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Albury C, Barnes R, Ferrey A, Coleman T, Gilbert H, Naughton F, Aveyard P, Begh R. The old and familiar meets the new and unknown: patient and clinician perceptions on e-cigarettes for smoking reduction in UK general practice, a qualitative interview study. Addiction 2022; 117:1427-1437. [PMID: 34859526 PMCID: PMC9306504 DOI: 10.1111/add.15760] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/05/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Clinicians could promote e-cigarettes for harm reduction to people who smoke but cannot stop, but many clinicians feel uneasy doing so. In a randomized controlled trial (RCT), primary care clinicians offered free e-cigarettes and encouraged people with chronic diseases who were unwilling to stop smoking to switch to vaping. We interviewed clinicians and patients to understand how to adopt harm reduction in routine practice. DESIGN Qualitative analysis nested within an RCT, comprising thematic analysis of semi-structured interviews with primary care clinicians who delivered the trial intervention, and patients who took part. SETTING Primary care clinics in England. PARTICIPANTS/CASES Twenty-one patients and 11 clinicians, purposively sampled from an RCT. MEASUREMENTS We qualitatively explored patients' and clinicians' experiences of: being offered/offering an e-cigarette, past and current perceptions about e-cigarettes and applying a harm reduction approach. FINDINGS Four themes captured clinicians' and patients' reported perspectives. These were: (1) concepts of safety/risk, with clinicians concerned about recommending a product with unknown long-term risks and patients preferring the known risks of cigarettes; (2) clinicians felt they were going out on a limb by offering these as though they were prescribing them, whereas patients did not share this view; (3) equating quitting with success, as both patients and clinicians conceptualized e-cigarettes as quitting aids; and (4) unchanged views, as clinicians reported that training did not change their existing views about e-cigarettes. These themes were united by the higher-order concept: 'The old and familiar meets the new and unknown', as a contradiction between this new approach and long-established methods underpinned these concerns. CONCLUSIONS A qualitative analysis found barriers obstructing clinicians and patients from easily accepting e-cigarettes for harm reduction, rather than as aids to support smoking cessation: clinicians had difficulty reconciling harm reduction with their existing ethical models of practice, even following targeted training, and patients saw e-cigarettes as quitting aids.
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Affiliation(s)
- Charlotte Albury
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Rebecca Barnes
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Anne Ferrey
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Tim Coleman
- Division of Primary CareUniversity of NottinghamNottinghamUK
| | - Hazel Gilbert
- Dept. of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Felix Naughton
- School of Health SciencesUniversity of East AngliaNorwichUK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Rachna Begh
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
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Levy DT, Sánchez-Romero LM, Travis N, Yuan Z, Li Y, Skolnick S, Jeon J, Tam J, Meza R. US Nicotine Vaping Product SimSmoke Simulation Model: The Effect of Vaping and Tobacco Control Policies on Smoking Prevalence and Smoking-Attributable Deaths. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4876. [PMID: 34063672 PMCID: PMC8124578 DOI: 10.3390/ijerph18094876] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 12/17/2022]
Abstract
The public health impact of nicotine vaping products (NVPs) is subject to a complex set of uncertain transitions between NVP and cigarette use. Instead, we apply an indirect method to gauge the impact of NVP use on smoking prevalence and smoking-attributable deaths (SADs) using the well-established SimSmoke tobacco control policy simulation model. Upon validating the model before NVPs were more widely used, we project a No-NVP (i.e., in the absence of NVPs) while controlling for the impact of cigarette-oriented policies. The net impact of NVPs on smoking prevalence is inferred by comparing the projected No-NVP smoking trends to corresponding trends from two US national surveys. Using the TUS-CPS estimates for the period 2012-2018, we estimate that adult smoking prevalence declined in relative terms by 9.7% (95% CI: 7.5-11.7%) for males and 10.7% (95% CI: 9.1-13.0%) for females. Compared to NHIS, smoking prevalence declined by 10.7% (95% CI: 6.8-14.6%) for males and 11.3% (95% CI: 7.4-15.6%) for females. These impacts were confined mainly to ages 18-44. Vaping-related reductions in smoking prevalence were projected to avert nearly 0.4 million SADs between 2012 and 2052. Our analysis indicates that NVP use is associated with substantial reductions in US smoking prevalence among younger adults.
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Affiliation(s)
- David T. Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA; (L.M.S.-R.); (N.T.); (Z.Y.); (Y.L.)
| | - Luz María Sánchez-Romero
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA; (L.M.S.-R.); (N.T.); (Z.Y.); (Y.L.)
| | - Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA; (L.M.S.-R.); (N.T.); (Z.Y.); (Y.L.)
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA; (L.M.S.-R.); (N.T.); (Z.Y.); (Y.L.)
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA; (L.M.S.-R.); (N.T.); (Z.Y.); (Y.L.)
| | - Sarah Skolnick
- Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA; (S.S.); (J.J.); (R.M.)
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA; (S.S.); (J.J.); (R.M.)
| | - Jamie Tam
- Department of Health Policy and Management, Yale University School of Public Health, Hartford, CT 06520, USA;
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA; (S.S.); (J.J.); (R.M.)
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Levy DT, Sánchez-Romero LM, Li Y, Yuan Z, Travis N, Jarvis MJ, Brown J, McNeill A. England SimSmoke: the impact of nicotine vaping on smoking prevalence and smoking-attributable deaths in England. Addiction 2021; 116:1196-1211. [PMID: 32949419 PMCID: PMC9364758 DOI: 10.1111/add.15269] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/14/2020] [Accepted: 09/11/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Whereas the use of nicotine vaping products (NVPs) is widespread, their impact on smoking prevalence is controversial. This study considered the potential impact of NVPs on smoking prevalence in England. DESIGN Indirect simulation model. The England SimSmoke model is validated through 2012, before NVP use became more widely used by smokers. Because information on NVP-related transitions is limited, an indirect method is used; the difference in observed smoking prevalence (reflecting NVPs) is compared with a 2012-2019 counterfactual No-NVP scenario (without NVPs) to estimate the impact of NVPs on smoking and smoking-attributable deaths. SETTING England, 2000-2019. PARTICIPANTS Nationally representative sample of population. MEASUREMENTS England's population, mortality rates and smoking prevalence estimates from three national surveys and tobacco control policies. FINDINGS Between 2000 and 2012, SimSmoke projected a decline in age 18+ smoking prevalence of 23.5% in men and 27.0% in women. These projections, as well as those by specific age groups, were generally consistent with findings from the three national surveys. Comparing 2012-2019 relative reduction in age 18+ prevalence from the Annual Population Survey (males, 27.5%) with the model-predicted No-NVP reduction (males, 7.3%), the implied NVP-attributable relative reduction in adult smoking prevalence was 20.2% (95% CI, 18.8%-22.0%) for males and 20.4% (18.7%-22.2%) for females. The NVP-attributable reduction was 27.2% (22.8%-31.6%) for males and 31.7% (27.4%-36.5%) for females ages 18-24 and 18.6% (15.2%-21.8%) for males and 15.0% (11.1%-18.8%) for females ages 25-34, with similar reductions for ages 35+. The implied reduction in smoking prevalence between 2012 and 2019 equates to 165 660 (132 453-199 501) averted deaths by 2052. Other surveys yielded smaller, but relatively consistent results. CONCLUSIONS An indirect method of simulation modelling indicates that substantial reductions in smoking prevalence occurred in England from 2012-2019 coinciding with the growth in nicotine vaping product use.
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Affiliation(s)
- David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Martin J Jarvis
- Department of Behavioural Science and Health, University College London, Gower Street, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, Gower Street, London, UK
| | - Ann McNeill
- National Addiction Centre, King's College London, UK
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Fulton EA, Newby K, Kwah K, Schumacher L, Gokal K, Jackson LJ, Naughton F, Coleman T, Owen A, Brown KE. A digital behaviour change intervention to increase booking and attendance at Stop Smoking Services: the MyWay feasibility RCT. PUBLIC HEALTH RESEARCH 2021. [DOI: 10.3310/phr09050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Smoking remains a leading cause of illness and preventable death. NHS Stop Smoking Services increase quitting, but, as access is in decline, cost-effective interventions are needed that promote these services. StopApp™ (Coventry University, Coventry, UK) is designed to increase booking and attendance at Stop Smoking Services.
Design
A two-arm feasibility randomised controlled trial of StopApp (intervention) compared with standard promotion and referral to Stop Smoking Services (control) was conducted to assess recruitment, attrition and health equity of the design, alongside health economic and qualitative process evaluations.
Setting
Smokers recruited via general practitioners, community settings and social media.
Participants
Smokers aged ≥ 16 years were recruited in one local authority. Participants had to live or work within the local authority area, and there was a recruitment target of 120 participants.
Interventions
StopApp to increase booking and attendance at Stop Smoking Services.
Main outcome measures
Participants completed baseline measures and follow-up at 2 months post randomisation entirely online. Objective data on the use of Stop Smoking Services were collected from participating Stop Smoking Services, and age groups, sex, ethnicity and socioeconomic status in baseline recruits and follow-up completers/non-completers were assessed for equity.
Results
Eligible participants (n = 123) were recruited over 116 days, with good representation of lower socioeconomic status groups; black, Asian and minority ethnic groups; and all age groups. Demographic profiles of follow-up completers and non-completers were broadly similar. The attrition rate was 51.2%, with loss to follow-up lowest in the social media setting (n = 24/61; 39.3%) and highest in the general practitioner setting (n = 21/26; 80.8%). Most measures had < 5% missing data. Social media represented the most effective and cost-efficient recruitment method. In a future, definitive, multisite trial with recruitment driven by social media, our data suggest that recruiting ≥ 1500 smokers over 12 months is feasible. Service data showed that five bookings for the Stop Smoking Services were scheduled using StopApp, of which two did not attend. Challenges with data access were identified. A further five participants in the intervention arm self-reported booking and accessing Stop Smoking Services outside StopApp compared with two control arm participants. Event rate calculations for the intervention were 8% (Stop Smoking Services data), 17% (including self-reports) and 3.5% from control arm self-reports. A conservative effect size of 6% is estimated for a definitive full trial. A sample size of 840 participants would be required to detect an effect for the primary outcome measure of booking a Stop Smoking Services appointment in a full randomised controlled trial. The process evaluation found that participants were satisfied with the research team contact, study methods and provision of e-vouchers. Staff interviews revealed positive and negative experiences of the trial and suggestions for improvements, including encouraging smokers to take part.
Conclusion
This feasibility randomised controlled trial found that, with recruitment driven wholly or mainly by social media, it is possible to recruit and retain sufficient smokers to assess the effectiveness and cost-effectiveness of StopApp. The study methods and measures were found to be acceptable and equitable, but accessing Stop Smoking Services data about booking, attendance and quit dates was a challenge. A full trial may be feasible if service data are accessible. This will require careful planning with data controllers and a targeted social media campaign for recruitment. Changes to some study measures are needed to avoid missing data, including implementation of a more intensive follow-up data collection process.
Future work
We plan a full, definitive randomised controlled trial if the concerns around data access can be resolved, with adaptations to the recruitment and retention strategy.
Limitations
Our trial had high attrition and problems with collecting Stop Smoking Services data, which resulted in a reliance on self-reporting.
Trial registration
Research Registry: 3995. The trial was registered on 18 April 2018.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Emily A Fulton
- Faculty of Health & Life Sciences, Coventry University, Coventry, UK
| | - Katie Newby
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Kayleigh Kwah
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Lauren Schumacher
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Kajal Gokal
- Faculty of Health & Life Sciences, Coventry University, Coventry, UK
| | - Louise J Jackson
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Tim Coleman
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Alun Owen
- Faculty of Engineering, Environment and Computing and Sigma Mathematics and Statistics Support Centre, Coventry University, Coventry, UK
| | - Katherine E Brown
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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Skelton E, Guillaumier A, Tzelepis F, Walsberger S, Paul CL, Dunlop AJ, Palazzi K, Bonevski B. Alcohol and other drug health-care providers and their client's perceptions of e-cigarette use, safety and harm reduction. Drug Alcohol Rev 2021; 40:998-1002. [PMID: 33774886 DOI: 10.1111/dar.13276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION E-cigarettes containing nicotine may potentially assist cessation in a heavily nicotine-dependent population with high relapse and tobacco-related burden. This study aims to determine alcohol and other drug (AOD) health-care provider and client awareness, use and attitudes regarding harm reduction and safety of e-cigarettes. METHODS The study was part of a larger cluster randomised controlled trial with 32 Australian AOD services. At a post-intervention survey conducted October 2016, health-care providers were asked whether they believed e-cigarettes could help smokers quit tobacco, whether they believe e-cigarettes are safer than tobacco smoking and whether they would recommend e-cigarettes to clients who are interested in quitting smoking. At the 6-month follow-up survey conducted January 2015-March 2016, AOD clients were asked about their e-cigarette knowledge, ever use, current use, reasons for use and place of purchase. RESULTS One hundred and eighty health-care providers and 427 AOD clients responded. A minority of health-care providers agreed with the statements that e-cigarettes could help smokers quit tobacco (30%), while just under one-third (25%) agreed that e-cigarettes were safer than tobacco smoking. However, only 19% would recommend e-cigarettes. Most AOD clients (93%) reported awareness of e-cigarettes, 39% reported ever use; however, only 7% reported current use. Of those reporting ever use, 52% used a nicotine e-cigarette. The most common reasons for e-cigarette use were 'wanted to try' (72%) and 'help cut down smoking' (70%). DISCUSSION AND CONCLUSIONS Both AOD health-care providers and clients are aware of e-cigarettes but are cautious in using and recommending their use.
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Affiliation(s)
- Eliza Skelton
- Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Ashleigh Guillaumier
- Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Flora Tzelepis
- Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia
| | | | - Christine L Paul
- Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Adrian J Dunlop
- Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Newcastle Community Health Centre, Hunter New England Local Health District, Newcastle, Australia
| | | | - Billie Bonevski
- Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
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Erku DA, Gartner CE, Morphett K, Steadman KJ. Beliefs and Self-reported Practices of Health Care Professionals Regarding Electronic Nicotine Delivery Systems: A Mixed-Methods Systematic Review and Synthesis. Nicotine Tob Res 2020; 22:619-629. [PMID: 30938442 DOI: 10.1093/ntr/ntz046] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/20/2019] [Indexed: 12/28/2022]
Abstract
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.
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Affiliation(s)
- Daniel A Erku
- School of Pharmacy, University of Queensland, Woolloongabba, Queensland, Australia
| | - Coral E Gartner
- School of Public Health, University of Queensland, Herston, Queensland, Australia.,Queensland Alliance for Environmental Health Sciences, University of Queensland, Woolloongabba, Queensland, Australia
| | - Kylie Morphett
- School of Public Health, University of Queensland, Herston, Queensland, Australia
| | - Kathryn J Steadman
- School of Pharmacy, University of Queensland, Woolloongabba, Queensland, Australia
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Hartwell G, Egan M, Petticrew M. Understanding decisions to use e-cigarettes or behavioural support to quit tobacco: a qualitative study of current and ex-smokers and stop smoking service staff. Addiction 2020; 115:518-526. [PMID: 31628817 DOI: 10.1111/add.14844] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/28/2019] [Accepted: 09/27/2019] [Indexed: 01/31/2023]
Abstract
AIM To examine factors influencing current and ex-smokers' decisions to use e-cigarettes or behavioural support, including potential impacts of any differences in perspectives between smokers and their local stop smoking services (SSSs). DESIGN Semi-structured qualitative interviews followed by framework analysis, with the 'capability', 'opportunity', 'motivation' and 'behaviour' (COM-B) model of behaviour change used to frame findings. SETTING SSSs and surrounding local areas in England. PARTICIPANTS Interviewees (n = 46) were current or recent smokers (n = 29) and SSS staff or stakeholders (n = 17). MEASUREMENTS Interview topic guides explored influences on smokers' choice of quit method and characteristics of support offered by local SSSs. FINDINGS Current and ex-smokers showed a range of views on potential risks from long-term vaping, which appeared to be particularly relevant for the capability dimension of COM-B. These different attitudes to vaping appeared to be linked to variations in people's perceived capability to assess evidence around e-cigarettes' safety. Motivations for using or avoiding e-cigarettes and SSSs often appeared to overlap: attitudes to both e-cigarettes and nicotine replacement therapy from SSSs often reflected personal experiences and views on whether switching from smoking to these alternatives represented successful quitting or simply ongoing nicotine addiction. For smokers, opportunities to use e-cigarettes or SSSs appeared to be largely determined by perceived time requirements. Furthermore, interviews with SSS professionals suggested that opportunities to access SSSs for ex-smokers who were now regular vapers may be being influenced by different e-cigarette policies adopted in individual areas. CONCLUSIONS In England, smokers' decisions to use e-cigarettes and local stop smoking services appear to be determined by varied influences across the COM-B framework. Both smokers and stop smoking service professionals display diverse views about potential risks from e-cigarettes, which has relevance for the provision of behavioural support as well as the uptake of vaping.
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Affiliation(s)
- Greg Hartwell
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, NIHR School for Public Health Research, London, UK
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, NIHR School for Public Health Research, London, UK
| | - Mark Petticrew
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, NIHR School for Public Health Research, London, UK
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8
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‘It's a bit of a grey area’: challenges faced by stop smoking practitioners when advising on e-cigarettes. J Smok Cessat 2019. [DOI: 10.1017/jsc.2019.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AbstractIntroductionAccording to UK guidelines, stop smoking practitioners are expected to be open and supportive towards e-cigarette users. As adequate support from practitioners can be instrumental for smokers to successfully quit smoking, it is crucial to explore the challenges that stop smoking practitioners face when advising on e-cigarette use.AimThis qualitative study explores the challenges that stop smoking practitioners face when advising patients on e-cigarettes.MethodsA qualitative study was conducted with semi-structured interviews with 10 stop smoking practitioners from four stop smoking services in London. Face to face interviews were recorded and transcribed verbatim. Inductive thematic analysis was conducted to explore practitioners' experiences when advising on e-cigarettes.FindingsTwo themes were noted: practitioners' concerns and practitioner–patient interactions. Practitioners were particularly concerned regarding the lack of information, safety issues and the maintenance of addiction linked with e-cigarettes. They emphasised the difficulty of advising on a product that they cannot prescribe. Overall, practitioners expressed the lack of confidence when advising on e-cigarettes since they were often unprepared and not able to answer patients' questions on e-cigarettes.ConclusionsStop smoking practitioners' lack of confidence and limited knowledge regarding e-cigarettes emphasises the necessity for training and guidance on e-cigarettes to improve their interactions with patients on this subject. In particular, practitioners need to be provided with clear guidance on how to counsel patients about how and where to buy e-cigarettes.
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9
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Fulton E, Newby K, Gokal K, Kwah K, Schumacher L, Jackson LJ, Naughton F, Coleman T, Brown K. Tailored digital behaviour change intervention with e-referral system to increase attendance at NHS stop smoking services (the MyWay project): study protocol for a randomised controlled feasibility trial. BMJ Open 2019; 9:e028721. [PMID: 30962245 PMCID: PMC6500333 DOI: 10.1136/bmjopen-2018-028721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION In the UK, smokers who use stop smoking services (SSSs) are four times more likely to stop smoking than smokers who do not. Attendance has declined, warranting the development of interventions to address this. StopApp is a novel, brief online behaviour change intervention designed to address common barriers to SSS attendance. It links to widely commissioned service management software that enables instant appointment booking at a user's location and time of choice. METHODS AND ANALYSIS A two-arm parallel group, individual participant feasibility randomised controlled trial of StopApp (intervention) compared with the standard promotion of and referral to SSSs (control). The study includes a nested qualitative process evaluation to assess the acceptability of the research processes, with a subsample of participants. Smokers aged over 16 years will be recruited via three routes: General Practice (GP), community settings and online. After consenting and the collection of baseline data, participants will be randomised to control or intervention groups. Participants in the intervention group receive a link to StopApp and those in the control group receive standard web-based information about the SSSs. All participants are told they can book a SSS appointment but are under no obligation to do so. Online follow-up 2 months post randomisation includes data on SSS use and carbon monoxide verified 4-week quit rates. The study aims to recruit 162 smokers. ETHICS AND DISSEMINATION Ethics approval has been granted by the West Midlands-Edgbaston NHS Research Ethics Committee. The findings will be reported in conferences and peer-reviewed publications; and will be used to design the parameters necessary for a definitive trial to ascertain the effectiveness of StopApp at increasing booking and attendance at SSSs compared with existing methods for encouraging uptake.
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Affiliation(s)
- Emily Fulton
- Centre for Advances in Behavioural Science, Coventry University, Coventry, UK
| | - Katie Newby
- Centre for Advances in Behavioural Science, Coventry University, Coventry, UK
| | - Kajal Gokal
- Centre for Advances in Behavioural Science, Coventry University, Coventry, UK
| | - Kayleigh Kwah
- Centre for Advances in Behavioural Science, Coventry University, Coventry, UK
| | - Lauren Schumacher
- Centre for Advances in Behavioural Science, Coventry University, Coventry, UK
| | | | - Felix Naughton
- School of Health Sciences, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK
| | - Tim Coleman
- Division of General Practice, University of Nottingham, Nottingham, UK
| | - Katherine Brown
- Centre for Advances in Behavioural Science, Coventry University, Coventry, UK
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Herbeć AA, Chang Y, Tindle HA, Rigotti NA. Smokers' use of electronic cigarettes before, during, and in the month after hospitalization. Findings from the Helping HAND 2 Study. Addict Behav 2019; 91:5-11. [PMID: 30502929 DOI: 10.1016/j.addbeh.2018.10.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 10/23/2018] [Accepted: 10/28/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Hospitalization can motivate smokers to attempt cessation, and some smokers might use e-cigarettes to aid quitting after discharge. Little is known about the patterns and predictors of smokers' e-cigarette use immediately before, during, and after hospitalization. METHODS Secondary data analysis of a multi-site randomized controlled trial that enrolled 1357 hospitalized smokers planning to quit offered two intensities of post-discharge cessation treatment and reached 1100 participants at 1-month follow-up. We assessed reasons for and patterns of e-cigarette use before, during and immediately after hospitalization. Multivariable logistic regression models identified independent predictors of e-cigarette use. RESULTS E-cigarettes were used, primarily to aid quitting, by 21.4% of smokers in the month before admission, 3.1% during hospitalization, and 18.3% in the month after discharge. At 1 month, 10.6% were past 7-day (current) e-cigarette users, but few used e-cigarettes regularly and 57.3% also smoked tobacco. New e-cigarette use in the month after discharge was rare. The adjusted odds ratio (AOR;95%CI) for current e-cigarette use was higher among smokers who used e-cigarettes before hospitalization (5.08;3.31-7.81), consumed more alcohol (1.80;1.16-2.80) and had less confidence to quit (1.66;1.05-2.61). The AOR was lower among non-Hispanic blacks (0.25;0.09-0.71), Medicaid-insured (0.56;0.33-0.93), and those randomly assigned to receive free cessation medication and counseling at discharge (0.58;0.38-0.90). CONCLUSIONS Following hospitalization, some smokers who plan to quit use e-cigarettes, particularly if they used them before admission, are less confident to quit, or have less easy access to conventional treatment. Clinicians should document and be prepared to address e-cigarette use among hospitalized smokers.
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Affiliation(s)
- Aleksandra A Herbeć
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA; Department of Behavioral Science and Health, University College London, London, UK.
| | - Yuchiao Chang
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Hilary A Tindle
- Vanderbilt Center for Tobacco, Addiction, and Lifestyle (ViTAL), Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center and Vanderbilt Medical School, Nashville, TN, USA; Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Farrimond H, Abraham C. Developing E-cigarette friendly smoking cessation services in England: staff perspectives. Harm Reduct J 2018; 15:38. [PMID: 30075724 PMCID: PMC6076389 DOI: 10.1186/s12954-018-0244-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/26/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Public health leadership in England has taken a distinctive international stance by identifying the potential public health benefit of e-cigarettes for smoking cessation. This includes the development of a ground-breaking set of national guidelines for developing e-cigarette friendly stop smoking services. However, little is known about the views of staff engaged within these services and whether or how such services are becoming e-cigarette friendly. This study aimed to investigate the uptake and usage of e-cigarette guidance, from the perspective of those enacting tobacco cessation interventions 'on the ground'. METHODS Qualitative semi-structured interviews were conducted with 25 cessation service staff, including advisors (n = 15), managers (n = 5) and commissioners (n = 5) from eight different services in the South-West of England, UK. A thematic analysis of the transcripts was conducted using NVivo software. RESULTS Although some stop smoking services labelled themselves e-cigarette friendly, there was no consensus over what this should entail. For some, this meant active engagement, such as working with local vape shops, and in the case of one service, offering e-cigarettes through a voucher scheme to disadvantaged groups. For others, an e-cigarette friendly service was conceptualized in a passive sense, as one which welcomed service users using e-cigarettes. Many services did not use the 'e-cigarette friendly' claim in their branding or promotional material. Several discursive themes underlay differing staff attitudes. Those more reluctant to engage framed this in terms of their 'duty of care', with concerns focusing on the addictiveness of nicotine, lack of medically licensed product and ongoing scientific controversy. Those motivated to engage drew on a discourse of social justice goals and 'doing things differently' in relation to lower socio-economic status smokers, those with mental health issues and other vulnerable groups. Strong public health leadership was also identified as a key factor in changing staff attitudes towards e-cigarettes. CONCLUSIONS On-the-ground enactment of e-cigarette friendly services is varied as well as reflective of the wider policy and regulatory environment. Although the context of English stop smoking services is one of austerity and change, there are opportunities for active engagement with e-cigarettes to achieve overall cessation goals. For this to occur, training, policy consistency and sharing best practice are needed.
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Affiliation(s)
- Hannah Farrimond
- EGENIS (Exeter Centre for the Study of Life Sciences), Department of Sociology, Philosophy and Anthropology, University of Exeter, FF16, Byrne House, Streatham Campus, Exeter, EX4 4PJ UK
| | - Charles Abraham
- School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, 3010 Australia
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12
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Tamimi N. Knowledge, attitudes and beliefs towards e-cigarettes among e-cigarette users and stop smoking advisors in South East England: a qualitative study. Prim Health Care Res Dev 2018; 19:189-196. [PMID: 28774353 PMCID: PMC6452951 DOI: 10.1017/s1463423617000445] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 06/17/2017] [Accepted: 06/26/2017] [Indexed: 11/05/2022] Open
Abstract
Aim To explore how e-cigarettes are perceived by a group of e-cigarette users and a group of Stop Smoking Advisors (SSAs), what are the risks and benefits they associate with e-cigarettes and how do these understandings shape participants' attitude towards e-cigarettes? METHOD Face-to-face and phone interviews were conducted with 15 e-cigarette users and 13 SSAs in South East England between 2014 and 2015. Transcribed data were analysed inductively through thematic analysis. Findings E-cigarettes were used as a therapeutic aid to stop or cut down smoking and as a smoking substitute. A prominent theme is the uncertainty e-cigarettes have generated. This included ambiguity of e-cigarettes' status and efficacy, and ambiguity of e-cigarettes' physical and social risks. Different attitudes towards e-cigarettes were identified. CONCLUSION E-cigarettes' benefits and risks should be continuously evaluated, put into perspective and circulated to avoid ambiguity. Stop smoking services need to recognise the benefits that can be gained by using e-cigarettes as a harm reduction tool.
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Affiliation(s)
- Nancy Tamimi
- Department of Social Sciences, Media & Communications, Brunel University London, Uxbridge UB8 3PH, United Kingdom
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13
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Glasser AM, Collins L, Pearson JL, Abudayyeh H, Niaura RS, Abrams DB, Villanti AC. Overview of Electronic Nicotine Delivery Systems: A Systematic Review. Am J Prev Med 2017; 52:e33-e66. [PMID: 27914771 PMCID: PMC5253272 DOI: 10.1016/j.amepre.2016.10.036] [Citation(s) in RCA: 320] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/07/2016] [Accepted: 10/26/2016] [Indexed: 12/20/2022]
Abstract
CONTEXT Rapid developments in e-cigarettes, or electronic nicotine delivery systems (ENDS), and the evolution of the overall tobacco product marketplace warrant frequent evaluation of the published literature. The purpose of this article is to report updated findings from a comprehensive review of the published scientific literature on ENDS. EVIDENCE ACQUISITION The authors conducted a systematic review of published empirical research literature on ENDS through May 31, 2016, using a detailed search strategy in the PubMed electronic database, expert review, and additional targeted searches. Included studies presented empirical findings and were coded to at least one of nine topics: (1) Product Features; (2) Health Effects; (3) Consumer Perceptions; (4) Patterns of Use; (5) Potential to Induce Dependence; (6) Smoking Cessation; (7) Marketing and Communication; (8) Sales; and (9) Policies; reviews and commentaries were excluded. Data from included studies were extracted by multiple coders (October 2015 to August 2016) into a standardized form and synthesized qualitatively by topic. EVIDENCE SYNTHESIS There were 687 articles included in this systematic review. The majority of studies assessed patterns of ENDS use and consumer perceptions of ENDS, followed by studies examining health effects of vaping and product features. CONCLUSIONS Studies indicate that ENDS are increasing in use, particularly among current smokers, pose substantially less harm to smokers than cigarettes, are being used to reduce/quit smoking, and are widely available. More longitudinal studies and controlled trials are needed to evaluate the impact of ENDS on population-level tobacco use and determine the health effects of longer-term vaping.
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Affiliation(s)
- Allison M Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia.
| | - Lauren Collins
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Jennifer L Pearson
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Haneen Abudayyeh
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Raymond S Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - David B Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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14
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Abstract
In this review, we discuss current evidence on electronic cigarettes (ECs), a rapidly evolving class of nicotine delivery system, and their role in managing nicotine addiction, specifically in helping smokers to quit smoking and/or reduce the amount of tobacco they smoke. The current evidence base is limited to three randomized trials (only one compares ECs with nicotine replacement therapy) and a growing number of EC user surveys (n=6), case reports (n=4), and cohort studies (n=8). Collectively, these studies suggest modest cessation efficacy and a few adverse effects, at least with the short-term use. On this basis, we provide advice for health care providers on providing balanced information for patients who enquire about ECs. More research, specifically well-conducted large efficacy trials comparing ECs with standard smoking cessation management (eg, nicotine replacement therapy plus behavioral support) and long-term prospective studies for adverse events, are urgently needed to fill critical knowledge gaps on these products.
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Affiliation(s)
- Oliver Knight-West
- The National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Christopher Bullen
- The National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
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15
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Sherratt FC, Newson L, Field JK. Electronic cigarettes: a survey of perceived patient use and attitudes among members of the British thoracic oncology group. Respir Res 2016; 17:55. [PMID: 27184050 PMCID: PMC4869376 DOI: 10.1186/s12931-016-0367-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 03/10/2016] [Indexed: 11/30/2022] Open
Abstract
Background Smoking cessation following lung cancer diagnosis has been found to improve several patient outcomes. Electronic cigarette (e-cigarette) use is now prevalent within Great Britain, however, use and practice among patients with lung cancer has not as yet been explored. The current study aims to explore e-cigarette use among patients and examine current practice among clinicians. The results have important implications for future policy and practice. Methods Members of The British Thoracic Oncology Group (BTOG) were contacted via several e-circulations (N = 2,009), requesting them to complete an online survey. Of these, 7.7 % (N = 154) completed the survey, which explored participant demographics and smoking history, perceptions of patient e-cigarette use, practitioner knowledge regarding sources of guidance pertaining to e-cigarettes, and practitioner advice. Results Practitioners frequently observed e-cigarette use among patients with lung cancer. The majority of practitioners (81.4 %) reported responding to patient queries pertaining to e-cigarettes within the past year; however, far fewer (21.0 %) felt confident providing patients with e-cigarette advice. Practitioner confidence was found to differentiate by gender (p = 0.012) and employment speciality (p = 0.030), with nurses reporting particularly low levels of confidence in advising. The results also demonstrate extensive variability regarding the practitioner advice content. Conclusions The results demonstrate that patients refer to practitioners as a source of e-cigarette guidance, yet few practitioners feel confident advising. The absence of evidence-based guidance may have contributed towards the exhibited inconsistencies in practitioner advice. The findings highlight that training should be delivered to equip practitioners with the knowledge and confidence to advise patients effectively; this could subsequently improve smoking cessation rates and patient outcomes.
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Affiliation(s)
- Frances C Sherratt
- Department of Psychological Sciences, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, , L69 3GB, UK.
| | - Lisa Newson
- Research Centre for Brain and Behaviour, Natural Sciences and Psychology, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - John K Field
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, The Apex Building, 6 West Derby Street, Liverpool, L7 8TX, UK
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16
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Sherratt FC, Newson L, Marcus MW, Field JK, Robinson J. Perceptions towards electronic cigarettes for smoking cessation among Stop Smoking Service users. Br J Health Psychol 2015; 21:421-33. [DOI: 10.1111/bjhp.12177] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 11/05/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Frances C. Sherratt
- Roy Castle Lung Cancer Research Programme; Department of Molecular and Clinical Cancer Medicine; University of Liverpool; UK
| | - Lisa Newson
- Research Centre for Brain and Behaviour, Natural Sciences and Psychology; Liverpool John Moores University; UK
| | - Michael W. Marcus
- Roy Castle Lung Cancer Research Programme; Department of Molecular and Clinical Cancer Medicine; University of Liverpool; UK
| | - John K. Field
- Roy Castle Lung Cancer Research Programme; Department of Molecular and Clinical Cancer Medicine; University of Liverpool; UK
| | - Jude Robinson
- Department of Sociology, Social Policy and Criminology; University of Liverpool; UK
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17
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Brose LS, McEwen A, Michie S, West R, Chew XY, Lorencatto F. Treatment manuals, training and successful provision of stop smoking behavioural support. Behav Res Ther 2015; 71:34-9. [PMID: 26057438 DOI: 10.1016/j.brat.2015.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 05/15/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Translating evidence-based behaviour change interventions into practice is aided by use of treatment manuals specifying the recommended content and format of interventions, and evidence-based training. This study examined whether outcomes of stop smoking behavioural support differed with practitioner's use and evaluation of treatment manuals, or practitioner's training. METHODS English stop smoking practitioners were invited to complete an online survey including questions on: practitioners' training, availability, use and perceived utility of manuals, and annual biochemically-validated success rates of quit attempts supported (practitioner-reported). Mean success rates were compared between practitioners with/without access to manuals, those using/not using manuals, perceived utility ratings of manuals, and consecutive levels of training completed. RESULTS Success rates were higher if practitioners had a manual (Mean (SD) = 54.0 (24.0) versus 48.0 (25.3), t(838) = 2.48, p = 0.013; n = 840), used a manual (F(2,8237) = 4.78, p = 0.009, n = 840), perceived manuals as more useful (F(3,834) = 2.90, p = 0.034, n = 840), and had completed training (F(3,709) = 4.81, p = 0.002, n = 713). Differences were diminished when adjusting for professional and demographic characteristics and no longer reached statistical significance using a conventional alpha for perceived utility of manuals and training status (both p = 0.1). CONCLUSIONS Practitioners' performance in supporting smokers to quit varied with availability and use of treatment manuals. Evidence was weaker for perceived utility of manuals and practitioners' evidence-based training. Ensuring practitioners have access to treatment manuals within their service, promoting manual use, and training practitioners to competently apply manuals is likely to contribute to higher success rates in clinical practice.
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Affiliation(s)
- Leonie S Brose
- National Addictions Centre, UK Centre for Tobacco and Alcohol Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Andy McEwen
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK.
| | - Susan Michie
- Centre for Outcomes Research and Effectiveness, University College London, London, UK.
| | - Robert West
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK.
| | - Xie Yin Chew
- Department of Psychology and Language Sciences, University College London, London, UK.
| | - Fabiana Lorencatto
- Health Services Research and Management, School of Health Sciences, City University London, London, UK.
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18
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Yong HH, Borland R, Balmford J, McNeill A, Hitchman S, Driezen P, Thompson ME, Fong GT, Cummings KM. Trends in E-Cigarette Awareness, Trial, and Use Under the Different Regulatory Environments of Australia and the United Kingdom. Nicotine Tob Res 2014; 17:1203-11. [PMID: 25358657 DOI: 10.1093/ntr/ntu231] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 10/20/2014] [Indexed: 12/13/2022]
Abstract
INTRODUCTION E-cigarettes (ECs) have gained significant attention in recent years. They have been introduced in jurisdictions with divergent existing laws that affect their legality. This provides the opportunity for natural experiments to assess effects of such laws in some cases independent of any formulated government policy. We compare patterns of EC awareness and use over a 3 year period in Australia where laws severely restrict EC availability, with awareness and use in the United Kingdom where ECs are readily available. METHODS Data analyzed come from Waves 8 and 9 (collected in 2010 and 2013, respectively) of the International Tobacco Control surveys in Australia and the United Kingdom (approximately 1,500 respondents per wave per country). RESULTS Across both waves, EC awareness, trial, and use among current and former smokers were significantly greater in the United Kingdom than in Australia, but all 3 of these measures increased significantly between 2010 and 2013 in both countries, and the rate of increase was equivalent between countries. Seventy-three percent of U.K. respondents reported that their current brands contained nicotine as did 43% in Australia even though sale, possession and/or use of nicotine-containing ECs without a permit are illegal in Australia. EC use was greater among smokers in both countries, at least in part due to less uptake by ex-smokers. CONCLUSIONS EC awareness and use have risen rapidly between 2010 and 2013 among current and former smokers in both Australia and the United Kingdom despite different EC regulatory environments. Substantial numbers in both countries are using ECs that contain nicotine.
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Affiliation(s)
- Hua-Hie Yong
- VicHealth Centre for Tobacco Control, Cancer Council Victoria, Melbourne, Australia;
| | - Ron Borland
- VicHealth Centre for Tobacco Control, Cancer Council Victoria, Melbourne, Australia
| | - James Balmford
- VicHealth Centre for Tobacco Control, Cancer Council Victoria, Melbourne, Australia
| | - Ann McNeill
- Institute of Psychiatry, King's College London, UK
| | | | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Mary E Thompson
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - K Michael Cummings
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
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19
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Hiscock R, Goniewicz ML, McEwen A, Murray S, Arnott D, Dockrell M, Bauld L. E-cigarettes: online survey of UK smoking cessation practitioners. Tob Induc Dis 2014; 12:13. [PMID: 25170337 PMCID: PMC4147097 DOI: 10.1186/1617-9625-12-13] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 08/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Use of e-cigarettes (inhalable vapour producing battery powered devices that aim to simulate tobacco cigarettes), is rising in a number of countries, but as yet none of these products are regulated as medicinal devices or available as smoking cessation treatments. Smokers seeking support from health professionals to stop smoking are interested in e-cigarettes and may be buying them to aid a quit attempt. Determining what smokers are asking, and what health professionals think about these products may have implications for smoking treatment services in a number of countries. METHODS Stop smoking service advisors, managers and commissioners in the United Kingdom were asked to take part in two surveys on e-cigarettes. Data was analysed from 587 practitioners who completed a survey in 2011 and 705 practitioners who completed a repeat survey in 2013. Responses to multiple choice questions and free text comments were analysed. RESULTS Responding practitioners reported that interest in, and use of, e-cigarettes is growing among adults seeking help to stop smoking in the UK. In 2013 91% of respondents reported that interest in e-cigarettes had grown in the past year and whilst in 2011, 2% of respondents reported a 'quarter to a half' of their clients saying that they were regularly using e-cigarettes, by 2013 this had increased to 23.5% (p < .001). Responding practitioners' views towards e-cigarettes became more positive between the first and second surveys (15% strongly agreed/agreed in 2011 that 'e-cigarettes are a good thing' rising to 26% in 2013). However, they continued to have concerns about the products. In particular, analysis of free text responses suggested practitioners were unsure about safety or efficacy for smoking cessation, and were worried that smokers may become dependent on the products. Practitioners were also aware of the potential of e-cigarettes to undermine smokers' willingness to use evidence-based methods to stop, and to challenge policies aiming to denormalise tobacco smoking. CONCLUSIONS Health professionals are asking for reliable and accurate information on e-cigarettes to convey to smokers who want to quit. Randomized controlled trials and ongoing surveillance of e-cigarette use and its consequences for smoking cessation rates and smoking treatment services are required.
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Affiliation(s)
- Rosemary Hiscock
- Department for Health, University of Bath, Bath, UK
- UK Centre for Tobacco and Alcohol Studies, Nottingham, UK
| | | | - Andy McEwen
- UK Centre for Tobacco and Alcohol Studies, Nottingham, UK
- National Centre for Smoking Cessation and Training (NCSCT), London, UK
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
| | - Susan Murray
- School of Applied Social Science, University of Stirling, Stirling, UK
| | | | | | - Linda Bauld
- UK Centre for Tobacco and Alcohol Studies, Nottingham, UK
- Institute for Social Marketing, University of Stirling, Stirling, UK
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