Use of e-cigarettes among young queer men living in Aotearoa New Zealand

Keywords: behaviours, electronic cigarettes, marketing, nicotine, perceptions, queer, sexual minority, vaping.

Electronic cigarettes (hereafter ECs) have been commercially available in Aotearoa New Zealand (NZ) since 2016,¹ and have been incorporated into NZ’s comprehensive end-game-oriented tobacco control strategy.^2–4 In the context of unregulated advertising and promotion, the uptake of ECs in NZ has risen substantially, nearly doubling since 2019.^2,5,6 Online social media campaigns have proliferated, with paid sponsorship from vape retailers, point-of-sale advertisements and social media influencers all playing their part in the normalisation of vaping.^7,8 The promotion of ECs in a context of weak regulation raises concern about collateral impact on young people and marginalised communities.^9–11 The introduction of the Smokefree Environments and Regulated Products (Smoked Tobacco) Amendment Act, which was introduced in January 2023, responds to this concern by restricting access to products, in particular disposable vapes, for young people and non-smokers – while enabling access for smokers who want to quit.¹² The impact of this legislation on vaping among people is unclear.

Queer-identifying people are reported to use tobacco and to vape at higher rates compared to mainstream populations.^4,13 Community studies have found 10% of transgender people and 13% of gay and bisexual men (GBM) to be daily smokers.¹⁴ A recent study from NZ identified that gender diverse teens were three times more likely to vape than non-gender diverse teenagers,⁴ and 22.4% of surveyed GBM in 2020 reported having used e-cigarettes in the last 6 months.¹⁵ This brief report describes experiences of, and drivers to use of, ECs among queer-identifying young people living in NZ.

A series of focus-group discussions with queer-identifying men were hosted via the Zoom platform between August and October 2021. Participants were recruited through snowballing methods by the dissemination of study flyers via online social networks and community groups including rainbow networks. Inclusion criteria included self-identifying as queer, living in NZ, aged under 30 years and being a smoker and or vaper.

Focus group discussions were based around a semi-structured interview format to cover pre-identified topics but with flexibility to allow for new issues to be explored. Groups were conducted at the convenience of the participants, lasted up to 2 h and were audio-recorded. During the focus groups, participants were asked a range of open-ended questions around their identity, previous tobacco use, use and role of ECs in their daily lives and views on possible initiatives to curb vaping (for those who wanted to quit). Interviews were transcribed verbatim and an inductive analysis was conducted to identify key themes emerging within and across the interview data. The coding software Quirkos was used to support textual data management and inductive analysis. This study was approved by the University of Auckland Human Participants Ethics Committee (UAHPEC22654).

Twelve participants were interviewed in two focus groups. The median age was 23 (range: 19–29 years). All except three participants described themselves as regular vapers, the others, social (infrequent vapers); and all except three were cigarette smokers or former smokers. All participants identified themselves as queer; one participant identified as non-binary, all other participants were cis-gender male.

Our results indicate several strong themes that connect participants’ experiences of using ECs. Participants discussed how vaping was a highly acceptable social activity and a ‘normalised’ activity within their own queer community. Some participants noted that their queer friends were more likely to vape compared to their non-queer friends. Two participants also mentioned that people naturally assumed they would vape because they were gay.

When I think about my queerness, most of my queer friends are vaping and then its most of us queer men in a room vaping. (Asa)

Participants discussed their experiences and observations of vaping within their community as a highly acceptable social activity, synonymous with relaxing and socialising. Others in the groups spoke of their proclivity to share vapes with their queer friends and as an entry point to interact with strangers in a designated smoking area. These areas that are considered undesirable and off-limits to non-smokers/non-vapers offer social benefits to vapers. These protected spaces are the exclusive enclave of vaping without dealing with what is described as a negative ‘vibe’ from non-smokers. In essence, although vaping was perceived to be more socially acceptable than smoking, some felt judged by non-smokers and non-vapers.

Perhaps unsurprisingly, given the strong marketing and uptake of ECs as a means to quit (eg ‘making the switch’), vaping was universally considered a ‘healthier’ option compared to tobacco use. Use of ECs started during early adulthood, most commonly after trying vaping with their friends, whereas for a few EC use started because of a desire to cut down on the costs and health implications of tobacco use. Vaping was seen as a relatively low risk, and comparatively ‘healthy addiction’. However, this perceived relative safety (and social acceptability) meant that vaping had few drivers for self-regulation.

…because like my parents were saying, […] ‘I don’t want to kiss an ashtray’. The same doesn’t apply to a vaper. I don’t mind kissing someone and getting the taste of peach in my mouth. (Luke)

Participants reported that maintaining a healthy lifestyle is often considered synonymous with the queer community, or at least some sub-tribes within the community. Several participants reported that they see vaping as a healthier, cleaner and more palatable option. In particular, vape products, with their range of sweet and fruit options, were more socially acceptable. Most participants perceived the smell of vapour as ‘less offensive’ compared to cigarettes and was therefore more acceptable for indoor settings. Importantly, vaping was seen as fun, a source of pleasure, perhaps unlike cigarette use which is subject to social derision.

Vaping was also referred to as a ‘social enabler’, a distracting activity, easing interactions and opening up dialogue.

For me vaping, I don’t know, just helps like calm myself or take the edge off things like sometimes I could feel awkward in social situations like when I’m with my boyfriend or something like that, I don’t know maybe vaping helps with that kind of thing. (Ben)

Vaping was also widely appreciated among the group for its convenience and broad social acceptability. For the majority of participants, vaping was perceived to provide in-the-moment respite from the pressures synonymous with being an ‘outsider’ in a heteronormative society. Participants reported feeling awkward about being ‘out’ with their partner, or openly queer, particularly in social settings where they were a minority.

Yea like if you are out waiting for someone, if you sit at a park bench it’s easier to have your phone and a vape. Especially if you are waiting for your date to show up, you instantly feel less awkward. You look less out of place. You look like someone having a chill. (Luke)

Drivers to vaping were perceived to be a means to coping with stress, fitting in and feeling accepted. Moreover, within some queer communities the social pressure to confirm to an aesthetic physical ideal makes nicotine vapes appealing.

I just vape when I’m stressed full stop. I am definitely using my vaping as an emotional support vape is what I like to call it so whenever I’m stressed about something, I’m like arghh no I’m going to go for a walk with my emotional support vape. (Mo)

Furthermore, the relative ease of vaping in social settings translated into an increase in nicotine consumption, raising concern among some participants about potential dependency on vaping. Yet, when asked if they would be interested in queer specific cessation support, there was little interest. Queer-targeted programmes created by mainstream health providers were particularly unappealing, with some likening this idea to corporate ‘rainbow washing’ (the superficial adornment of a rainbow to signify solidarity with Rainbow communities).

Yeah, also what really is the reason that queer men smoke more? If it is additional stresses or social stresses that they are put on to them then that is not an issue for Quitline to solve. It is an issue for - I don’t know who, but not Quitline, it just does not feel right to me if there was a queer specific smoking cessation programme from Quitline. (Mo)

Vaping uptake in NZ has escalated partially in response to the unregulated promotion of ECs by tobacco companies, retailers and the Ministry of Health. This exploratory study describes the role of ECs for young queer men in NZ. Our study found that vaping plays an important role in the lives of young queer men, with associations with identity formation, belonging and going-out, and is both highly acceptable and normative. Doxbeck (2020) describes the concept of inter-minority stress as experienced among people who identify as queer; it is possible that vapes offer perceived remedial support.¹⁶ Vaping also shares very similar drivers to use as for tobacco, but with the additional assets of convenience, accessibility, appealing flavours, social acceptability and perceived reduced harm This study also found vaping to be widely accepted as the ‘healthier’ alternative to tobacco, while offering some of the benefits of mood and appetite regulation. This is despite public perception of vaping being far from a benign alternative to tobacco smoking.

It is clear that more needs to be done to address the convenience, accessibility, appeal and perceptions of reduced harm of ECs, particularly within the queer community. Healthcare professionals, including primary care professionals, are well positioned to actively engage with young people about EC use. Effective smoking cessation strategies already employed by primary care and community organisations supporting the queer community should be broadened to include ECs. The study findings also have implications for wider policy and regulation of ECs to prevent uptake among non-smoking queer people. As the Smokefree Environments and Regulated Products (Smoked Tobacco) Amendment Bill bans the sale of tobacco to a ‘smokefree generation’ born after 1 January 2009,¹² there is keen interest on the impact this will have on reducing young non-smoking people from starting vaping.

Our findings support others work on the impact of the unregulated vaping industry. A recent retail and hospitality site reports positive trends ahead, stating ‘As many smokers look to vaping to quit tobacco, and vaping becomes more acceptable, the number of first-time vape users continues to rise. This has led to non-smokers enjoying the flavourful fun of vaping more frequently as well’.¹⁷ In essence, ECs are commercial products driven hard by developers and retailers, particularly to niche markets. Young queer men present significant commercial gains for an industry looking to capitalise on an underdeveloped regulatory environment.

The de-identified data collected for the purposes of this study are available from the authors on request.

The authors declare no conflicts of interest.

This research did not receive any specific funding.