes where the images of
the stigmatised smoker and the stigma of smoking influenced their perception of vapers and
contaminated their use of e-cigarettes.
Academic and media discourses may also have contributed to curbing the adoption of vap-
ing in creating a narrative of uncertainty about the long-term health effects from the use of e-
cigarettes (Pepper et al. 2017, Roditis et al. 2016).
Nonetheless, we also observed resistance to such narratives. Participants in both groups
aggressively pointed to how health authorities had tried to make it harder to use vaping as a
smoking substitute. Hence, more liberal future regulations may affect the symbolic meaning of
vaping, potentially normalise vaping and lower the “switch barrier” for targeted smokers.

Limitations

There are limitations to the study. Firstly, the interviewees are not representative of the wider
population of vapers. This also goes for the relative prevalence of the varieties of vaper identi-
ties. Even though the interviewees are only scattered in two vaper identities, we do not claim
that the relative size of each group is representative of the broader picture. These identities are
typologies based on the common and distinguishing characteristics identified in this study.
Secondly, data were collected over an extended period of time (2014–2018), and this may
raise concerns about datedness, given the high level of innovation and changes characterising
the field of e-cigarettes (Farrimond 2017). However, as the goal in this explorative study was
to capture different user groups and identities, we argue that the design offers the needed vari-
ety to obtain new insights into the symbolic meaning of vaping.

Conclusion

The social meaning of e-cigarettes and vaping varies and involves a vaping subculture, ideas
about health through harm reduction, pleasure and community, as well as addiction and
stigma. The existing vaper subculture has played a significant role for some vapers; however,
the aesthetic and performance part of the subculture in particular may have little appeal for
large groups of other vapers. In conclusion, our findings suggest that there is a “split vision”
of health and stigma in the perceptions of vaping where the vaper identities are constantly
negotiated. We argue that our findings add to the understanding of varying motives for use
and new insights into the possible diffusion process of e-cigarettes.
© 2019 Foundation for the Sociology of Health & Illness
 Cloud chasers and substitutes 929

Address for correspondence: Rikke Tokle, Department of Alcohol, Tobacco and Drugs, Norwe-
gian Institute of Public Health, NIPH, Box 222, Skøyen, Oslo N-0213, Norway.
E-mail: rikke.tokle@fhi.no

Acknowledgements

We thank Karl Erik Lund and Janne Scheffels at the Norwegian institute of public health (NIPH) for
helpful comments, and the two anonymous peer reviewers whose suggestions to earlier drafts consider-
ably helped improve the article. This project has been made possible by the Norwegian ExtraFoundation
for Health and Rehabilitation.

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Appendix

Table A1 Participant characteristics

Pseudonym Age Gender Smoker status* Vaping status** Years vaped Device Vaper identity

Emma 27 F Former DS DV 3 Mod&VP Cloud chaser

Anne 33 F Former OS OV 1.5 Vape pen Substituter
Rita 34 F Former DS DV 3 Mod Cloud chaser
Nils 28 M Former OS DV 2 Mod Cloud chaser
Kenneth 34 M Former DS DV 6 Mod Cloud chaser
Monica 22 F Former DS DV 1 Vape pen Substituter
Edvard 25 M Former DS DV 1 Mod Cloud chaser
Marco 43 M Former DS DV 2 Mod Substituter
Oscar 29 M OS DV 1 Mod Cloud chaser
Andre 45 M Former DS DV 2.5 Mod Cloud chaser
Rolf 25 M Former DS DV 2.5 Mod Cloud chaser
Marte 34 F Former OS OV 2 Vape pen Substituter
Laila 40 F Former DS DV 1 Vape pen Substituter
Kare 51 M Former DS DV 2 Mod Cloud chaser
Ola 32 M Former DS DV 1.5 Vape pen Substituter
Tone 49 F Former DS DV 2 Vape pen Substituter
Axel 29 M DS Former DV 0.5 Mod Substituter
Roger 44 M Former DS DV 2 Mod Cloud chaser
Jack 40 M Former DS DV 3 Mod Substituter
Carl 33 M OS DV 2 Mod Substituter
Philip 30 M OS OV 1.5 Vape pen Substituter
Mikael 19 M NS OV 1 Mod Cloud chaser
Isak 48 M Former DS DV 3.5 Mod Substituter
Karen 52 F Intermittent DV 2.5 Mod Substituter
Ingrid 41 F Former DS DV 2 Mod Substituter
Noelle 27 F Intermittent DV 1 Vape pen Substituter
Camilla 23 F OS OV 0.5 Vape pen Substituter
Fanny 31 M Intermittent OV 1 Mod Substituter
Martin 40 M Former DS DV 3 Mod Cloud chaser
Lotta 43 F Former DS DV 3 Vape pen Substituter

*DS: daily smoker; OS: occasional smoker; NS, never smoker.

**DV: daily vaper; OV: occasional vaper.

© 2019 Foundation for the Sociology of Health & Illness

II
Health, Risk & Society, 2020
Vol. 22, No. 2, 118–135, https://doi.org/10.1080/13698575.2020.1749571

Bottom-up meets top-down: exploring vapers’ accounts of risk in a

context of e-cigarette controversies
Rikke Tokle*

Department of Alcohol, Tobacco & Drugs, Norwegian Institute of Public Health, Skøyen, Norway
(Received 6 May 2019; accepted 27 March 2020)

Framed both as a solution to and as an additional part of the tobacco problem, e-cigarettes
have been the subject of risk controversies since they were launched in 2006, followed by
massive divergence in media, public health approaches and regulations across the world.
This study explores vapers’ risk perceptions and accounts of the public risk communica-
tion and regulation of e-cigarettes in a Norwegian context were nicotine-containing
e-liquids are prohibited from being sold by domestic retailers. Based on analyses of semi-
structured qualitative interviews (n = 30, 17 males) with adult vapers, I find that the
participants emphasised three important dimensions related to risk. First, they perceived
vaping as harm reduction by substituting for smoking. Second, they devalued much of the
risk communication about e-cigarettes from Norwegian health authorities and media.
Interlinked with their harm-reduction approach, they perceived the present regulation of
nicotine e-liquid and vaporisers as increasing risk by decreasing their availability to
smokers. Third, in general they preferred the lay expertise available online to the health
authorities’ information on e-cigarettes. The analysis displays a lack of trust among the
participants in what can be labelled as top-down information. Based on these dimensions,
I conclude that the dissonance between vapers risk perceptions and the regulation and
mixed messages in risk communication of e-cigarettes has contributed to their preference
for bottom-up expertise. From the vapers’ point of view, e-cigarettes represent harm
reduction, and the vaper community symbolises a bottom-up health movement where
peer assistance compensates for a perceived lack of assistance from health authorities.
Keywords: risk communication; lay expertise; e-cigarettes; controversies; regula-
tions; trust; risk perceptions

Introduction
Since the e-cigarette was launched as a smoking substitute in 2006 (Hajek et al., 2014), it has
been the object of increasing interest and controversy (Bell & Keane, 2012). The use of
e-cigarettes have been presented as a solution to the tobacco smoking problem, one of the
main causes of ill health and premature death worldwide (Gowing et al., 2015), as well as
evoked fear of additional harm, renormalisation of smoking (Fairchild et al., 2014) and new
nicotine-addicted generations (Gilreath et al., 2016). The controversies have been followed
by massive divergence in media, public health approaches and regulations across the world
(Adekola et al., 2019; Annechino & Antin, 2016). In this paper, set in a Norwegian context
were the sale of nicotine liquid is prohibited, I explore how vapers perceptive and account for
the public risk communication and regulations of e-cigarettes.

*Corresponding author. Email: rikke.tokle@fhi.no

© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives
License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction
in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.
 Health, Risk & Society 119

In what follows, I outline an overview of the present context and literature on the
epistemic climate of vaping and introduce the concepts of risk and stigma relevant to the
analysis. I then present the qualitative design of the study, which consist of data from
semi-structured individual interviews with adult users of e-cigarettes. The analysis of
these data revealed a lack of trust among the participants in what can be labelled as top-
down risk information. I identified three main dimensions associated with e-cigarettes
and risk. First, they framed e-cigarettes as a smoking substitute and hence vaping as harm
reduction. Second, they dismissed risk communication from health authorities when it
conflicted with their harm reduction approach. Third, the adult vapers commonly
favoured lay expertise over health authorities’ information on e-cigarettes

Context
The invention of the e-cigarette can be understood as a disruptive technology
(Fagerstrom et al., 2015) and a turning point in the history of tobacco, due to its
contribution to a dramatic change in the nicotine market, with a shift away from
combustion. Moreover, e-cigarettes, defined as handheld electronic devices that vaporise
a flavoured liquid, often containing nicotine, for users to inhale (WHO, 2014), were
relatively early on acknowledged, from a harm-reduction perspective, as having the
potential to yield positive results on smoking cessation at a public health level
(Fairchild et al., 2014). At the same time, applying a precautionary principle, e-cigarettes
are a relatively recent addition to the nicotine market and there is a possibility that future
research might reveal negative health effects from long-term use (Drope & Schluger,
2018). Furthermore, evidence to date indicates that e-cigarettes are not without risk,
albeit likely to involve substantially less health risk than combustible cigarettes despite
the long-term health effects of vaping remaining unknown (See National Academies of
Sciences, E. & Medicine, 2018, for a more comprehensive review of public health
consequenses of e-cigarettes).

The epistemic climate of vaping

The communication of risk following use of new products encompasses both political
implications and moral questions (Lupton, 1993). At present, there are complex interna-
tional and multi-sourced risk communications on e-cigarettes. Health authorities across
the world, including public health officials, regulators, and scientific scholars and
professional communities, have been divided on matters relating to e-cigarettes with
a more critical ‘anti-vaping’ community suggesting implementation of a ban on e-cigar-
ettes, and a more pragmatic ‘pro-vaping’ community advocating for their use as an
important tool in a harm-reduction strategy (Fairchild et al., 2014; Green et al., 2018;
Warner & Schroeder, 2017). Focusing on the risk proportionality in their risk commu-
nication, harm-reduction-focused researchers are upholding evidence that e-cigarettes
have the potential to save lives as a smoking substitute (Rooke et al., 2012).
The ‘pro-vaping’ community also consists of users of e-cigarettes offering their bottom-
up expertise (Abrams et al., 2018; Green et al., 2018). The bottom-up approach emphasises
local decision-making, community participation and grassroots mobilisation (Panda, 2007).
On the opposite side are the anti-vaping community, consisting largely of representatives of
the health authorities supporting tobacco-denormalisation policies which imply a rejection of
the idea of tobacco harm reduction (Annechino & Antin, 2016) and strongly favour an
120 R. Tokle

abstinence-only vision (Warner & Schroeder, 2017). Such rejection applies even if the harm
potential of the product might be drastically reduced (Glantz & Bareham, 2018), as is the
case with e-cigarettes and low nitrosamine ‘Swedish’ snus – a smokeless type of tobacco that
is significantly less harmful than cigarettes (Nutt et al., 2014; Royal College of Physicians of
London. Tobacco Advisory, G, 2007).
Some of the reluctance by some health authorities to welcome e-cigarettes as an
adequate tool against tobacco smoking can be connected to ideology and the way that
vaping mimics smoking (Bell & Keane, 2012), a practice that has been increasingly
stigmatised over recent decades (Peretti-Watel, Legleye et al., 2014). Although e-cigar-
ettes do not contain tobacco or involve combustion, they enhance the most dominant
semiotic referent of the cigarette: the maintenance of ‘smoke’ (Bell & Keane, 2012).
From a tobacco-control point of view, this can serve as a signifier of smoking and invoke
the memory of public smoking and ‘renormalisation’. This can be challenging from some
perspectives because of the role of tobacco denormalisation in current policies (Bell &
Keane, 2012). Fear of a ‘gateway effect’ is an additional argument propounded by some
health authorities, with the idea that use of e-cigarettes can cause subsequent uptake of
cigarette smoking (Drope & Schluger, 2018). Moreover, additional controversies con-
cerning e-cigarettes centre on how to define them, how to measure their effectiveness in
smoking cessation and how to interpret the relevance of biomedical markers of short-
term exposure for potential health effects. The involvement of ‘big tobacco’, such as
British American Tobacco (BAT) and Altria (formerly Phillip Morris) (Abate, 2017) in
e-cigarette production has further increased scepticism (Glantz & Bareham, 2018). At
present, both pharmaceutical companies and ‘big tobacco’ have developed their own
e-cigarette brands (Bareham et al., 2016).
Based on these highly contested debates over risk, e-cigarettes have presented
a regulatory challenge for policymakers and governments, resulting in various outcomes;
the products are banned in several countries; others permit the sale of devices, but not the
sale of nicotine-containing e-liquid. Most countries have a regulated market, but often
under tobacco control policies rather specific e-cigarette regulation (Drope & Schluger,
2018; Kennedy et al., 2017). In most European countries, e-cigarettes are regulated as
a tobacco product under the EU’s Tobacco Products Directive (TPD). In Norway,
however, the sale of nicotine-containing e-liquids is banned, although evaporator devices
are legally available from a steadily increasing number of vapour shops (Vedoy & Lund,
2017). Under the EEA agreement, Norway is committed to adopting EU regulations
(TPD) and consequently the ban on nicotine-containing e-liquids is expected to be lifted
in 2020. The most commonly used nicotine products in Norway are Swedish snus (a low-
nitrosamine smokeless tobacco product) (daily use across 12 per cent of the population)
and conventional cigarettes (daily use across 12 per cent of the population) (SSB,
Statistics Norway, 2018). In a recent national representative survey, 1.2 per cent of the
respondents reported using e-cigarettes daily, while an additional 2.4 per cent reported
occasional use (Lund et al., 2018). Despite a level of scientific disagreement as noted
above, the Norwegian health authorities have traditionally been reluctant to adopt
tobacco harm reduction as a supplementary strategy in tobacco control, and neither
e-cigarettes nor Swedish snus are considered part of the official solution to the tobacco
problem (Lund, 2016). In spite of the ban, prior research has identified a vaping sub-
culture in Norway, typically expressed through social media (Tokle & Pedersen, 2019).
 Health, Risk & Society 121

Risk communication and stigma

In line with several approaches to risk which consider a combination of probabilities and
values, Sandman (1993) considers risk as a function of hazard and outrage. Hazard here
involves the multiplication of two factors: how bad the event is when it happens and how
likely it is to happen. Outrage points to the worries and risk perceptions of the non-expert
public representing the bottom-up-approach. According to Sandman (1993, p. 20): ‘The
public often misperceives the hazard. The experts often misperceive the outrage. But the
overarching problem is that the public cares too little about the hazard, and the experts
care too little about the outrage.’
My analysis in this article follows this approach of Sandman (1993) and is moreover
guided by an understanding of risk as a constructed and sociocultural concept, rather than
a neutral and easily measurable one (Lupton, 1993, 1999; Sandman, 1993). The concept
of risk is for example, interlinked with the sociological concept of stigma. A social
stigma can be defined as a distinguishing behaviour, or status, which is socially dis-
crediting in a particular way (Goffman, 2009). Individuals who choose to ignore health
risks can be perceived as placing themselves in danger of illness and disability, which
puts them in a stigmatised role, as their activities can impose a cost on the community
(Lupton, 1993, p. 429). Smoking is a commonly used example of a lifestyle risk, with
smoking in the presence of bystanders adding the dimension of harm to others. The
communication of the risk of vaping seems to be interlinked with that of smoking, with
various arguments put forward, such as that vaping means swapping one addiction for
another or that vaping leads to the renormalisation of smoking (see above).
Public health authorities have traditionally held a position as providers of objective
guidance on matters affecting public health. However, against the backdrop of mixed risk
communication of e-cigarettes, a lack of trust in researchers and health authorities has been
observed in studies of members of e-cigarette forums (Annechino & Antin, 2016). Trust is
often addressed in terms of its function in society (Meyer & Ward, 2009), as it reduces the
complexity of how we think about phenomena and simplifies our resolutions to act
(Pearson et al., 2005). Trust can be defined as an optimistic acceptance based on positive
expectations of the intentions of the trusted individual and institution in a vulnerable
situation (Meyer & Ward, 2009). It is unreasonable to expect the public to seek sufficient
information to assess potential risk in its entirety. Thus, laypeople, here users of e-cigar-
ettes, ‘must’ trust scientists, government officials, and the news media to inform them
(Lupton, 1993, pp. 430–431). Such risk communication can be considered as a ‘top down’
validation exercise in which experts seek to educate a seemingly misguided public into the
‘reality’ of possibility and danger (O’Riordan et al., 1989). These mediators can potentially
distort the ‘facts’ to further their case, making it difficult for laypeople to conceptualise risk
in the face of conflicting perspectives (Lupton, 1993, p. 431).
The expert role has changed dramatically over the last decade. The current trend
involves consumers collecting facts and information online from multiple sources in an
increasingly self-sufficient manner, which marks a decentralising shift away from top-
down authority (Lankes, 2008). While vaping companies promote e-cigarettes on
YouTube as an alternative to cigarettes (Willis et al., 2017) and use social media
influencers to create trust among a loyal audience of like-minded peers (Daniel et al.,
2018), media are found to present varied and contradictory messages in their risk
communication about e-cigarettes (Morphett et al., 2019). Simultaneously, Annechino
and Antin (2016, pp. 110–111) found that mass media campaigns aiming at discrediting
the e-cigarette industry were dismissed by pro-vapers as false information presented by
122 R. Tokle

biased health authorities. In line with the bottom-up approach, online communities offer
lay expertise in the form of alternative notions of health and risk based on assistance
from peers. The community dimension within such online communities also forms
a basis for personal and collective support (Bilgrei, 2019; Daniel et al., 2018).
Previous studies have found perceived risk to motivate health behaviour (Pepper et al.,
2015). Amrock et al., 2014) reported that many adolescents felt unable to assess the
comparative harms and benefits of using e-cigarettes relative to cigarettes, however, those
who perceived e-cigarettes as less harmful than conventional cigarettes were more likely to
practice vaping. Such positive user predispositions can be explained by theories of selective
exposure (Hart et al., 2009) and perception or optimism bias (Masiero et al., 2015).
To date, little research has been conducted on the association between vapers perceptions
of risk, risk communication and the regulation of e-cigarette use. By utilising a bottom-up
perspective, in a sample of adult vapers in Norway, this study explores users’ perceptions of
risk and risk communication of e-cigarettes in a restricted legislative context.

Methodological account
Sample, procedure and analysis
In this study I analyse qualitative data collected from 30 interviews with users of
e-cigarettes, of whom 17 were male, set in Oslo, Norway between February 2014 and
April 2018. The age range was 19–52 years (mean age 35). The interviewees’ socio-
economic status varied. Employment status ranged from managers to students and to
those who are unemployed and on welfare support. All but one of the participants were
former smokers (See Table 1 for more details on participant characteristics).
Following an inductive logic of investigation, my sampling approach and analysis were
inspired by grounded theory (Denzin & Lincoln, 2008). I began to analyse the data in parallel
with data collection. To explore themes that occurred in the material and ensure a spectrum of
perspectives, I purposively sampled vapers from various locations (Charmaz & Belgrave,
2012). The sampling process started at a vape meeting with the inclusion of two experienced
vapers. Three users were recruited from two different vape shops; six participants were
recruited through a post on the Facebook page of the largest Norwegian vaping group. The
explorative recruitment design continued by visiting music festivals and venues in the night-
time economy with the aim of investigating the use of e-cigarettes among young adults.
Finally, in order to reduce sample bias and locate participants from categories that were
missing in the sample, such as the less visible substitute vapers, I recruited half the sample by
using a chain-referral strategy and extended personal networks.
The interviews lasted between 1 and 2 hours and were semi structured by an interview
guide consisting of 10 main themes. Those most relevant for the analysis were ‘risk
perceptions’ and ‘regulation and opposition’. Interviews were audio recorded and tran-
scribed verbatim to provide access to the vapers’ own descriptions during the process of
analysis. The data were subject to comparative analysis that developed over multiple stages
(Charmaz & Belgrave, 2012). HyperRESEARCH software was used to sort and break down
the material. Codes were generated based on the themes in the interview guide, previous
research and phrasing of the participants (Glaser et al., 1968). The most frequently used
codes in the study were: ‘e-cigarettes and perceived health risks’, ‘personal health experi-
ences following use’, ‘e-cigarettes relative to smoking/snus/NRT-products’, ‘e-cigarettes as
smoking cessation’, ‘regulation’, ‘risk communication’ and ‘gateway’. After systematic, yet
open, analysis and comparing of the concrete content in these codes (Charmaz & Belgrave,
 Health, Risk & Society 123

Table 1. Sample characteristics (N = 30).

Characteristics N

Gender
Female 13
Male 17
Years of age
19-29 10
30-39 8
40-49 10
50-59 2
Smoker status
Former daily smoker 18
Daily smoker 1
Former occasional smoker 3
Occasional smoker 4
Intermittent smoker 3
Non smoker 1
Vaping status
Daily vaper 23
Occasional vaper 6
Former daily vaper 1
Device
Mod 19
Vape pen 10
Mod & vape pen 1
Vaper identity
Substituter 18
Cloud chaser 12

2012), using simple tables, I identified a consistent pattern whereby vapers perceived their
risk perceptions as conflicting with what I label ‘top down risk communication’. The term
‘Top down risk communication’, is in this study used as a collective term to capture the
vaping participants’(often conflated) perceptions of the risk communication and regulation
of e-cigarettes by perceived health authorities, including some researchers, and the media.
I organised the risk-pattern in the interviewees’ accounts by constructing three main dimen-
sions presented in the findings: ‘Vaping as harm reduction’. ‘Dismissal of health authority
messages’ and a ‘bottom-up movement celebrating lay expertise’. Subsequently, relevant
theoretical frameworks were integrated (Denzin & Lincoln, 2008), such as the concept of
risk (Lupton, 1999) and stigma (Goffman, 2009).
The study received ethical approval from the Privacy Protection Committee at NIPH and
was carried out in accordance with their ethical guidelines. Interviewees were thoroughly
informed of the study and gave active consent for participation. Identifying features, such as
name and place of residence, were changed or omitted from transcripts and scientific output.
Participants were compensated with a NOK 300 fee for their time (approximately GBP 30).

Findings
Bottom-up meets top-down in vapers’ accounts of risk
The analysis presents three dimensions in the interviewees’ accounts of risk related to the
use of e-cigarettes. First, they accounted for the risk perceptions of vaping as harm
124 R. Tokle

reduction. Second, they dismissed the more ‘top down’ risk communication by perceived
health authorities, as they often perceived their communication and the regulation as ‘anti-
vaping’, and hence increasing risk by preventing smokers’ access to nicotine-containing
products. Third, the interviewees emphasised the importance of lay-expertise on vaping.
Finally, I discuss how the dissonance between the participants harm-reduction approach to
vaping, and their devaluation of the top-down risk communication and regulation of
e-cigarettes can be seen as contributing to a bottom-up movement among vapers.

Vaping as harm reduction

The interviewees represented a heterogeneous group in terms of vaper identities, ranging
from ambivalent, pragmatic substitute users to dedicated vapers engaged in the hobby
and of vaping as a sub-culture. However, despite their various user patterns and char-
acteristics, they shared important common perceptions of risk in their accounts. Their
risk perceptions were interlinked with their former smoker status, and they considered
the switch from tobacco cigarettes to e-cigarettes as health improving. Nils (28), for
example, stated: I perceive them [the e-cigarettes] as health promoting and as an
investment for our welfare state when the alternative so obviously is cigarettes. Many
echoed Nils, and a distinction between e-cigarettes and tobacco cigarettes was at the
centre of the majority of the adult vapers’ accounts. They described how vaping was
superior in smoking cessation, and how vaping had relieved them of a series of health
hazards, ranging from constant colds, chest pain, and poor physical condition to a loss of
their sense of taste. Emma described a common version of the transition to e-cigarettes:

I started smoking when I was very young to appear cool. I didn’t become cool, I became
addicted. From 2009 I started my non-stop history with failed attempts to quit. I used those
band-aids, Champix tablets, Nicorette inhalator, nicotine gum, I tried everything from 2009
to 2013. Nothing worked; I was not able to stop. It has to do with the fumbling, the
psychological more than the physical dependence. Then I got an e-cigarette. I thought, “I
never gonna quit because of this”, but I haven’t smoked since. (Emma, 27)

The e-cigarettes were perceived as both a functional and vital smoking substitute. Several
dimensions in Emma’s account resonated with the overall data, such as the feeling of
decreasing acceptance of smoking in society, managing an addiction, experience with
failed cessation attempts and, importantly, e-cigarettes as superior to traditional nicotine
replacement (NRT) products in smoking cessation. Similarly to Emma, the interviewees
commonly structured their narratives with a clear ‘before’ and ‘after’ being introduced to
e-cigarettes. In addition to health as a focal point in many of these accounts, the stigma
attached to their former smoking habit was an additional dimension that traversed the
data. Emma continued from the turning point like this:

Suddenly I noticed that people did not label me as a smoker anymore – they couldn’t label
me because I didn’t smell. It was such a relief getting rid of the social stigma, to be able to
hold my head high and not be the victim of socially acceptable bullying.

Emma perceived e-cigarettes as important in coping with the incriminating stigma

attached to smoking. Several interviewees echoed Emma in describing stigmatisation
and the lack of the ‘ugly’ smell when vaping. In addition, many talked about the
importance of e-cigarettes not possessing the dimension of causing harm to others
posed by conventional cigarettes.
 Health, Risk & Society 125

Intertwined with the perceived low status of tobacco cigarettes, the controversies
of how e-cigarettes ought to be defined were addressed. There was an evident
ambiguity to the term ‘e-cigarette’ in their accounts. Statements such as Kenneth’s
(34) were common: Vaporisers is the right term. This [referring to his e-cigarette] is
not a cigarette. In general, the term e-cigarette was perceived as misleadingly con-
noted with harmful and stigmatised smoking. Despite health being a focal point for the
transition from smoking to vaping, most still rejected labelling e-cigarettes as
a medical product. Ola said: You can say that e-cigarettes are a smoking substitute
and a product for pleasure. It is certainly not a medical product! (Ola, 32). The harm-
reduction dimension of the e-cigarettes was connected to their appeal, and the appeal
to the fact that they were not a prescribed therapeutic remedy. Several interviewees
instead suggested defining e-cigarettes as a pleasurable consumer good, stating that
the e-cigarette and the e-liquid are neither harmful tobacco nor a medical product.
The interviewees’ risk perceptions of vaping also conflicted strongly with the risk
controversies suggesting that vaping could lead to renormalisation or serve as a gateway.
Ingrid was provoked when questioned about this:

If you start with e-cigarettes, there is no chance in hell that you will switch to tobacco
cigarettes. Because it’s not the same; it’s not the same way of inhaling, it’s not the same
taste, it would hurt in comparison. (Ingrid, 41)

Ingrid rejected the idea of e-cigarettes renormalising smoking or serving as a gateway

to smoking by highlighting the differences. Emphasising the lack of similarities was
a common response. For example, interviewees focused on the relative risk by stating
how much more harmful smoking was for the body, as well as the bad smell and
distastefulness of smoking compared to the use of e-cigarettes. The negative norma-
tive climate around smoking was also a commonly used argument for dismissing the
gateway and renormalisation theses. As Edward (25) stated: Smoking is decidedly
uncool. Smoking and vaping are just two very different things. Their identity as former
smokers was visible in their accounts, and they highlighted smokers as the target
group for e-cigarettes. However, several stated that, if young people were to try
a nicotine-containing product, e-cigarettes would be preferable to tobacco cigarettes:

Young people have always wanted to test new things, especially if it’s unavailable. And even
though I would never encourage it, vaping is by far a better alternative than smoking. If they
were to prohibit e-cigarettes because young people might start vaping, then they need to
prohibit a lot of things. Why are cigarettes allowed? Why is alcohol allowed? How can they
sell red wine if young people can turn into alcoholics? It is so unfair and it is not a valid
argument! (Rita, 34)

Rita pointed to adolescence as a time for experimentation and maintained her perception
of e-cigarettes as substantially less harmful than smoking. In addition, she displayed her
frustration over the strict regulation of e-cigarettes in Norway, by attempting to discredit
the perceived contrary position with whataboutery. Rolf continued in the same vein: It’s
naive to think young people won’t try any nicotine products, and it’s better if they try
e-cigarettes rather than cigarettes. In general, interviewees gave ambivalent accounts on
how non-smoking adults and non-smoking youth might become consumers of e-cigar-
ettes. On the one hand, they argued that e-cigarettes are relatively safe and their use
unproblematic. On the other, they dismissed the whole issue as irrelevant, stating that
e-cigarettes only appeal to those with an existing addiction. However, in terms of young
126 R. Tokle

people who otherwise might have taken up smoking, the majority presented e-cigarettes
as a better alternative. Their negotiation of the risk of vaping is hence best captured by
understanding their harm-reduction approach to vaping: many described the pleasure and
the appeal of vaping, but still asserted harm reduction by switching from conventional
cigarettes to e-cigarettes to be the most important underlying motive.

Dismissal of health authority messages

The interviewees generally shared a common narrative of taking responsibility for their
own health by substituting smoking with vaping, and perceived the health authorities as
failing to facilitate, support and acknowledge it. ‘Health authorities’ emerged as
a collective term that commonly included and entangled Norwegian legislators and
health officials, including researchers, holding a critical approach towards e-cigarettes.

How can they say that e-cigarettes don’t work as an aid to quitting smoking? They don’t
know what they are talking about! It really gets to me. I would not have been able to quit
without my vaporizer. (Jack, 40)

According to Jack, ‘they’, referring to the health authorities, undermined the role of
e-cigarettes in smoking cessation. In addition, Jack perceived that ‘they’ lacked proper
knowledge of e-cigarettes and vaping. Several interviewees echoed this view. In these
accounts, the public information on e-cigarettes conflicted with their personal experience
of the harm-reduction side of e-cigarettes as a pleasurable and well-functioning smoking
substitute. Hence, the frustration and reactance evident in these accounts seemed to be
interlinked with the interviewee’s former smoker status: they reported feeling stigmatised
as smokers, and then they reported not feeling acknowledged as vapers. In addition, they
were upset over the lack of clear communication on the relative harm of these products.
Anne expressed it as follows:

How can the health authorities not communicate how much less health-damaging this is
[referring to her vape-pen] compared to smoking? There is no tar in this, no toxic metals and
carcinogens, no combustion. It’s just unbelievable! (Anne, 33)

Anne had a hard time understanding why e-cigarettes were not offered to smokers who
wanted to stop smoking. She continued to talk about what she perceived as misleading
risk communication in the form of newspaper headlines stating that use of e-cigarettes
could lead to cancer, vaping being the same as – or worse than – smoking and the lack of
both pro-vaping information and availability of products in physical stores. Several
accounts echoed Anne’s critique of what they perceived as negative media coverage of
risk of e-cigarettes. Martin stated:

We lose all the smokers who read all the wrong headlines on vaping in the newspaper. It’s
frustrating with all the misconceptions: all the ignorant people claiming that you are still
smoking when that is so completely wrong. Yes, you have the vapour coming out, but this
has nothing to do with combustion. (Martin, 40)

The interviewees’ accounts of the risk communication of vaping frequently ended up

negotiating how the mixed media content, health institutions’ lack of harm-reduction-
communication and the present regulatory status of nicotine-containing e-liquids,
affected the publics views of e-cigarettes and vapers. In addition, the present market
 Health, Risk & Society 127

situation was perceived as having negative impacts, in that it kept smokers away from the
less harmful e-cigarettes, as well as creating uncertainty around the quality of existing
products. In addition the importance of distinguishing between vaping and smoking-
products was also evident in this regard, as they perceived the definition and regulation
of e-cigarettes to be interlinked. Monica stated:

They [public regulators] have handled e-cigs in a messy and confusing way. You have some
drug legislation and then you have some tobacco legislation, despite e-cigarettes being
neither medicine nor tobacco. (Monica, 22)

Monica described what she perceived as disorganised and unclear labelling of e-cigar-
ettes. In general, the vapers were unhappy with the prohibition against selling nicotine-
containing e-liquids in Norway, as the prohibition resonated poorly with their risk
perceptions. Rather they reported availability as important, not only for current users,
but particularly for all the remaining smokers.

This [referring to his e-cigarette] should be sold over the counter, like a slightly more
regulated kiosk product. The prohibition is unbearable and that it hasn’t been changed yet is
unbelievable to me! (Nils)
The enormous potential e-cigarettes have to save lives is heavily curbed by the [Norwegian]
sales restrictions. I will go so far as to say that it is completely unethical and irresponsible of
the Ministry of Health. They are neglecting the smoking population. (Rita, 34)

Nils and Rita critically expressed their dissatisfaction with the present situation and the
health authorities. The repeated account was that the government should help smokers
switch from conventional cigarettes to e-cigarettes, but instead vapers were forced into
buying nicotine-containing e-liquid and vaporisers online, or abroad. According to them,
this created a harmful barrier to swapping ordinary cigarettes for e-cigarettes. The
interviewees also presented low availability as an important explanation for the low
vaping prevalence in Norway. The elderly and the marginalised were often referred to as
‘the losers’ in the present regulatory regime. Moreover, some interviewees expressed fear
and uncertainty for their own future vaping:

I must admit that I worry a lot about how the government will end up regulating e-cigarettes
in the future. I’m so grateful for the existence of e-cigarettes, if it wasn’t for them I would
never have become smoke-free (Tone, 49).
I just hope that the health authorities value our right to remain smoke-free and that they take
our health seriously (Lotta, 43).

Tone and Lotta talked about the distress of stricter future regulations, such as prohibition
against importing nicotine. In their accounts, vaping was framed as the only alternative to
smoking. Data revealed a cost connected to what the interviewees perceived as uncer-
tainty and inconclusive treatment of e-cigarettes at the time of the interviews. As Roger
(44) said: If they take the wrong path with the regulation, they create an unnecessary
disaster – or to be more accurate – thousands of them. Accounts such as Roger’s imply
that the interviewees believed in regulation and, in general, they agreed that a certain
level of regulation of e-liquids and e-cigarettes was important. However, they argued that
the regulation should mirror the risk; they suggested measures such as setting the
128 R. Tokle

minimum age for purchasing e-cigarettes to 18 [same as for tobacco products], child-
proof containers for e-liquids, content declarations and battery controls.

When I buy the nicotine-containing e-liquids, I can’t know for sure who made them. I can’t
know if the people producing juice in England are doing it in their backroom, whether they
have clean hands or mix it in a dirty bowl. (Monica, 22)

Monica described what she perceived as the present regulation leading to unnecessary
increased risk from vaping by decreasing consumer safety. Online purchases from
various sources allowed for products of lesser quality, uncertainty around the content
of e-liquids and lack of transparency in the manufacturing process. Kenneth (34) reported
on the room for improvement with regard to both the health authorities’ risk commu-
nication and their future regulation of e-cigarettes, and said: If they [the health autho-
rities] do it right this time, it will help many people quit. This could be the invention that
finally ends the tobacco pandemic. In general, the vapers seemed to perceive the health
authorities as lacking in their knowledge of e-cigarette-related matters, such as the
importance of numerous independent distributors for keeping the price low and main-
taining appeal through product diversity.

A bottom-up movement celebrating lay expertise

Across various age groups and social backgrounds, the risk communication and treatment of
e-cigarettes appeared to fail to resonate with their own experiences of improved health. In
general, the interviewees’ negative perception of the public risk communication of e-cigar-
ettes seemed connected to a discrepancy between their harm-reduction approach to e-cigar-
ettes, on the one hand, and the Norwegian health authorities risk communication and
regulation’ being more aligned with the precautionary principle, on the other:

The best would be if the information from the public sector were accurate, but that ship
sailed long ago. Today we just have these two alternative lines from them: the moralists or
the precautionary principle. Even though the public health authorities should be responsible
for providing the public with accurate information to enable us to make the right decisions,
it seems they just fail completely and leave it up to us to seek this information through other
channels. (Rolf, 25)

Rolf described the health authorities as moralists who have failed to inform the public of
safer alternatives to smoking. The interviewees in general talked about how the dominant
focus on the uncertainty of long-term health effects of vaping came with a ‘high price’
both for themselves as vapers having to defend their vaping, and also, and for the
smokers who were not informed of the relative harm and hence were less likely to
switch. Importantly, Rolf also reported on how the present situation made vapers search
for information elsewhere. Several of the adult vapers echoed this and highlighted the
importance of getting information from alternative sources:

I have vaped for two years thanks to help and support from the vape forum. If it wasn’t for
them, I would never be able to stick to e-cigarettes and quit smoking. They provide support,
information on equipment and a community. From my point of view, vaper forums are more
important in the fight against tobacco smoking than the health authorities’ campaigns and
pages. On forums, everything is presented as more nuanced and not as politically coloured
as the information from the health authorities. (Kåre, 51)
 Health, Risk & Society 129

Vape forums and YouTube were described as important and more ‘neutral’ channels for
vape-related information in contrast to the ‘top down risk communication’ in Norway.
Similarly, to Kåre, several of the interviewees followed forums and/or vape-related
profiles on YouTube in order to learn and stay up-to-date. In these accounts, it became
evident that forums served as an entry point for many smokers into the world of
e-cigarettes. The purpose of such vape forums was delineated as a way to learn how to
navigate in the product jungle, learn how to use e-cigarettes and the various components
such as coils, batteries, e-liquids and safety procedures. Vape forums were also arenas
where participants shared up-to-date information on relevant research, media coverage of
e-cigarettes and the present regulatory landscape.
Especially among some of the most dedicated vapers in the sample, the lack of pro-
vaping information in the ‘top-down’ risk communication, was framed as creating
a bottom-up movement. These vapers displayed a more organised ‘revolt’ against the
authorities and described how they advocated the vape cause. Their activity was primar-
ily visible online and made possible by user-edited platforms, such as vape forums and
Facebook. They talked about the importance of more organised communities that had
dispensed with traditional means of determining trustworthiness, based on information
from the health authorities, in favour of digital tools and new network approaches. Oscar
and Martin expressed it as follows:

The Facebook pages of the Norwegian vape society are a ‘must’ when it comes to uniting
vapers in the fight for the vape cause. As a user, you are educated in vaping and as a group,
you can influence. (Oscar, 29)
Without social media, vaping would not be where it is today. Forums were the place to go
for information and help in Norway in the beginning. Few would have known so much
about vaping without these networks. As the press have been limiting vapers’ access to the
media, user groups online are invaluable for the products and the users. (Martin, 40)

Martin pointed to how social media was a go-to-place for vaping-related information.
The national health authorities and the media were perceived by several interviewees as
having ‘prevented them’ from easy access to ‘valid’ public information on e-cigarettes.
Moreover, as the interviewees had managed a switch from smoking to vaping in the
present regulatory and discursive landscape, some accounted for a feeling of responsi-
bility to help the ‘unenlightened’ smokers. Oscar stated how, as a vaper, he possessed
knowledge, and how vapers as a group became empowered. Hence, the public risk
communication on vaping was not only framed as preventing smokers from quitting,
but also as having a role in creating virtual platforms and vaping communities. These
interviewees repeatedly described vape forums as a more trusted place for gathering
information compared to public channels.

There is research spreading doubt about the effectiveness of vaping in smoking cessation. If
I hadn’t stumbled upon a vaper forum and got in touch with other vapers, I wouldn’t have
been smoke-free for the last two and half years. (Andre, 45)

Andre was one of the dedicated interviewees who acknowledged the importance of the
forum for managing his switch from combustible cigarettes to e-cigarettes. Among the
interviewees who participated in vape forums, the social interaction in these settings was
contrasted with the ‘negatively biased’ health authorities’ risk communication; they
described the forums as empowering, in that members experienced increased control
130 R. Tokle

over their own health because of the positive risk communication and the supportive
actions characteristic of these environments.
The findings seemed to reflect the interviewees’ various vaper identities; those who
described feeling part of a community were also more likely to describe feeling more
proud and more confident in their use of e-cigarettes, compared with the more pragmatic
and defensive substitute users who saw their vaping as a private act, and displayed their
frustration in the form of a more solitary complaint. In sum, participants’ perceptions of
the present regulation and risk communication were of increasing rather than preventing
risk. Moreover the importance of lay expertise in this context, resonated not only with the
experience of devaluation of official risk communication about e-cigarettes, but also as
contributing to a bottom-up vaping movement.

Discussion
By exploring how thirty adult vapers negotiate risk and perceive the risk communication
on the use of e-cigarettes in Norway, I identified three dimensions that resonated across
the data and various user identities: first, the importance of vaping as harm reduction.
Second, a devaluation of the health authorities’ risk communication and regulation as
anti-vaping. Third, the vapers perceptions of lay expertise as more trustworthy than ‘top
down’ risk communication.
The Norwegian setting is contextually relevant for the discussion of the findings.
This context include illegality of nicotine liquids and health authorities who traditionally
have (with exceptions) based their risk communication on the precautionary principle,
hence been reluctant towards adopting perspectives of relative risk and harm reduction in
their risk communication on use of tobacco products (including snus and e-cigarettes).
The understanding of e-cigarettes in relation to health and risk largely depends on the
perspective underlying the argumentation; particularly whether we view e-cigarettes as
a less hazardous smoking substitute or an isolated consumer product with potential
harmful side effects following use.
Researchers and health authorities advocating the precautionary principle will typi-
cally be reluctant to recommend e-cigarettes as a smoking substitute and call for
awareness in the adoption of e-cigarettes (Cai & Wang, 2017; Glantz & Bareham,
2018; Reidel et al., 2018). Conversely, being a current user of a product is associated
with an optimistic bias (Masiero et al., 2015). In the interviewees’ accounts of risk
perception, vaping is harm reduction and, from the same perspective, they perceive the
precautionary principle, the ‘negative’ risk communication and ‘strict’ regulation as
creating risk by generating uncertainty that may prevent smokers from switching to
a less harmful product. The elderly and the marginalised smokers were often referred to
as ‘the losers’ in this context, aligning with the literature that portrays the remaining
smokers as middle-aged persons of low educational attainment living in rural areas
(Peretti-Watel, Seror, et al., 2014b).
Moreover, the interviewees’ former smoker status in a smoking-hostile environment
is also relevant for the analysis. Numerous studies have identified the increasing stigma
attached to conventional smoking (Peretti-Watel, Legley et al., 2014; Sæbø, 2017; Sæbø
& Scheffels, 2017). The interviewees accounted for feeling as ‘outsiders’ and being
socially acceptable victims of bullying when they previously smoked. Stigmatisation can
lead to an ‘outsider’ position (Goffman, 2009) with the potential to explain some of the
frustration, reactance and opposition present in the interviewees’ accounts. In terms of
 Health, Risk & Society 131

stigma, the participants’ former-smoker status speaks to a more general conception of the
individual’s responsibility for avoiding health risks for the sake of their own health, as
well as for the greater good of society (Lupton, 1993, p. 433). The vapers perceived that
they had taken responsibility for their health by substituting cigarettes with e-cigarettes;
however, instead of recognition, they accounted for the health authorities’ lack of
support. In terms of opposition, their former smokers’ status was evident in the con-
struction of ‘them’ and us’ The authorities were simplistically presented as anti-vaping
and unenlightened, despite the health authorities themselves being divided in their
approach to the controversies attached to vaping (Green et al., 2018).
Lupton describes risk definitions as hegemonic conceptual tools that can maintain
power structures in society (Lupton, 1993). According to Lupton (1993, p. 432), the
laypeople’s perspective is rarely accorded an equal hearing with that of big business and
politicians. Moreover, risk controversy is of interest to the media (Sandman, 1993).
Motivated by attracting readers, the media can use negative headlines to over-
dramatise or simplify information about health risks, leaving the general public confused
(Lupton, 1993). In this study, the interviewees’ emphasised how negative- and mixed
risk-communication of use of e-cigarettes in the media created uncertainty in the public
around the harmfulness of vaping, which in turn affected the social meanings of vaping
and their status as vapers. The public media could, in addition, influence and shape
public policy by setting an agenda for the public discussion of risk.
My findings from exploring risk from the vapers’ perspective also imply that
messages from public health channels can be undermined and overlooked. The most
dedicated vapers in the study were most likely to express an outspoken and organised
opposition towards the Norwegian health authorities’ handling of e-cigarettes. Their
dissatisfaction was manifested as distrust in their risk communication, which they
perceived as too anti-vaping with a dominant negative focus on e-cigarettes. More
broadly, a narrative of insecurity about the long-term health effects of vaping may
decrease the adoption of e-cigarettes (Pepper et al., 2017).
The participants in my study generally described vapers as the experts on vaping,
possessing ‘lay expertise’ with their special knowledge based on their personal and
cultural experiences (Lupton, 1999). As a consequence of the lack of trust risk in health
authorities, many relied on consumers’ expertise concerning e-cigarettes by gathering
information online, often from forums or on YouTube. These findings reflect other
studies that have identified how increased use of the internet has led to greater self-
sufficiency (Lankes, 2008; Morris & Anderson, 2015). The information available on
online networks marks a general shift in perceived credibility away from traditional
authority models, to reliability approaches with increased room for user participation
(Lankes, 2008). Similar processes of devaluing the expertise of health authorities are
identified in other studies exploring substance-oriented forum-cultures (Bilgrei, 2019;
Boothroyd & Lewis, 2016; Soussan et al., 2018).
Despite this study being set in a Norwegian context, the devaluation of health
authorities information echo findings derived in different regulatory contexts
(Annechino & Antin, 2016). The interviewees in this group describe being part of
a movement where vapers are offering lay expertise to smokers to cater for a lack of
public support and availability. Vaping forums and YouTube play a significant part in
this, as important channels for what the participants perceive as trustworthy vape-related
information. At the same time vaping companies seem to use this context – of uncer-
tainty and challenged authority – as an opportunity, by promoting e-cigarettes through
132 R. Tokle

social media influencers with status among peer-followers (Daniel et al., 2018), and
YouTube (Willis et al., 2017). The lay expertise represents guidance in a bewildering
context, marked by rapidly evolving product technology and new products entering the
market (Niaura, 2018). In line with this, vaper forums are reported to be places for
receiving support online and advice, hence my understanding of these social contexts in
terms of ‘vaping as a bottom-up movement’. Such developments point to a more general
shift in risk communication on substance use, where the bottom-up structures of online
communities not only seem to evolve as a reaction to top-down control, but also can
challenge the discourse on risk matters and harm reduction in substance use.
There are limitations to the study. Firstly, this study are based on a sample of
Norwegian adult vapers perceptions in a pre-TPD context, with restricted access to
nicotine containing e-liquid, hence the viewpoints presented by the interviewees are
not necessarily representative of the wider population of vapers. Secondly, data were
collected over an extended period of time (2014–2018), and this may raise concerns
about datedness, given the high level of innovation and changes characterising the field
of e-cigarettes (Farrimond, 2017). However, there were highly consistent patterns in the
interviewees’ accounts of risk throughout the period. Nevertheless, there is a need for
studies exploring vapers’ perceptions’ of risk and risk communication of e-cigarettes in
different jurisdictive and moral contexts, as well as for studies of how those currently
smoking tobacco cigarettes understand and perceive risks associated with vaping.

Conclusion
In the study above I have found evidence that controversies around technologies – in this
case, e-cigarettes – can enlarge the gap between public health authorities and users of
e-cigarettes. In the study, a dissonance between vapers’ risk perceptions of e-cigarettes as
harm reduction, and their perceptions of the regulations, negative risk communication
and lack of assistance from the health authorities, have contributed to a bottom-up health
movement based on peer assistance. Related processes of distrust can lead to a devaluing
of messages from health authorities, and may hence extend challenges in risk commu-
nication and public health governance. A way of addressing such a trust-gap could be to
consider examining more closely why harm reduction in the field of tobacco seems to
have developed such a controversial status.

Disclosure statement
No potential conflict of interest was reported by the author.

Funding
This work was supported by Dam Foundation [2015/FO5245].

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III
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Contents lists available at ScienceDirect

International Journal of Drug Policy

journal homepage: www.elsevier.com/locate/drugpo

Research Paper

‘Vaping and fidget-spinners’: A qualitative, longitudinal study of e-cigarettes

in adolescence
⁎
Rikke Tokle
Department of Alcohol, Tobacco & Drugs, Norwegian Institute of Public Health, PO Box 222 Skøyen, 0213 Oslo, Norway

A R T I C L E I N FO A B S T R A C T

Keywords: Background: We see the contours of a cigarette-free adolescent cohort in Norway. Simultaneously, increasing use
E-cigarettes of vaping devices among adolescents internationally, and in the US in particular, has evoked fear of a new
Vaping nicotine-addicted generation. This longitudinal study explores the vaping phenomenon in a context where ni-
Adolescence cotine e-liquid is still prohibited.
Qualitative Longitudinal study
Methods: Data are from longitudinal, qualitative interviews with a sizable sample of 12-17 year olds (118 8th
Actor Network Theory
graders from 6 schools/classes at baseline). Four follow-ups were conducted from 2015 to 2019 (a total of 50
Interaction Ritual
Trend semi-structured group and 175 individual interviews). The interviews were coded using HyperResearch software
and thematically analysed in the light of actor network and interaction ritual theory.
Results: Gradual and collective shifts in vaping practices and in the symbolic meaning of vaping were observed
in three phases. First, in 8th grade, few had tried to vape, even if several were curious about this novel invention,
practice and the available flavours. Second, after 9th grade, one in three reported personal use. They emphasised
harmlessness, coolness, performance and accessibility online. However, by the end of middle school, a third
phase became visible; vaping had lost status and was described as ‘childish’ and unpopular. Interviewees re-
peated the lack of relevance in high school, comparing e-cigarettes with the fidget-spinner and reserving vaping
for kids and addicted adult smokers. The analysis displays a systematic pattern in which adolescents account for
vaping as a time-limited trend.
Conclusion: E-cigarettes were devalued from novelty and transgression to childish and uninteresting within the
same sample over a four-year period. In conclusion, e-cigarettes in the sample represented fashionable experi-
mentation rather than steady user patterns.

Introduction sociability in their vaping, drawing on Actor Network Theory (ANT)

(Latour, 1987; 1994; 2005) and Interaction Rituals (IR) (Collins, 2004).
We see the contours of a cigarette-free generation of adolescents in I outline the restrictive Norwegian context, before presenting the
Norway (Vedoy, 2015). Simultaneously, increasing use of e-cigarettes methods. The study is based on extensive longitudinal, qualitative data
or vaping devices, especially among young people in the US, has evoked (Brunborg et al., 2019). Through repeated interviews with adolescents
fear of new nicotine-addicted generations (Gilreath et al., 2016). Al- from 2015 to 2019, the study identifies changes in perceptions and use
though vaping is found to occur among Norwegian adolescents connected with both the technical sides of e-cigarettes and the social
(Lundberg, Kvaavik et al., 2019), we lack representative data and sides of vaping.
qualitative studies on e-cigarette use in this age group. The study offers
a contribution to our understanding of young people's vaping, by ex- E-cigarettes, vaping and young people
ploring how the social meaning and usage of e-cigarettes evolves in a
sizeable sample of Norwegian adolescents. Such knowledge of young Studying the features of the e-cigarette is beneficial for under-
people's perceived and evolving meaning of the technology and prac- standing the meaning and appeal of vaping in adolescence. Originally e-
tices is important for identifying general attitudes, as well as mechan- cigarettes or ENDS (Electronic Nicotine Delivery Systems) were de-
isms in and out of use. signed to replace combustible cigarettes (Hajek, Etter, Benowitz,
In what follows, I provide context on e-cigarettes and young people's Eissenberg, & McRobbie, 2014), as handheld electronic devices that
vaping. I then conceptualize the interwoven role of technology and allow users to inhale an evaporated flavoured liquid, often containing

⁎
Corresponding author.

https://doi.org/10.1016/j.drugpo.2020.102791

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nicotine (WHO, 2014). Studying understandings of these devices is symbols is the label Collins uses for items upon which a group has fo-
however complicated by the rapidly moving commercial technology cused attention during such rituals (2004, p. 150). Collins’ idea of focus
(Farrimond, 2017). The present e-cigarette market offers products with is useful when exploring the meaning of e-cigarettes in adolescence.
a wide variety of flavoured e-liquids, levels of nicotine and product Following Collins, an IR “is the process in which participants develop a
versatility (Goniewicz, Hajek, & McRobbie, 2014). The ‘first generation’ mutual focus of attentions and become entrained in each other's bodily
of e-cigarettes, which largely mimicked smoking, has been overtaken by micro-rhythms and emotions” (Collins, 2004, p. 47). IRs create symbols of
‘second’ and ‘third’ generation devices, such as ‘mods’ or ‘tanks’ fa- group membership, and represent boundaries of inclusion and exclu-
voured by many users (Etter, 2016). The pod versions are among the sion (Collins, 2004, p. 297). Rituals, hence, can show how much soli-
newer vaporizers on the market, most notably those branded JUUL, darity and commitment to shared symbols will occur in a wide variety
which seem to particularly appeal to young people in the US of situations, and how external conditions can shift the symbolic
(Huang et al., 2019). Relatedly, young people are found to view the e- meaning and the strength of a social ritual (Collins, 2004). The shifting
cigarette as a product in its own right (Hardcastle et al., 2014; position of smoking in society, from status to stigma, serves as an ex-
Measham, O'Brien, & Turnbull, 2016) and rather focus on flavours, ample of such. Smoking, through the lens of IR, is a low-intensity ritual,
product design and the opportunity to customize devices and show defined as a practice that involves varying levels of formality and
individuality (Hardcastle et al., 2014). process. Depending on the social context, smoking has been interpreted
In parallel with the inventions of novel objects, new social practices as an elegance ritual as well as an anti-elite and toughness ritual
have emerged. E-cigarettes are now the most commonly used tobacco (Collins, 2004). Correspondingly, vaping among young people has been
product among young people in the US (Cullen et al., 2019). During the identified as a low-intensity ritual, and been linked to both resistance
2017–2018 period, the prevalence of current vaping (in the past 30 and mechanisms for misbehaviour (Yule & Tinson, 2017).
days) increased from 12 per cent to 21 per cent among US high school Notably, when exploring adolescents’ vaping longitudinally, ado-
students. Similarly, data from the UK show that 23 per cent of 11-18 lescence is in itself an important transformative, social context char-
year olds have used e-cigarettes, but typically in an experimenting acterized by physical, mental, and psychosocial development and
pattern. Only 1.6 per cent reported use more than once a week changes (Forehand & Wierson, 1993). Adolescents become increasingly
(ASH, 2019), indicating that the recent rise in adolescents’ use of e- concerned with peer-relationships during this developmental period
cigarettes does not necessarily point to a new nicotine epidemic (Vartanian, 2000), both in terms of conformity with peers and social
(Miech, Patrick, O'Malley, & Johnston, 2017). Moreover, in contra- acceptance (Forehand & Wierson, 1993).
diction to the original conception of e-cigarettes as an alternative to
combustible cigarettes, young people are found to be novel users of e-
cigarettes, with no previous history with tobacco (Chapman & The Norwegian context
Wu, 2014), and to vape for reasons unrelated to conventional smoking
(Evans-Polce et al., 2018). Rather, scholars have suggested that many Norway, which is the focus in this study, serves as a restricted
young people use e-cigarettes for fun, to try something new regulatory context for vaping, in line with Australia and in contrast to
(Hardcastle et al., 2014), or for the performative aspects of vaping the UK (Erku, Kisely, Morphett, Steadman, & Gartner, 2020). Nicotine-
(Measham et al., 2016). containing e-liquids are not available from domestic retailers, although
adult consumers are allowed to import them for personal use. Vaping
Conceptualizing the agency of technology and sociability in adolescents’ devices are legally available at selected shops for those over the age of
vaping 18. However, to evade the current regulation, the majority of adult
users of e-cigarettes are found to purchase the nicotine, liquid and
ANT allows agency to be found in both human and nonhuman ob- equipment from foreign retailers online (Vedoy & Lund, 2017). The ban
jects (actants). Hence, the ANT perspective provides attentiveness to on nicotine e-liquid is expected to be lifted in 2020, with the im-
how nonhuman objects such as the e-cigarette are part of – and evolve plementation of the Tobacco Product Directive (TPD). How these reg-
in – networks (assemblages) and how experiences pass through objects ulatory changes will affect use in adolescence is frequently debated in
and act on users (Latour, 2005, p. 68). The ANT concepts of inscriptions the media against the backdrop of increasing use among young people
and translations are of particular relevance in this study of vaping in internationally, and the EVALI outbreak in the US in 2019.
adolescence. Inscriptions refer to how a technical object creates a user The aim of this unique longitudinal study is to identify the evolving
pattern by way of how the object facilitates its own use (Latour, 1987). social meaning of vaping devices and usage in a sample of 12-17 year
Consequently, an object with a strong inscription will force use in a olds in the above-outlined context.
given way, whilst a weak inscription allows alternative user patterns
than the ones originally intended by the creator. Translations refer to
creating an inscription with the purpose of aligning the object or the Methods
assemblage in a given direction (Latour, 1994, pp. 32-41). E-cigarettes
in the hands of non-smoking adolescents may indicate that e-cigarettes The data consists of interviews from the qualitative arm of the
have weak inscriptions, given their original conception as a smoking MyLife study, a prospective, longitudinal quantitative and qualitative
substitute. This is further evident in studies identifying use for fun study of young people's development and substance use in Norway
(Hardcastle et al., 2014) or performance and ‘cloud chasing’ (Brunborg et al., 2019). To explore the perceived meaning of e-cigar-
(Farrimond, 2017; Tokle & Pedersen, 2019; Measham et al., 2016). ettes and vaping, a sizeable sample from six schools from geo-
Meanwhile, a translation of an inscription might be to decrease the graphically and economically dispersed areas were recruited to parti-
availability of flavours in vaping devices. A relatable example from the cipate with one 8th grade class each. Two schools were located in the
tobacco field are the translations of the inscription of cigarette packets, north (N), two in the south-east (E) and two in the south-west (W) of
through plain packets and the increased size of health warnings, in Norway. The abbreviations of region (N/E/W), together with school
order to try to decrease package appeal (McNeill et al., 2017). number (1/ 2), are used in the findings to clarify the geographical lo-
While ANT's strength is making objects participants in the course of cation of each participant. In addition, two schools were rural, while
action (Latour, 2005 p.70), the IR perspective provides a supplementary four were located in urban areas. The analysis is based upon four
analytical tool for investigating adolescents’ notion of the sociability of rounds of group (T1, T2) and individual interviews (T3, T4) with the
vaping. Collins (2004) partly meets Latour (2005) in acknowledging the participants from 2015 to 2019. Experienced qualitative researchers
importance that material objects can have in an IR. Membership (the author being one of them) conducted all interviews.


R. Tokle ,QWHUQDWLRQDO-RXUQDORI'UXJ3ROLF\  

Data collection and sample and how these products acted on and integrated into the participants’
practices (Latour, 2005; 2004), whilst IR (Collins, 2004) offered an
A pilot study was completed 1 year ahead of the main study sche- analytical tool to investigate how the symbolic meaning of e-cigarettes
dule and informed decisions concerning the timing and balance of in- and vaping played out in the sample. In addition to the coded interview
dividual and group interviews, group sizes and composition. The pilot transcripts, field notes contributed to the analyses in providing context
class (n = 13) is included in the overall sample, except at T2 due to to each interview, as well as to changes over time.
incomparability with the main study, as the first pilot follow-up was The study was approved by the Norwegian Data Protection
carried out with the participants at a younger age and conducted as Authority (reference no.:15/01495). Both parents and the participants
personal interviews. Group interviews were selected at the two first gave their active informed consent. Identifying information, such as
time points in the main study based on the participants’ young age at names and locations, was replaced with pseudonyms.
study onset.
At baseline (T1), spring semester 2015 (main study), 26 semi- Findings and analysis
structured group interviews were carried out with 118 (58) boys and
(60) girls, in 8th grade, age 12-13. First follow-up (T2), fall semester Vaping's symbolic journey from “transgressive” to “childish”
2017, 24 group interviews (n = 85), was conducted when the parti-
cipants were aged 14-15 years. Time 3 (T3), spring semester 2018 Outlined in three phases, the analysis shows the gradual and col-
(main study), was conducted as individual interviews (n = 95), when lective shifts in the agency of e-cigarettes and the social meaning of
the participants were in 10th grade, age 15-16. Finally, Time 4 (T4), vaping in a group of Norwegian adolescents over four years. First, I
spring 2019 (main study), was completed as individual interviews present how the adolescents’ accounts were marked by a distance to the
(n = 80) when the participants were 16-17 years old and in their first vaping phenomenon. Second, I show how this distance was replaced by
year of high school (for more details, see Brunborg et al., 2019). perceptions of vaping as a cool and established practice. Third, at T3, I
T1-T3 interviews were carried out at the schools during school show how vaping was suddenly perceived as a marginal activity, and
hours. At T4, the interviewees were contacted individually. Interview how, at T4, the collective negotiated meaning of vaping as an uncool,
locations were decided based on participants’ preferences, ranging from out-group practice was further established. Findings are presented with
school areas, cafes and the interviewees’ homes. Interviews lasted on awareness of the transitional context, and with attention paid to both
average between 45 and 60 minutes. All interviews followed a semi- the mediating role of the technological objects (e-cigarettes) inspired by
structured guide, in which participants were questioned about e-ci- the logic of ANT and the collective dimension of vaping through the
garettes, first in the form of general questions on their knowledge of e- lens of IR.
cigarettes and use among peers, then personal experience. Those with
lived experience were asked to elaborate on initiation, practices and Technology, novelty and transgression
exposure, such as: when, why, where, with whom, type of device, ni- At baseline, the 12-13 year old participants had recently made their
cotine exposure and user patterns. In addition, both pupils who had transition from elementary school to middle school, and described
vaped and those who had not were encouraged to elaborate upon how ambivalence about their new role as “more mature” and “no longer
they perceived e-cigarettes and vaping. Field notes were written up playing” in the school playground, as well as being the youngest in the
after each interview, providing additional contextual data on aspects school peer culture.
such as environment and appearance. When asked about e-cigarettes, most had heard about them, but few
Attrition is a challenge in longitudinal studies (Farrall, Hunter, had personal experiences of vaping. The inscription and the novelty, in
Sharpe & Calverley, 2015). 118 students were interviewed at T1 to terms of the product not yet being “black-boxed” as in normalized and a
ensure an adequate sample size throughout the study. Because of ad- matter of indifference (Callon & Latour, 1981, p. 279), were present in
ministrative recruitment issues, 20 participants were lost from T1 to T2 the way they talked about e-cigarettes by actually describing what they
(pilot class included). Learning from these experiences, the attrition were, as when Bjoern (T1.W1) stated: “it's vapour, it's a vapour device”. In
was minimized to 3 participants at T3. T4 recruitment was organized these accounts, a level of unfamiliarity was typically visible:
outside the school context, which increased the effort to partake in the
E-cigarettes? That's like those fake smokes, isn't it?” (Jorunn T1.N2),
study. Although all participants were contacted personally, 15 were lost
“E-cigarettes? That's vapour, right? Electronic ones? (Frank T1.W1).
from T3 to T4. All had changed schools, some had moved away, one
had died. However, the selective attrition was kept to a minimum in From an ANT perspective, the way many replied in the form of a
that the heterogeneity in the sample was maintained, in terms of question highlighted the weak connections between the human and
gender, location and inclusion of vulnerable participants. nonhuman actants (Latour, 2005). From a IR perspective
(Collins, 2004), e-cigarettes seemed to have little membership sig-
Thematic analysis nificance. This distance was also evident in their accounts of being
exposed to vaping by adults who used e-cigarettes for smoking cessa-
All interviews were audiotaped, transcribed verbatim and system- tion typically in the form of: “My mum's boyfriend had one because he
atically sorted using the HyperRESARCH software. Two researchers used to smoke” (Kjersti T1.N2); or “Mum bought one last year to quit
coded one third of the interviews to ensure that ambiguity in meaning smoking” (Cecilie T1.N1).
was kept to a minimum. Coding involved developing a codebook con- In line with the quotes by Kjersti and Cecilie, vaping was primarily
sisting of 15 e-cigarette-related codes based on predefined themes from described as a means of quitting smoking, in accordance with the ori-
the interview guide, such as ‘perceptions of e-cigarettes’, ‘own experi- ginal inscription (Latour, 1987), and hence as a practice detached from
ence’ and ‘perceptions of vapers’. Thematic sub-codes such as ‘relative their peer culture. However, a level of appeal was evident in the way
risk’ ‘flavours’ and ‘symbolic meaning of vaping’ were developed and some mentioned flavoured e-liquids. One of them, Halvor, eagerly
added during the process of closely reading the transcripts. Data was talked about his first encounter with e-liquids after a visit to a store in
initially thematically analysed based on the above-mentioned codes. Spain:
After rounds of sorting and comparing codes, both for each code and
(…) they had tobacco flavour, weird ones mixed with various flavours,
time point, a pattern became evident in the large material in respect of
and there was Coke and Red Bull flavour – and you can probably find
how e-cigarettes and vaping changed their meaning for the participants
them with cannabis-flavour and many more (Halvor T1.W2).
over the study years. The ANT perspective guided the analysis process
by increasing attentiveness to how they reported on the vaping devices, The range of flavours seemed to increase curiosity by creating a


R. Tokle ,QWHUQDWLRQDO-RXUQDORI'UXJ3ROLF\  

“wow” effect, highlighting another side of e-cigarettes’ inscription transgression and opposition.
(Latour, 1987) as well as their novelty in the period. Flavours were also
mentioned relative to conventional cigarettes, by way of increasing the Vaping in focus: Performance, experimentation and social status
attractiveness of e-cigarettes, as expressed by Roald: A second phase emerged at T2, as the now 14-15 year old inter-
viewees had entered 10th grade and become the oldest pupils in middle
I think e-cigarettes are cooler. It sounds cool to use, to breathe out wa-
school. The two years that had passed had not only caused a visible
termelon-smoke, just without the harmful substances in it, but it's not like
physical transformation, the interviewees had also matured in their way
I want to order it (Roald T1.N1).
of speaking. Somewhere along the move towards increased status in the
Roald stood out in the group interview due to his oppositional, too- school hierarchy, a transition from perceptions of, to experience with,
cool-for-school attitude, where he refused to take his headset off during e-cigarettes had occurred for many. One-third now reported having
the interview. In line with Roald, several interviewees reported ado- used vaping devices themselves.
lescents’ rationales for using e-cigarettes as being related to perceived Arvid expressed it in a typical manner: “I think most have tried them,
harmlessness, with emphasis on the lack of nicotine, and perceptions of especially my friends” (Arvid T2.W1). Vaping seemed especially to ap-
vaping as cool. Halvor said: peal to boys, but not just boys, as Jorunn specifically pointed out: “Most
have tried them, even many of the girls” (Jorunn T2.N1). Hence, the
I want to start with e-cigarettes, with strawberry flavour, but without
connections between the human and nonhuman objects had now
nicotine. I have seen it on YouTube. Those making rings out of the mouth.
strengthened (Latour, 2005).
You can practise and stuff (Halvor T1.W2).
The increased focus was also evident in terms of where they were
Halvor linked his curiosity to exposure on social networking sites used, such as Kjersti and Stian stating: “Many have used them on the
(SNS), and asserted what the vaping devices allowed him to do. SNS school bus” (Kjersti T2.N2), and: “We used them on this school trip, in our
emerged as an important translator in the network between curious rooms” (Stian T2.E2). Such observations were associated with an evol-
adolescents and the vaping product, as several described learning about ving IR (Collins, 2004), but also pointed to the agency of vaping de-
e-cigarettes from sources online. Moreover, Katrine said: “I think young vices, in that, compared to conventional cigarettes, they seemed to open
people use them to appear cool” (Katrine T1.N2). Using e-cigarettes to up alternative spaces for use. Moreover, Marit talked about how e-ci-
enhance one's image as ‘cool’ has previously been identified as a feature garettes were passed around in social settings and, addressing her own
of young people's use in a UK study (Hardcastle et al., 2014). experience, she said, “I just tried it from my friend, I don't have my own”
Whether located in the north, south-east or south-west of the (Marit T2.W2). By pointing to how these products were easy to share,
country, the minority with positive attitudes, such as Roald and Halvor, Marit highlighted another aspect of the e-cigarettes’ inscriptions
shared some similarities. They were most often boys; they exhibited a (Latour, 2005) in that they were not perceived as exclusively personal,
level of opposition towards authority and seemed to value a ‘tough rather they emerged as membership symbols in a social practice
image’ in their way of dressing and talking of not caring for school, (Collins, 2004).
together with a level of curiosity towards substance use. Such opposi- Importantly, the vaping practice was typically presented in the form
tional denotations of vaping were echoed in the general sample: of: “I have tried them, but just like one puff of an e-cig without nicotine”
(Egil T2.W1). The participants generally described experimentation,
I have seen this girl, a 9th grader, she has started vaping. She often hangs
motivated by an urge to ‘give it a try’, echoing previous findings of use
out in the city late. I even heard her talk about alcohol (Erling T1.E2).
among young people (Hardcastle et al., 2014). Similarly to Egil, Steffen
Erling paired vaping with boundary-testing activities. The trans- said: “It's without nicotine, for me that's the whole point of e-cigarettes”
gressive status of vaping became visible in the way several participants (Steffen T2.N1). Overall, few described a steady user pattern and few
connected its use to those seemingly perceived as tougher peers. Trond vaped with nicotine. On the contrary, non-nicotine-containing e-liquids
expressed it like this: and vaporizers were presented as part of the attraction.
Interlinked with their preference for non-nicotine vaping, conven-
The 9th and 10th graders use them at school, they don't even care,
tional cigarettes held low status among the interviewees. Several ap-
especially not the ones sitting in the chief coach [referring to the spot
plied symbolic boundaries, by describing their use of vaping devices as
reserved for pupils at the top of the school popularity hierarchy], they just
“something else” than smoking:
sit there and barely bother to attend classes (Trond T1.N1).
No one uses e-cigarettes to quit smoking, it's just to do tricks and
In Erling's and Trond's accounts, vaping was associated with a se-
have fun (Dennis T2.W1).
lected group of oppositional peers. Hence e-cigarettes’ cool connotation
in the hands of adolescents emerged as interlinked with a symbolic Dennis’ quote is representative, as no-one in the sample reported
meaning signalling both counterculture and opposition. Moreover, this addiction or substitution as a motive for using e-cigarettes. Moreover,
symbolic meaning seemed to connote transgression in line with what Aksel expressed it like this:
has previously been identified with the smoking ritual (Turbin, Jessor,
E-cigarettes are much more common than normal cigarettes for people
& Costa, 2017), but with a renewed focus on the performance. Hence,
our age (Aksel T2.W1).
drawing on Collins (2004, p. 49), the majority of the participants re-
served the focus on e-cigarettes to selected groups of ‘others’, namely Many justified their experimentation by pointing to the perceived
the adult smokers or oppositional peers. In addition, following Latour lack of health hazards. As Steinar stated: “It's exciting and at the same
(1987; 2005), these descriptions implied an altered inscription of the time it doesn't seem dangerous” (Steinar T2.E2). The way the interviewees
technical object for some, as the smoking substitute for adults trans- described their vaping as ‘not containing nicotine’, not in the form of
lated to an object that also could act on young people within the net- established and regular user patterns, and not in order to substitute
work of SNS and oppositional peers. smoking, distinguished the vaping practice of the young interviewees
In summary, it was the novice perspective on both the school con- from how they presented vaping among adults in the first phase. These
text and e-cigarettes that marked the first phase. The 8th graders ex- accounts of using e-cigarettes as a product in its own right, rather than
pressed a general distance to the vaping phenomenon, and presented for nicotine, also point to e-cigarettes’ weak inscriptions (Latour, 1987)
the object primarily as a smoking-cessation tool for adults. Few had and a translation of the technical invention (Latour, 2004, p. 33), as
tried vaping, and few reported detailed knowledge. The ones with in- their perceptions break with those of the original conception of e-ci-
sight expressed some curiosity, and associated the social meaning of e- garettes as a smoking substitute.
cigarettes in the hands of adolescents with novelty, appealing flavours, Awareness of the technology part of the device and appeal in terms


R. Tokle ,QWHUQDWLRQDO-RXUQDORI'UXJ3ROLF\  

of flavours were also more present: and IR helped identify drivers for use, as the e-cigarettes weaved in and
interacted in peer networks and SNS (Latour, 2005, p. 68), while the IR
I have one which looks like a big pen with a tank where you can
dimension was present in the increased focus (Collins, 2004) and the
refill the liquid, most often vanilla, and then you just push the
performance vaping in this phase.
button and vape. (Roald T2.N1)
In summary, vaping among the 14-15 year olds emerged as an ac-
Roald was attentive to the technological and visible features of his tivity one third of the sample played with for its performance, status
vape pen. Echoing previous findings (Measham et al., 2016), the in- and flavour aspects. In addition to talking about the amusing possibi-
terviewees with lived experience, similarly to Roald, also expressed lities of learning new tricks, e-cigarettes in the overall sample seemingly
clear preferences for sweet or fruity flavours, such as peach, tutti-frutti, held a position as something new – but not too harmful; transgressive –
apple, grape, strawberry, vanilla and Red Bull. but not too boundary breaking.
The increased focus on vaping was also demonstrated when the
participants talked about user motives, in these terms: “It's fun and it's “Unpopular and childish”: Processes of devaluation
the flavours” (Anikken T2.W2), “I use it to make rings” (Bjarte T2.N2) and A third phase became evident at T3. The now 15-16 year old par-
“It's like a hobby” (Sturla T2.W1). ticipants were about to graduate from middle school. Many reported
In line with Anikken, Bjarte and Sturla, the interviewees typically being tired of their present school setting, reading for exams, paralleled
related the experimentation to curiosity and performance, by high- with strong expectations of the coming transition to high school.
lighting how the devices enabled them to act and engage in a practice. Interestingly, in the nine months that had passed since T2, they also
However, the greatest focus of attention seemed to be on the ritual seemed to have grown tired of e-cigarettes.
preparation (Collins, 2004, p. 319) of vaping more than on the vaping
E-cigarettes? They were popular a year ago but I rarely see them
itself (Yule & Tinson, 2017). Johannes explained:
anymore (Jetty T3.N2).
I do tricks. You have all that vapour that allows you to do tricks, for
As expressed by Jetty, processes of devaluation of e-cigarettes
example with your tongue. There is this trick called the tornado. You
marked the interviews. Jorunn stated similarly:
blow all the smoke down, and then you do like this [illustrates with
his hands and his mouth] and two lines come up, and you make Before Christmas there were many who vaped. I guess they used
rings, that's why I do it, not in order to vape, but because it's cool to them to get status, to appear cool and like they did not care. Now it
do tricks (Johannes T2.W2). seems like no one uses e-cigarettes (Jorunn T3.N2).
In the above excerpt, the agency of the e-cigarette (Latour, 2005) is From the interviewees’ accounts of vaping as cool and transgressive,
visible as Johannes states that ‘the vapour allows him to do tricks’. e-cigarettes had undergone a symbolic turnaround, and were now
There is, however, also an IR aspect in Johannes’ perceptions of the predominantly described as ‘pointless’ or ‘childish’. Ulf talked about the
‘cool’ play and performance features of vaping, evident in the way he change in perceptions in a representative way:
expressed subcultural argot and displayed vape competence by de-
I had one of those cheap shitty ones without nicotine, but I don't see
scribing the ‘tornado’ trick.
the point, really, it was supposed to be cool because of all the va-
The IR aspect of vaping was also evident in the way adolescents
pour, but seriously, no one uses e-cigarettes anymore, except per-
translated a symbolic and social dimension of coolness to the practice of
haps for some younger ones (Ulf T3.N2).
vaping in the second phase. Mats addressed this explicitly: “Most of the
young people who vape, do it in order to appear cool” (Mats T2.W2). The Ulf described his e-cigarette as a low quality product, which in ANT
cool connotation was often interlinked with performance: “I think it terms, no longer acted on him (Latour, 2005), although he did not rule
looks cool, with the possibility to do tricks, those rings for example” (Snorre out that younger adolescents still used these devices. Ulf lived in North
T2.E2). Norway. His perception of the devalued status of e-cigarettes was,
Descriptions of vaping as ‘cool’ highlighted the increased status and however, part of a collective shift in focus (Collins, 2004) echoed in the
ritual aspects of the practise, as “rituals do honour to what is socially wider sample, regardless of gender, personal experiences and geo-
valued” (Collins, 2004, p. 25). In addition to the performance part of graphical location. Lea talked about the shift in focus using the word
vaping, the status was related to novelty, typically in the form: “It's new; ‘hype’:
it provides status to try new things” (Aase T2.E2).
At one point everyone was supposed to do it, but then it just dis-
The 14-15 year olds also associated the increased status of vaping appeared, like a hype that passed (Lea T3.N2).
with vape influencers on YouTube and Instagram.
Dina echoed it by describing the use of e-cigarettes as a passing
You see those people online, crazy people, who make all these vape trend:
tricks, it's cool to watch (Sturla T2.W1).
Now I look at vaping as if it's untrendy. It was a trend, you know,
Sturla talked about how he enjoyed watching vape performances on everybody did it, but not anymore (Dina T3.W2).
YouTube. Regardless of their own experience, the majority reported
The shared and radical change in status seemed connected to the
having watched e-cigarette tutorials or videos of vapers performing
same entangled dimensions of technology and collective mechanisms
tricks on SNS. Hence, SNS also involved exposure to vaping for the
that first made e-cigarettes appealing, namely the novelty. Earlier the
majority who had not used e-cigarettes themselves. Vaping on SNS was
interviewees had connected a certain status to e-cigarettes as the new
however not solely reserved for pro-vapers:
gadget, and of users being “in the know” (Thornton, 1997) through
Many people share videos of themselves performing vape tricks, possessing or using e-cigarettes. However, when status is linked to the
blowing rings and stuff. I see it on Instagram and My Stories all the novelty of the product, as well as to older peers, the product's appeal
time. It's very like; “I vape, that's cool” sort of (Ida T2.W2). can fade as the product becomes established and they come of age. This
mechanism seemed to affect the perceptions and meaning-making of e-
In line with Ida's observations of vape content from peers on SNS,
cigarettes in the sample. By way of illustration, Arvid talked about e-
several described sharing their own vape videos and pictures. The
cigarettes in a manner that connoted an old toy:
practice of adolescents distributing content of themselves vaping on
SNS emerged as a self-presentation strategy that most perceived as It was a thing you used to play with, but then it just became boring
socially rewarding. Moreover, it demonstrated how drawing on ANT (Arvid T3.W1).


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In general, e-cigarettes were now denoted as something they had compared vaporizers with out-of-fashion fidget spinners illustrated the
grown tired of – similar to the fast fading glory of new toys. It was continued weak connections (Latour, 2005) between e-cigarettes and
evident that the intriguing aspect of e-cigarettes had been related to the the participants. Brita contributed additional information through ret-
translations made possible by these products’ weak inscriptions rospective reflections:
(Latour, 1987); the options of customization, flavours and playfulness.
Back when we were in middle school, many brought their e-cigar-
However, the devaluation seemed connected to social dimensions.
ettes into the classroom. I think it was mostly for fun – they used
When Nova discussed the diminished status of vaping, she included
them for the vapour and flavours, but without nicotine. I feel that is
SNS:
something you do when you are younger, because it's the first thing
It was a trend a year ago, when everybody was supposed to have an you test because it is not perceived to be as dangerous as other
e-cigarette and take pictures with it to appear cool, but now it has things. But then you stop, at least if you were born in 04 like me
just flattened out (Nova T3.N2). (Brita T4.W1).
Vaping's presence on SNS hence emerged as important for their Brita similarly addressed temporality in describing how e-cigarettes
shared understanding. Several described the fall in popularity as being had been a way to test and push boundaries in a controlled manner, for
linked with vaping's reduced presence in their social media feeds: herself and her peers in middle school. She also implied that younger
pupils still could find value in vaping, based on the same transgressive
Vaping has become unpopular this year [2018] – it was popular in
mechanisms. Erlend equally emphasised age as an important contextual
2017. Then it was this huge thing, now there is no fuss about it and
dimension, as he differentiated between older and younger adolescents
it's not all over social media anymore (Ida T3.W2).
when asked about use of e-cigarettes:
When asked to elaborate, Ida explained the devaluation process like
The thing with vaping is that it's such an 8th grade thing to do. Lots
this:
of 8th graders buy them, believing it to be cool, however if you vape
People got tired. It is always fun in the beginning to try new stuff, in high school people will tell you that it's so childish (Erlend
and in this case, new ways of blowing smoke, trying new flavours T4.W1).
and such. It's like when you get a new phone, it's cool in the be-
Like Brita, Erlend still connected a symbolic meaning of transgres-
ginning, but then it's soon just an ordinary phone. I think it's the
sion to the vaping ritual for young adolescents, while labelling it as
same with e-cigarettes, you put them away and forget them.
unappealing for young people of his age. Peers emerge as drivers in the
Vaping was denoted a temporal practice now belonging to the past. devaluation process, in line with Collins’ assertion that rituals generate
Ida pointed to how vaping had gone through various stages in a hype situational ranking, between the popular and the unpopular, between
cycle, initially triggered by novelty and social status. Such plasticity of the cool and the uncool (2004, pp. 337-8). In their rejection of vaping,
vaping among young people has been identified in other studies the interviewees seemed to position themselves apart from the un-
(McKeganey, Barnard, & Russell, 2018). Moreover, vaping was com- popular or ‘less mature’ adolescents:
monly reserved for younger adolescents or peers described as ‘out-
That's the thing with e-cigarettes, you know, it passes. It's a thing for
siders’:
middle school pupils and older folks who quit smoking, not for us in
I feel that they are unsocial, it just like a small gang sitting in their high school (Kjetil T4.W2).
room and vaping for themselves. They are excluded from other
Kjetil's quote indirectly points to how the focus on vaping had
people (Anja T3.W2).
changed in the transitional phase of adolescence (Forehand &
Anja described the ones who still vaped in an unflattering manner, Wierson, 1993). Moreover, the stories of how the vaping practice had
highlighting how perceptions of the ritual boundaries of vaping had faded away in this third phase denoted a ‘failed ritual’, deemed by
shifted from that of a valued IR to being perceived as an exclusionary Collins (2004 p. 50) as practices with a “low level of collective efferves-
practice reserved for the out-group. Mats echoed this: cence”.
In summary, the 15-17 year old interviewees established vaping as
Those using e-cigs? It's the douchebags, those who think they are
an activity of the past. Vaping had gone from a symbol of social in-
cool, but who everyone knows are the lame ones (Mats T3.W2).
clusion to one of social exclusion, whereby the interviewees, including
Mats’ quote points to how continued use of vaping at this time in- the vast majority of those with personal experience thereof, distanced
flicted damage on users’ social self (Collins, 2004, p. 32) and illustrates themselves from both e-cigarettes and the practice of vaping, labelling
the importance of peer-impact on adolescents’ vaping. them as childish and unpopular. Their comparisons of e-cigarettes with
trendy toy-gadgets like fidget-spinners highlighted both the translation
Vaping and “fidget-spinners” and the agency of e-cigarettes in adolescent networks, but in the sense
The story of e-cigarettes as out-of-date was collectively confirmed of how these devices had stopped acting on them.
when our participants were interviewed again at T4. They were now
16-17 years old and in high school; many reported increased autonomy Discussion
in that they were treated as more mature in the school setting, and had
less strict rules at home. In addition, many had started experimenting This study is the first extensive qualitative, longitudinal study of
with alcohol and sometimes the occasional party cigarette. Echoing the adolescents’ user transitions and perceptions of e-cigarettes and vaping
T3 findings, vaping, however, was primarily talked about in retrospect. in a restricted regulatory context. The study contributes to the under-
standing of the evolving meaning of vaping devices and usage among
I don't think it's cool. I don't know anyone my age who vapes any-
adolescents. The longitudinal design illuminates changes in the in-
more, even though it used to be popular. It was a middle-school
scription of ‘e-cigarettes’, first as novel objects, which act within a
thing. A trend, like the fidget spinner. Those are not trendy anymore
network with their own independent meaning regardless of the original
either, it just dies out (Gaute T4.W1).
conception, then as discarded ‘old toys’. The study also identifies the
Gaute talked illustratively about the temporality of vaping, by social processes that shape perceptions and experiences of vaping in
pointing to how the symbolic meaning of vaping had turned from adolescence, such as transitions in age, positioning among peers and
trendy to uncool. Gaute included both age and period (Suzuki, 2012) as SNS. And importantly, how these changes interlink with variations in
important translators in this devaluation context. The way Gaute adolescents’ vaping perceptions and practices over time. The


R. Tokle ,QWHUQDWLRQDO-RXUQDORI'UXJ3ROLF\  

development can be distinguished in three phases; first, e-cigarettes can be affected by the regulatory context to a certain degree, but also
were perceived as novel and transgressive. Second, e-cigarettes and unfold outside the control of policymakers. Advertising bans seem, for
vaping held status as appealing, harmless and cool, intertwined with example, to be challenged by online content. Across the sample, the
increased use and performance vaping. In the final phase, the vaping adolescents in our study reported SNS to be an important information
devices no longer acted on them, and vaping was devalued and coined source, both for their initial curiosity, in line with Park and colleagues’
as childish. In summary, e-cigarettes and vaping are identified as a findings (2019), and for the continuous collective process of negotiating
time-limited trend rather than steady user patterns and a successful IR the meaning of vaping. The performance aspect of vaping mimicked by
in the sample. some interviewees in middle school was, for instance, associated with
SNS influencers. Especially at T2, experience, displayed by ‘cloud
Fluidity and experimentation chasing’ and performing tricks (Measham et al., 2016; Tokle &
Pedersen, 2019) interlinked with status, inclusion and competence,
A backdrop for the study was the restrictive Norwegian context and highlighting SNS as an important socio-spatial context of vaping.
the growing public health concern over young people's vaping inter- The social mechanism at play can also be related to adolescence as a
nationally (Gilreath et al., 2016). In the current study, rather than signs transformative, social context (Forehand & Wierson, 1993), and age as
of nicotine-addicted use, as observed in the US (Cullen et al., 2019), a an important driver for change (Suzuki, 2012), evident in the way the
low-intensity and temporal vaping pattern marked by fluidity and ex- participants first connoted vaping with older, tougher peers or adults,
perimentation is witnessed. The evolving meaning of vaping devices then as they devalued vaping as ‘childish’. Moreover, the increased
and usage in the sample constitute use which, on the one hand, is knowledge and prevalence of vaping at T2 may be age-related, since
motivated by non-nicotine devices, lack of addiction, and perceived curiosity, reward-seeking behaviour and wanting to be “in the know”
harmlessness, and, on the other, by status, play and performance. Such (Thornton, 1997) have a special place in middle school
fluid and gradually changing vaping patterns are also found in studies (Steinberg, 2010).
using a longitudinal design in other regulatory contexts, such as the US
study by Hair and colleagues (2019) and in the small UK case-study by Actor-Network and Interaction Ritual
McKeganey and Barnard (2018).
The first phase includes a general distance to the vaping phenom- In line with the logic of ANT, the study also identifies the im-
enon. The 12-13 year olds primarily deem e-cigarettes as smoking portance of nonhuman actants for human practices (Latour, 2005). The
cessation-tools reserved for adults, whilst a minority express curiosity adolescents in our sample adapted a technology designed to aid
related to the products’ novelty and flavours. They also attach a social smoking cessation, and altered its meaning in their social context.
meaning of maturity, transgression and opposition to young people's Latour (2004, p. 234) noted how the effect of an actant depends on its
vaping, corresponding with the insights of Yule and Tinson (2017), use, as “not all rocks are the same”. Latour outlined how objects which,
while also echoing meanings previously identified with young people's on a broad scale, can be labelled the same, still act differently on us – a
smoking (Turbin, Jessor, & Costa, 2017). Moreover, the minority of stone on a ring versus a stone in the shoe. This can be transferred to the
curious adolescents emphasise the appeal of flavours, echoing previous interviewees’ descriptions of vaping devices. The participants with
findings of young people's vaping motivated by varieties of flavours personal experience primarily described vaping non-nicotine liquid
(Measham et al., 2016; Park, Kwon, Gaughan, Livingston, & Chang, from low quality e-cigarettes. None reported use of nicotine-containing
2019). pod-versions like JUULs as found popular in the US (Hajek et al., 2020).
The second phase involves an increase in lived experience among Hence, the decreased interest could be related to their choice – or
the now 14-15 year olds, as well as general accounts of vaping as availability of ‘rocks’. Moreover, they assigned a new meaning to these
popular and vaping devices as appealing, in line with the findings of products, presenting them as toys, in contrast to the original inscription
Hardcastle and colleagues (2014). The novelty and flavours are still of the e-cigarette as a smoking cessation tool (Hajek et al., 2014). In this
present, but in addition performance and status are key aspects, translation (Latour, 1987; 1994), the adolescents created their own
matching the findings of Measham and colleagues (2016). Non-nico- vaping rituals (Measham et al., 2016). Hence, the participants highlight
tine-containing e-liquids and vaporizers are part of the attraction, the independent symbolic meaning of e-cigarettes for young people
perhaps as a way of indicating that these vaping products were not relative to their original purpose (Pokhrel, Herzog, Muranaka, & Fagan,
dangerously acting objects (Latour, 2005) leading to addiction, as they 2015), as a marker of transgression, status and finally stigma. More-
rather seem to delegate more innocent and beneficial actions to them. over, Latour (2005, p. 39) wrote: “No matter how apparently simple a
Vaping's appeal is rather connected to the amusing possibilities of mediator might look, it may become complex; it may lead in multiple di-
learning new tricks, and seemingly partaking in a ritual allowing them rections which will modify all the contradictory accounts attributed to its
to transgress with limited risk. role”. Such shifting directions is evident in the way e-cigarettes were
The third phase represents a symbolic turnaround, as the 15-17 year given agency in the second phase, ‘allowing’ the actors to perform tricks
olds deem vaping to be an irrelevant practice, and hence a ‘failed ritual’ and present themselves. Then, as they were disconnected from the
(Collins, 2004). The former attractions attached to the vaping devices human actors in the third phase, and discarded as old phones and un-
(novelty, status, transgression) are no longer evident, rather distance is fashionable fidget-spinners. Hence, the e-cigarettes interact with the
apparent in the way they label devices and usage as childish and un- adolescents not only in their vaping practices, but also integrate into a
popular. From an ANT perspective, these devices no longer act on them, larger network of consumer practices.
as the practices they enabled are dismissed (Latour, 2004, p. 45). Ra- Collins (2004) meets Latour (1994; 2005) in his conceptions of the
ther they are resorting to an external force (unpopular toys) that has importance of material resources in social practices. The interviewees
little in common with the original translation or ‘purpose’ of the object did not perceive e-cigarettes as particularly personal objects, rather
(Latour, 2004, p. 38). they described the social aspects of how they were passed around,
Similar fluid and gradually changing vaping patterns are identified implying a low-intensity IR taking place (Yule & Tinson, 2017).
in a US study (Hair et al., 2019) and a small UK case-study (McKeganey Collins (2004) describes the relationship between the material market
& Barnard, 2018), despite different regulatory contexts. Moreover, and IR as feedback loops; each is a necessary input into the other. In
McKeganey and Barnard (2018) suggested that the development in correspondence with Yule & Tinson's (2017) findings, the social sides of
perceptions among peer group members was one possible explanation vaping are also driven by the processes of IR. For instance, having an e-
of why adolescents’ perceptions of vaping can rapidly shift. The fluidity cigarette in the initial phases was associated with positive attention, as
may hence indicate that diffusion processes, both in and out of vaping, vaping represented novelty and transgression. Hence, the vaping ritual


R. Tokle ,QWHUQDWLRQDO-RXUQDORI'UXJ3ROLF\  

could socially include the ones who ‘dared’ to try. However, the suc- sample members in a qualitative longitudinal study. International Journal of Social
cessful IR (Collins, 2004) side to vaping simultaneously disappeared as Research Methodology, 19(3), 287–300.
Farrimond, H. (2017). A typology of vaping: Identifying differing beliefs, motivations for
the focus and meaning of vaping in the sample shifted. use, identity and political interest amongst e-cigarette users. International Journal of
The study adds to the literature on vapers as a heterogonous group Drug Policy, 48, 81–90.
vaping for various reasons (see e.g. Farrimond, 2017; Tokle & Forehand, R., & Wierson, M. (1993). The role of developmental factors in planning be-
havioral interventions for children: Disruptive behavior as an example. Behavior
Pedersen, 2019), suggesting a need for targeted public health messages. Therapy, 24(1), 117–141.
Preventing vaping among young people implies a policy of altering the ...Gilreath, T. D., Leventhal, A., Barrington-Trimis, J. L., Unger, J. B., Cruz, T. B., Berhane,
translations, to use Latour's (1994) terminology. This could involve K., & McConnell, R. (2016). Patterns of alternative tobacco product use: Emergence of
hookah and e-cigarettes as preferred products amongst youth. Journal of Adolescent
implementing regulations that prevent access to low-cost vaporizers Health, 58(2), 181–185.
and appealing flavours online and maintaining restrictions on products Goniewicz, M. L., Hajek, P., & McRobbie, H. (2014). Nicotine content of electronic ci-
with high likability such as JUULs in this age group. Importantly, the garettes, its release in vapour and its consistency across batches: Regulatory im-
plications. Addiction, 109(3), 500–507.
fluidity of adolescent's perceptions and vaping practices emerged as
Hair, E. C., Romberg, A. R., Niaura, R., Abrams, ... Vallone, D. (2019). Longitudinal to-
largely influenced by their shifting focus in peer networks and SNS. bacco use transitions among adolescents and young adults: 2014-2016. Nicotine and
Hence, the important connection between symbolic meaning and use Tobacco Research, 21(4), 458–468.
seems largely to be governed within the adolescent population itself. Hajek, P., Etter, J. F., Benowitz, N., Eissenberg, T., & McRobbie, H. (2014). Electronic
cigarettes: Review of use, content, safety, effects on smokers and potential for harm
and benefit. Addiction, 109(11), 1801–1810.
Conclusion Hajek, P., Pittaccio, K., Pesola, F., Smith, Myers, Phillips-Waller, A., K., & Przulj, D.
(2020). Nicotine delivery and users’ reactions to Juul compared with cigarettes and
other e-cigarette products. Addiction. https://doi.org/10.1111/add.14936.
In this study I have found evidence that e-cigarettes or vaping de- Hardcastle, K., Hughes, K., Worsley, J., Bennett, A., Ireland, R., & Sweeney, S. (2014).
vices can represent fashionable experimentation rather than steady user “Most people I know have got one”: Young people's perceptions and experiences of
patterns. Overall, these findings add to the existing literature on vaping electronic cigarettes. Liverpool: Centre for Public Health, Liverpool John Moores
University.
in adolescence by acknowledging both the importance of the innovative ...Huang, J., Duan, Z., Kwok, J., Binns, S., & Emery, S. L. (2019). Vaping versus JUULing:
features of vaping devices, and the evolving symbolic meaning of How the extraordinary growth and marketing of JUUL transformed the US retail e-
vaping in peer groups for usage in adolescence. cigarette market. Tobacco Control, 28(2), 146–151.
Latour, B. (1987). Science in action: How to follow scientists and engineers through society.
Cambridge, Mass.: Harvard University Press.
Declaration of Competing Interest Latour, B. (1994). On technical mediation. Common Knowledge, 3(2), 29–64.
Latour, B. (2004). Why has critique run out of steam? From matters of fact to matters of
concern. Critical Inquiry, 30(2), 225–248.
The author declares no conflicts of interest. Latour, B. (2005). Reassembling the social: An introduction to actor-network-theory.
OxfordNew York: Oxford University Press.
Acknowledgements Lundberg, C. S., Kvaavik, E., & Tokle, R. (2019). Nye bruksmønstre i et tobakksmarked i
endring–kombinert bruk av sigaretter, snus og e-sigaretter blant ungdom. Nordic
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This project (2015/FO5245) has been funded by the Dam McKeganey, N., & Barnard, M. (2018). Change and continuity in vaping and smoking by
Foundation. I would like to thank Janne Scheffels and Kristin Buvik at young people: A qualitative case study of a friendship group. International Journal of
Environmental Research and Public Health, 15(5), 1008.
NIPH for their valuable support and helpful comments. I am also McKeganey, N., Barnard, M., & Russell, C. (2018). Vapers and vaping: E-cigarettes users
grateful to the editor and the anonymous reviewers whose suggestions views of vaping and smoking. Drugs: Education, Prevention and Policy, 25(1), 13–20.
improved the article from the first draft. Dam Foundation (earlier called McNeill, A., Gravely, S., Hitchman, S. C., Bauld, L., Hammond, D., & Hartmann-Boyce, J.
(2017). Tobacco packaging design for reducing tobacco use. Cochrane Database of
Extra stiftelsen) have 38 members, all voluntary health and re- Systematic Reviews(4).
habilitation organisations based in Norway. The foundation support Measham, F., O'Brien, K., & Turnbull, G. (2016). “Skittles & Red Bull is my favourite
free research and receives part of the profit the national lottery in flavour”: E-cigarettes, smoking, vaping and the changing landscape of nicotine con-
sumption amongst British teenagers–implications for the normalisation debate. Drugs:
Norway, Norsk Tipping. Education, Prevention and Policy, 23(3), 224–237.
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