Online Patient-Provider E-cigarette Consultations: Perceptions of Safety and Harm

Barriers to helping patients quit smoking: Lack of knowledge about cessation methods, E-cigarettes, and why nurse practitioners and physician assistants can help

OBJECTIVES

Health care settings are ideal for addressing patients' smoking and quitting, but barriers may limit providers' assistance with cessation, including lack of knowledge about newer devices being used by some smokers to quit (e.g., e-cigarettes). Cessation practices among nurse practitioners (NPs) and physician assistants (PAs) are also unknown.

STUDY DESIGN

Cross-sectional.

METHODS

Participants (N = 459) were 151 oncologists, 150 primary care physicians (PCPs), 98 nurse practitioners (NPs), and 60 physician assistants (PAs) recruited from a national online panel who completed an online survey.

RESULTS

Four barriers were common across specialties: "patient doesn't want to quit, and it is their decision," "smoking is not reason for patient's visit; must treat the immediate problem first," "patient wants to quit on their own," and "lack of effective methods available." While a majority of oncologists (58%) were aware of free telephone counseling for cessation, only 29% of NPs were aware. Perceived knowledge of e-cigarettes was low. Greater comfort treating patients' smoking predicted greater frequency of engagement in 4 of 5 general cessation practices (βs = 0.15-0.26, all p ≤ .001). NPs and PAs more frequently asked patients about smoking and e-cigarette use compared to oncologists, but oncologists more frequently referred patients to effective quitting resources (e.g., quitlines).

CONCLUSIONS

NPs and PAs may be uniquely positioned to provide cessation assistance, but providers need more education on currently available, effective cessation methods, and about e-cigarettes. Addressing patient resistance to offers of cessation services and improving clinical workflows to enhance cessation service provision should be investigated in future research.

Displacement imposition scale assesses reactions of cigarette and e-cigarette users impacted by a campus-wide smoking ban

OBJECTIVE

The present study developed a measure assessing the emotional responses, "Displacement Imposition," of cigarette and e-cigarette users on a college campus with a smoking/vaping ban. It also examined the relationship between Displacement Imposition and readiness to quit smoking/vaping, and how this relationship differed between cigarette and e-cigarette users.

PARTICIPANTS

Participants (N = 297) were from a large, Midwestern university.

METHODS

Participants completed online questionnaires assessing demographics, cigarette and e-cigarette use, Displacement Imposition, and readiness to quit.

RESULTS

All six Displacement Imposition items loaded onto a single factor. A significant interaction emerged between Displacement Imposition and product use in predicting readiness to quit. At high levels of Displacement Imposition, cigarette users were less ready to quit than e-cigarette users.

CONCLUSIONS

Findings suggest restrictions imposed on cigarette and e-cigarette users were associated with reduced readiness to quit. Findings inform tobacco control policies as tobacco denormalization may increase the burden placed on tobacco users.

A targeted approach to using e-cigarettes for harm reduction in adults

Smoking remains the leading preventable cause of death and disease in the US. While e-cigarettes (EC) are undeniably harmful when used by adolescents and nonsmokers, the perpetuation of the increasing negative perceptions of EC and widespread false belief that EC are equal or more harmful than combustible cigarettes (CC) represents a significant missed public health opportunity. EC have great potential to serve as a mechanism for smoking harm reduction among hard-to-treat populations of smokers who have failed to quit with currently available treatments. In this paper, we outline why we need to overcome the hostile EC research environment to explore the potential use of EC as a harm-reduction strategy in hard-to-treat populations.

Beliefs and Self-reported Practices of Health Care Professionals Regarding Electronic Nicotine Delivery Systems: A Mixed-Methods Systematic Review and Synthesis

AIMS

This review explores the (1) beliefs and attitudes of health care professionals (HCPs) toward electronic nicotine delivery systems (ENDS) including use as a smoking cessation aid and/or harm reduction, safety and regulation, and (2) the extent and content of patient-HCP communication about ENDS.

METHODS

PubMed, Embase, CINAHL, and PsycINFO were searched to identify articles published since 2003. The Mixed Methods Appraisal Tool and Strengthening the Reporting of Observational Studies in Epidemiology checklists were used to assess the quality of studies. Thematic synthesis was used to analyze qualitative data.

RESULTS

A total of 45 articles (32 quantitative, 12 qualitative, and 1 mixed) were included. There was wide variation regarding beliefs about the efficacy of ENDS as a cessation aid. Although the majority of HCPs believes that ENDS are safer than combustible cigarettes, they also have concern about the short and long-term safety of ENDS, uptake by adolescents, and the potential for ENDS to act as a "gateway" to smoking cigarettes. Beliefs about ENDS are influenced by media stories and experiences provided by patients. Although most HCPs do not proactively recommend ENDS, they are more likely to support ENDS use among patients with smoking related comorbidities, heavy smokers with previous unsuccessful quit attempts, or patients who express interest in trying them.

CONCLUSIONS

Overall, HCPs hold diverse views about the efficacy of ENDS and expressed wariness over their potential health effects. HCP endorsement of ENDS use seems to depend largely on patient health status, the presence of other competing risk factors and patient preferences.

IMPLICATION

Although evidence on safety and efficacy of ENDS is emerging, HCPs should be honest with their clients, stating that the long-term safety is not yet established but what is known is that they appear to be a lower risk alternative to cigarettes. Our review highlights a need for further training and support for HCPs regarding ENDS use, which would enable them to guide their clients in making evidence-based decisions.

Combustible and electronic cigarette use among patients at a large academic dental school clinic: A preimplementation needs assessment survey

BACKGROUND

Tobacco product use is a significant public health concern, particularly with the increasing use of electronic nicotine delivery systems (electronic cigarettes [e-cigarettes]). Dental care providers are well positioned to screen and provide guidance regarding tobacco use, but these services are generally underused.

METHODS

In preparation for a quality improvement project, patients at a large academic dental school clinic were anonymously surveyed regarding past and current use of combustible cigarettes and e-cigarettes, attitudes about quitting, and health beliefs regarding these products.

RESULTS

Among 166 surveyed patients, past month use of combustible cigarettes, e-cigarettes, and both combustible cigarettes and e-cigarettes (dual use) was reported by 14.5%, 2.4%, and 5.4% of patients, respectively. Daily combustible cigarette, e-cigarette, and dual use was reported by 12.7%, 1.2%, and 1.8% of patients, respectively. Most current tobacco users expressed thoughts or plans about changing their tobacco use and concerns regarding continued use of these products on their oral health. More than one-half of the current tobacco users expressed interest in receiving additional support to help them quit.

CONCLUSIONS

Dental care providers see a sizable number of patients who use combustible cigarettes and e-cigarettes, many of whom are concerned about the potential harms of these products on their health and express interest in tobacco-use cessation support.

PRACTICAL IMPLICATIONS

It is critical that dental care professionals engage in efforts to assess combustible cigarette and e-cigarette use and provide guidance regarding these products to their patients.

Beliefs and practices regarding electronic cigarettes in smoking cessation among healthcare professionals in Slovenia

INTRODUCTION

Electronic cigarettes (ECs) have generated extensive discussion about their role in smoking cessation. The Slovenia National Institute of Public Health's recommendations state that ECs are not to be recommended for smoking cessation or reduction. The aim of this study was to explore how healthcare professionals working in the field of preventive healthcare and smoking cessation in Slovenia communicate with and counsel patients regarding electronic cigarettes and smoking cessation or reduction.

METHODS

A cross-sectional, web-based survey was conducted among healthcare professionals working in the field of preventive healthcare and smoking cessation in Slovenia. A total of 479 healthcare professionals were included in the analysis.

RESULTS

While a minority of participants (12.7%) do or would recommend electronic cigarettes for smoking cessation or reduction in general, a higher proportion of participants (33.1%) would recommend electronic cigarettes to specific groups of patients. Knowledge on electronic cigarettes was the key determinant of differences in recommendations. Only a minority of participants (9.1%) reported availability of workplace guidelines/recommendations regarding counselling about electronic cigarettes.

CONCLUSIONS

Training programmes, educational materials and existing guidelines/recommendations regarding counselling about electronic cigarette use should be provided and distributed among healthcare professionals, together with efforts to ensure compliance to official guidelines/recommendations.

Health Professionals' Counseling about Electronic Cigarettes for Smokers and Vapers in a Country That Bans the Sales and Marketing of Electronic Cigarettes

This study describes the prevalence and correlates of adult smokers’ discussions about electronic cigarettes (e-cigarettes) with health professionals (HPs), including whether these discussions may lead smokers and vapers to use e-cigarettes for smoking cessation. Methods: We analyzed data from an online survey of Mexican smokers recruited from a consumer panel for marketing research. Participants who had visited an HP in the prior four months (n = 1073) were asked about discussions of e-cigarettes during that visit and whether this led them to try to quit. Logistic models regressed these variables on socio-demographics and tobacco use-related variables. Results: Smokers who also used e-cigarettes (i.e., dual users) were more likely than exclusive smokers to have discussed e-cigarettes with their HP (adjusted odds ratio (AOR) = 3.96; 95% C.I. 2.73, 5.74), as were those who had recently attempted to quit smoking (AOR = 1.89; 95% C.I. 1.33, 2.7). Of smokers who had discussed e-cigarettes, 53.3% reported that the discussion led them to use e-cigarettes in their quit attempt. Also, dual users (AOR = 2.6; 95% C.I. 1.5, 4.5) and daily smokers (>5 cigarettes per day) (AOR = 3.62; 95% C.I. 1.9, 6.8) were more likely to report being led by their HP to use e-cigarettes in the quit attempt compared to exclusive smokers and non-daily smokers, respectively. Conclusions: Discussions between HP and smokers about e-cigarettes were relatively common in Mexico, where e-cigarettes are banned. These discussions appear driven by the use of e-cigarettes, as well as by greater smoking frequency and intentions to quit smoking.

Dental Students' Knowledge and Attitudes About Electronic Cigarettes: A Cross-Sectional Study at One Saudi University

There is limited information about what dental students know about the risks and effects of e-cigarettes, and there is even less information regarding their attitudes about e-cigarettes. The aim of this study was to assess dental students' knowledge, education, and attitudes regarding e-cigarettes and their confidence in discussing e-cigarettes with patients. All fourth- to sixth-year students registered at the King Abdulaziz University Faculty of Dentistry were invited to participate in this cross-sectional study conducted during a three-week period in December 2018. The focus was a comparison of never versus ever e-smokers ("ever" meaning current or former e-smokers). The response rate was 38.7% (193/498). Among the responding students, 43.2% (n=83) had ever used an e-cigarette, and 11 (5.7%) reported being current users. Almost 95% (n=183) of the total participants said they did not feel confident about their e-cigarette education in dental school. Students who had ever used an e-cigarette said they were more confident discussing e-cigarettes with patients than did students who had never used them and also demonstrated greater belief that e-cigarettes lower the risk of cancer for patients who use them as an alternative to smoking traditional cigarettes (p<0.001). This study provides evidence of a gap in dental students' attitudes and knowledge regarding e-cigarettes, making it necessary to integrate e-cigarette education into future curricula.

Trust of Information about Tobacco and E-Cigarettes from Health Professionals versus Tobacco or Electronic Cigarette Companies: Differences by Subgroups and Implications for Tobacco Messaging

Smoking behavior may be influenced by perceived trust of information from tobacco and e-cigarette companies about their products. The purpose of this study was to identify sociodemographic subgroups with more trust in tobacco product (tobacco and e-cigarette) companies than health professionals and explore associations between this relative trust and tobacco product use.Health Information National Trends Survey (HINTS 4, FDA Cycle) data were analyzed (N = 3,738). Two relative trust measures were developed identifying respondents who trust tobacco companies or e-cigarette companies as much as or more than health professionals for information about the health effects of tobacco products or e-cigarettes versus those who place more trust in health professionals. Dependent variables were smoking status (current, former, never) and e-cigarette use (ever, never). Bivariate analyses and multivariable logistic regressions were conducted in SAS 9.4 using jackknife replicate weights.Respondents who trusted tobacco or e-cigarette companies as much as or more than health professionals were disproportionately from racial/ethnic minority groups or had low levels of income or education (all p < 0.05). Relative trust was not associated with smoking status. After controlling for demographics, respondents who trusted e-cigarette companies as much as or more than health professionals had 87% greater odds (95% CI: 1.16, 3.00) of e-cigarette use, compared to respondents who placed higher trust in health professionals.Findings suggest that population subgroups with greater trust in e-cigarette companies relative to health professionals are more prone to e-cigarette use. Targeted communication strategies may be needed for underserved populations and to counter messaging from e-cigarette companies.

Perceptions, Knowledge, and Use of Electronic Cigarettes: A Survey of Mental Health Patients

Tobacco smoking is the leading cause of preventable illness and death in the United States. Smoking and mental illness are often comorbid, yet little is known about mental health patients' perceptions, knowledge, and use of electronic nicotine delivery systems (ENDS). ENDS may be a beneficial short-term intervention to help this group quit smoking. A survey was administered to a sample of patients at an adult outpatient mental health office (N = 109, 45% male, mean age 33). The majority of participants had tried ENDS. Most used ENDS to quit smoking, and believed it was less harmful than smoking. Participants had variable knowledge about ENDS, but few had asked providers for recommendations. They reported providers were not very knowledgeable about ENDS, and were not asking providers for recommendations. ENDS may help mental health patients who have been unable to quit tobacco, but should not be recommended outside of smoking cessation. This survey provides needed information about how ENDS are being used by mental health patients to help guide future recommendations by their healthcare providers when screening for tobacco use.

Discussions between health professionals and smokers about nicotine vaping products: results from the 2016 ITC Four Country Smoking and Vaping Survey

BACKGROUND AND AIMS

Debate exists about whether health professionals (HPs) should advise smokers to use nicotine vaping products (NVPs) to quit smoking. The objectives were to examine in four countries: (1) the prevalence of HP discussions and recommendations to use an NVP; (2) who initiated NVP discussions; (3) the type of HP advice received about NVPs; and (4) smoker's characteristics related to receiving advice about NVPs.

DESIGN

Cross-sectional study using multivariable logistic regression analyses on weighted data from the 2016 ITC Four Country Smoking and Vaping Survey (ITC 4CV1).

SETTING

Four countries with varying regulations governing the sale and marketing of NVPs: 'most restrictive' (Australia), 'restrictive' (Canada) or 'less restrictive' (England and United States).

PARTICIPANTS

A total of 6615 adult smokers who reported having visited an HP in the last year (drawn from the total sample of 12 294 4CV1 respondents, of whom 9398 reported smoking cigarettes daily or weekly). Respondents were from the United States (n = 1518), England (n = 2116), Australia (n = 1046), and Canada (n = 1935).

MEASUREMENTS

Participants' survey responses indicated if they were current daily or weekly smokers and had visited an HP in the past year. Among those participants, further questions asked participants to report (1) whether NVPs were discussed, (2) who raised the topic, (3) advice received on use of NVPs and (4) advice received on quitting smoking.

FINDINGS

Among the 6615 smokers who visited an HP in the last year, 6.8% reported discussing NVPs with an HP and 2.1% of smokers were encouraged to use an NVP (36.1% of those who had a discussion). Compared with Australia (4.3%), discussing NVPs with an HP was more likely in the United States [8.8%, odds ratio (OR) = 2.15, 95% confidence interval (CI) = 1.41-3.29] and Canada (7.8%, OR = 1.87, 95% CI = 1.26-2.78). Smokers in Australia were less likely to discuss NVPs than smokers in England (6.2%), although this was not statistically significant (OR = 1.47, 95% CI = 0.98-2.20). Overall, the prevalence of HPs recommending NVPs was three times more likely in the United States than in Australia (OR = 3.07, 95% CI = 1.45-6.47), and twice as likely in Canada (OR = 2.28, 95% CI = 1.06-4.87) than in Australia. Australia and England did not differ (OR = 1.76, 95% CI = 0.83-3.74). Just over half (54%) of respondents brought up NVPs themselves; there were no significant differences among countries.

CONCLUSIONS

Discussions in Australia, Canada, England, and the United States between smokers and health professionals about nicotine vaping products appear to be infrequent, regardless of the regulatory environment. A low percentage of health professionals recommended vaping products. This was particularly evident in Australia, which has the most restrictive regulatory environment of the four countries studied.

Combustible Cigarette Smoking and Alternative Tobacco Use in a Sample of Youth Transitioning from Foster Care

Among the struggles faced by youth currently in or recently exiting foster care, tobacco use remains a low priority for practitioners and researchers, alike. Indeed, despite the dramatically altered landscape of tobacco products on the market, there have been no studies evaluating the use of alternative tobacco products among this vulnerable population. The current study aimed to determine the prevalence of lifetime and current combustible and non-combustible tobacco use among youth exiting foster care, and report on the prevalence of nicotine dependence, motivation to quit, and preferred methods of tobacco cessation. Youth aged 18-24 (M = 20.13, SD = 1.16) who were transitioning from foster care (N = 154) completed a survey of tobacco product use adapted from the Population Assessment of Tobacco and Health Baseline Survey. Most participants (76%) reported lifetime use of combustible cigarettes, while almost half (42%) were current combustible cigarette smokers. Current use of electronic cigarettes was comparable to general population rates. Many participants (76%) reported interest in quitting and willingness to try through patches/gum (56%) and technology-based (61%) approaches. Youth exiting foster care are at high risk for smoking and other tobacco product use, as well as dependence, yet are rarely screened for use or advised to quit. As tobacco use remains among the most preventable causes of mortality and morbidity, future work should involve implementation of screening within child welfare and tailoring interventions to the unique needs of this population. The current results underscore a missed opportunity to promote public health in a vulnerable population.

Documentation of e-cigarette use and associations with smoking from 2012 to 2015 in an integrated healthcare delivery system

It is unclear whether use of electronic nicotine delivery systems (ENDS) precedes cigarette smoking initiation, relapse, and/or quitting. Healthcare systems with electronic health records (EHRs) provide unique data to examine ENDS use and changes in smoking. We examined the incidence of ENDS use (2012-2015) based on clinician documentation and tested whether EHR documented ENDS use is associated with twelve-month changes in patient smoking status using a matched retrospective cohort design. The sample was Kaiser Permanente Northern California (KPNC) patients aged ≥12 with documented ENDS use (N = 7926); 57% were current smokers, 35% former smokers, and 8% never-smokers. ENDS documentation incidence peaked in 2014 for current and former smokers and in 2015 for never-smokers. We matched patients with documented ENDS use to KPNC patients without documented ENDS use (N = 7926) on age, sex, race/ethnicity, and smoking status. Documented ENDS use predicted the likelihood of smoking in the following year. Among current smokers, ENDS use was associated with greater odds of quitting smoking (OR = 1.17, 95%CI = 1.05-1.31). Among former smokers, ENDS use was associated with greater odds of smoking relapse (OR = 1.53, 95%CI = 1.22-1.92). Among never-smokers, ENDS use was associated with greater odds of initiating smoking (OR = 7.41, 95%CI = 3.14-17.5). The overall number of current smokers at 12 months was slightly higher among patients with (N = 3931) versus without (N = 3850) documented ENDS use. Results support both potential harm reduction of ENDS use (quitting combustibles among current smokers) and potential for harm (relapse to combustibles among former smokers, initiation for never-smokers).

What do medical students know about e-cigarettes? A cross-sectional survey from one U.S. medical school

BACKGROUND

Although electronic cigarette (e-cigarette) use has rapidly increased, there is little data about what United States medical students know or are taught about them. This study examined medical students' experiences, knowledge, and attitudes regarding e-cigarettes, as well as their evaluation of their education on e-cigarettes.

METHODS

A cross-sectional online survey of medical students currently enrolled at the University of Minnesota Medical School (n = 984) was conducted over a three-week period in August and September 2015. Primary outcomes included students' personal experiences with e-cigarettes, knowledge and attitudes about e-cigarettes, and students' assessment of their education on e-cigarettes.

RESULTS

66.9% medical students completed the survey. 58% (n = 382) of participants identified as female. 35.8% (n = 235) were "not sure" whether e-cigarettes were approved by the FDA for smoking cessation, while 4.1% (n = 27) falsely believed they were. While 82.9% (n = 543) agreed or strongly agreed that they felt confident in their ability to discuss traditional cigarette use with patients, only 12.4% (n = 81) agreed or strongly agreed that they felt confident in their ability to discuss e-cigarettes with patients. 94.8% (n = 619) of participants believed that they had not received adequate education about e-cigarettes in medical school. A higher proportion of males reported ever using an e-cigarette.

CONCLUSIONS

The gaps in medical student knowledge and wide variances in attitudes about e-cigarettes at one medical school together with their report of inadequate education in an environment of increasing use of e-cigarette use in the U.S. speaks to a need for the development of medical school curriculum on e-cigarettes.

[Health Effects Accompanying the Transition from Cigarettes to Heat-not-burn Tobacco: Nicotine Dependence, Nicotine Withdrawal Symptoms, and Changes in Smoking Behaviors]

OBJECTIVES

The purposes of this research were to investigate the hazardous effects of heat-not-burn tobacco and to clarify the health effects accompanying the transition from cigarettes to heat-not-burn tobacco.

METHODS

The concentrations of carbon monoxide, ammonia, formaldehyde, acetaldehyde, and dust (hazardous substances) were measured in the smoke of heat-not-burn tobacco. Twenty-nine smokers were used as the subjects. The concentrations of hazardous substances were measured in exhalation of heat-not-burn tobacco. The concentration of cotinine in saliva was also measured after the transition. A questionnaire survey was performed before and after the transition to evaluate nicotine dependence, nicotine withdrawal symptoms, and smoking behaviors.

RESULTS

In the mainstream smoke, all hazardous substances investigated were detected. Carbon monoxide and dust were detected in the exhalation of heat-not-burn tobacco. The concentration of cotinine in the saliva of heat-not-burn tobacco users corresponded to that of cigarette smokers. Cigarette smoking was significantly positively related to the score of Fagerström Test for Nicotine Dependence (FTND). Heat-not-burn tobacco was significantly positively related to FTND and Minnesota Nicotine Withdrawal Scale (MNWS) scores. The group in which the number of heat-not-burn tobacco sticks consumed increased after transition showed a smaller number of cigarettes consumed and a higher MNWS score before transition than the group in which it decreased after transition. These two factors were significantly related to the difference between the numbers of cigarettes and heat-not-burn tobacco sticks in multiple linear regression analysis.

CONCLUSIONS

The mainstream smoke of heat-not-burn tobacco contains harmful substances. There were the possibilities that nicotine dependence and nicotine withdrawal symptoms appear after transition and that the number of heat-not-burn tobacco sticks consumed increases.

Do you vape? Leveraging electronic health records to assess clinician documentation of electronic nicotine delivery system use among adolescents and adults

Use of electronic nicotine delivery systems (ENDS) has increased substantially over the past decade. However, unlike smoking, which is systematically captured by clinicians through routine screening and discrete documentation fields in the electronic health record (EHR), unknown is the extent to which clinicians are documenting patients' use of ENDS. Data were gathered from medical visits with patients aged 12 and older (N=9,119; 55% male) treated in a large, integrated healthcare system. We used natural language processing to assess the incidence rates of clinician documentation of patients' ENDS use in unstructured tobacco comments in the EHR, and the words most frequently documented in relation to ENDS, from 2006-2015. ENDS documentation in the EHR increased dramatically over time (from 0.01 to 9.5 per 10,000 patients, p<0.0001), particularly among adults aged 18-24 and 25-44. Most prevalent were "e-cig," "electronic cigarettes", and "vape," with much variation in spelling and phrasing of these words. Records of adolescent and young adult patients were more likely to contain the word "vape", and less likely to have "e-cig" and "electronic cigarette" than records of adults (ps<0.0001). The relatively low observed number of patients with ENDS terms in the EHR suggested vast under documentation. While healthcare providers are increasingly documenting patients' use of ENDS in the EHR, overall documentation rates remain low. Discrete EHR fields for standard screening and documentation of ENDS that reflect the language used by patients would provide more complete longitudinal population-level surveillance of ENDS use and its association with short- and long-term health outcomes.

Vaporised nicotine and tobacco harm reduction for addressing smoking among people living with HIV: A cross-sectional survey of Australian HIV health practitioners' attitudes

BACKGROUND

Tobacco smoking is a major cause of morbidity and mortality among people living with HIV (PLHIV). Due to the limited success of standard abstinence-focused smoking cessation strategies in this population, there is growing interest in tobacco harm reduction (THR) approaches as an additional strategy to address these high smoking rates. This study explored the attitudes of health practitioners who provide healthcare to PLHIV towards THR.

METHODS

179 Australian health practitioners who provide healthcare to PLHIV completed an online survey that measured their attitudes towards THR approaches, including switching from cigarettes to e-cigarettes or vaporised nicotine products (VNPs).

RESULTS

Respondents supported the concept of THR but were undecided on the role of VNPs. Respondents most commonly reported 'don't know' or 'undecided' responses to statements regarding VNPs. More respondents, however, agreed than disagreed that switching from smoking to long-term vaping could reduce risk (36% and 22% respectively) and be an effective strategy to help PLHIV to quit smoking (37% agree and 17% disagree). Only a minority of respondents (20%) agreed that VNPs are too harmful to recommend to patients, however around half (53%) were undecided.

CONCLUSIONS

Despite supporting the principle of THR, health practitioners may require more evidence and knowledge about VNPs before being willing to consider them as a suitable intervention strategy.