QMJC September 2022: The relationship between vaping and smoking among adolescents

For their 5th contribution to the Qualitative Methods Journal Club, faculty and doctoral students from Drexel University’s Dornsife School of Public Health met to discuss an academic article exploring the relationship between vaping and smoking among a cohort of young people. The group talked about how the study challenged the ‘gateway’ theory of substance use, and instead applied the sociological concept of substance use ‘careers’ to describe intentional decisions and pathways, rather than just passive or random patterns of use.

Six members of Drexel University’s Dornsife School of Public Health, Department of Community Health and Prevention, convened via Zoom for a one-hour discussion on 29 September 2022.

Article summary

The article investigated the relationship between e-cigarette use (‘vaping’) and tobacco smoking among a cohort of adolescents, with a particular focus on unpacking the ‘gateway theory’. The proliferation of vaping among young people is of particular public health concern since it may re-normalise cigarette smoking, which is on the decline, or encourage young people to initiate cannabis use.

The study employed a qualitative longitudinal methodology, which consisted of recruiting a sample of 14–18-year-olds from Leicester, England (36 young people participated), and interviewing them twice across a period of 6–12 months. Notably, the results disrupted the conventional notion that vaping leads to smoking or vice versa. Rather, qualitative accounts suggested that vaping and smoking may represent distinct types of substance use ‘careers’ among young people.

Discussion

Members of the group liked the interrogation of the gateway construct and its application to the vaping/smoking context, since the gateway is often associated with cannabis and other drug use. The authors noted that the gateway theory has a political (as opposed to scientific) origin and is a popular theory among laypeople. Moreover, a close examination of this theory is useful in itself because the gateway has been used to justify so many ‘War on Drugs’ policies in the US and elsewhere.

Some also liked the application of the sociological concept of ‘careers’ to trajectories of substance use. Rather than conventionally applied as a person’s progression in a job or their employment history, careers can accurately describe decisions and pathways among people who use substances, including vaping and tobacco smoking, that result in achieved outcomes rather than just passive or random patterns of use. Hence, a career approach was viewed as a more nuanced and individualised way of understanding trajectories of substance use compared to the gateway theory.

Members thought that the use of longitudinal qualitative methods was well-conceived, since qualitative methods are particularly adept at unpacking relationships between quantitative variables and statistical relationships. For instance, vaping and smoking are conventionally viewed as linked or associated, which then becomes the end of the story. In this study, however, qualitative narratives revealed multi-directional connections between vaping and smoking, and pointed to broader themes, including risk behaviors and experimentation, consumption practices, and youth culture.

For instance, a quote by one participant described a transition between vaping and cigarette smoking that was not a simple gateway transition. He tried vaping prior to the first interview and while he moved on to smoking cigarettes and cannabis by the second interview (and had quit vaping which he viewed as ‘pointless’), he attributed the new practice to a new group of friends who all smoked cigarettes. Hence, while vaping did precede cigarette smoking in this case, one did not ‘lead’ to other as one might infer if viewing the two variables quantitatively and without the broader context.

The study sampled 14–18-year-olds, which is often a difficult age group to access due to ethical considerations and restrictions that seek to protect research subjects. However, since initiation of vaping, cigarettes, and cannabis often occurs between 14–18 years of age, studying this age group was felt to be crucial. Moreover, it was pointed out that gaining perspective on the early connections between vaping and cigarettes as they happen from this age group may be particularly rich and insightful compared to sampling young adults, which would elicit retrospective accounts about their adolescent substance use.

Members also liked the structure of the article. While it started out conventionally arranged – beginning with ‘Background’ and ‘Methods’ – the ‘Findings’ section was embedded with a combination of both qualitative narratives plus discussions of theoretical and methodological implications from these results. Members thought this structure worked better than the discrete ‘Findings’ and ‘Discussion’ sections found in other qualitative articles, which can sometimes decouple a rich qualitative quote from its theoretical implication.

In summary, members viewed this article as a good example of how to integrate theory and qualitative methods to challenge and unpack one of the orthodoxies in the field of substance use: ‘gateway theory’. While vaping and cigarette smoking may be linked in particular individual cases, this article demonstrates that the connection is by no means inevitable or necessarily causal, which is an important contribution to both the fields of substance use and public health.

by Dr Stephen Lankenau

The opinions expressed in this post reflect the views of the author and do not necessarily represent the opinions or official positions of the SSA or the author’s academic institution.

The SSA does not endorse or guarantee the accuracy of the information in external sources or links and accepts no responsibility or liability for any consequences arising from the use of such information.