E-Cigarettes: Practitioners Views, Beliefs, Experiences and Concerns

12 June 2015Tina Williams,

Head of Development and Training Tobacco Free Futures

Tobacco Free Futures is a social enterprise, and our mission is to Make Smoking History for

Children.

The North West Office of Tobacco Control; we are leading experts in tackling tobacco and our vision is to change the way children,

young people and adults think about tobacco and help future generations to be tobacco free.

We support regional and national tobacco control activity at a local level enabling local authorities, NHS and any organisation

we work with to tackle tobacco issues in their area.

Overview

• TFF commissioned by Greater Manchester PHE to develop and deliver a workshop 12 May 2015 – Identify and measure the views, beliefs, experiences,

concerns and attitudes of stop smoking (ss) practitioners to e-cigarettes

– Support stop smoking practitioners to understand and apply the evidence

• Event took place on May 12th 2015– 44 SS practitioners from GM and NW attended

Objectives

• To understand of SS practitioners perceptions of e-cigarettes:– Explore perceived benefits, risks and concerns– Tease out perceived opportunities and potential– To gather experiences of working with e-cigarettes as a quit

tool, both positive and negative– To gauge awareness of current evidence of e-cigarettes as a

quit aid

Objectives

• To identify and address any barriers to effective working with e-cigarettes:– What factors are inhibiting practitioners? – Are there knowledge gaps and if so how these might be

addressed?

Objectives • To inform the development of a guidance

resource for SS practitioners – What does this need to include?– How and where should it be presented?– At what level

• local • national?

Workshop Format

• Pre-workshop online survey• Welcome• Focus Groups• Expert Presentations / discussion• Second post-workshop online survey• Feedback of top-line findings / Q&A /

discussion

Expert Presentations - Professor Ann McNeill, King’s College London, E-

cigarettes: setting the scene- Sue Cumming, Liverpool City Council, Public

perceptions of e-cigarettes insight - Lisa Williams, Roy Castle FagEnds, Electronic

cigarette use and risk perception in a stop smoking service

- Karen House, Leicester Stop Smoking Service, Developing an e-cigarette

friendly service - Dr Heide Weishaar, University of Glasgow,

Understanding teenagers’ experiences and attitudes of e-cigarettes

- Andrea Crossfield, Tobacco Free Futures, What can North West data tell us?

Pre-event Survey

• Most felt under-informed, confused and ambivalent about e-cigarettes as a quit aid

• Few were working with e-cigarettes as part of their offer to clients– Not part of local delivery specification

• Therefore limited scope to discern experiences of effective or ineffective use as a quit aid

• Widespread concerns about long term health impact, efficacy as a quit aid, risk of re-normalising smoking, appeal to children and young people and impact on service footfall

Findings pre-workshop survey

Pre survey completed by 43 delegates

How well informed do you feel?

very well fairly well not very well not at all well0

10

20

30

40

50

60

Source: TFF/PHE research among workshop delegates before workshop; EBR: Evidence based research

Where do you look for information on e-cigs?

Online EBR Offline EBR Peers/colleagues Other online Word of mouth0

10

20

30

40

50

60

70

80

Source: TFF/PHE research among workshop delegatesbefore workshop; EBR: Evidence based research

E-cigs often seen as an effective quit aid

very fairly not very not at all0

10

20

30

40

50

60

70

Source: TFF/PHE research among workshop delegates before workshop; EBR: Evidence based research

But less keen to promote them as a quit aid

very fairly not very not at all0

10

20

30

40

50

60

evidence not yet clear; lack of regulation and guidance

Source: TFF/PHE research among workshop delegates before workshop; EBR: Evidence based research

Benefits and drawbacks of e-cigs as quit aid

Less toxins than tobacco

Stepping stone to stop smoking

New opp for SSS to engage

Long term risks not known

May normalise smoking

Appeal to young people

0 10 20 30 40 50 60 70 80 90 100

drawbacksbenefits

Source: TFF/PHE research among workshop delegates before workshop; EBR: Evidence based research

Findings - focus group work

Seven focus groups were carried out with a total of 44 delegates

How well informed did you feel?

Focus group outcomes:• Research sometimes conflicting about health

and safety• Media noise• No clear guidance• Uncertain how to advise service users• Much more confident about other quit aids

Source: TFF/PHE research among workshop delegates

Benefits of e-cigs as quit aid

Focus group outcomes:• Harm reduction – on balance is the biggest

benefit• Innovative new way to encourage smokers

with idea of quitting • An alternative for remaining ‘hardcore’

smokers • Potentially more cost-effective

Source: TFF/PHE research among workshop delegates

How to make e-cigs more useful as a quit aid

Source: TFF/PHE research among workshop delegates

Focus group outcomes:• Develop and communicate a firm evidence

base about safety and efficacy• Promote the SSS offer of support and advice

alongside quit aid

Drawbacks of e-cigs as quit aid

• Broad range of drawbacks /barriers emerged in focus groups– Impossible to harness without clear evidence /

regulation– Lack of clear guidance uncertainty (risk)– Bypassing SSS– Shifting focus away from behavioural support –

maintains or even reinforces addiction

Source: TFF/PHE research among workshop delegates

Feelings about promoting e-cigarettes

• Wide spread concern– Tobacco Industry involvement – Future role of SSS

• Potential to feel really positive – If licensed / evidenced / approved – Reduction of health inequalities

Source: TFF/PHE research among workshop delegates

Findings post-workshop survey

Post survey completed by 42 delegates

How well informed do you feel now?

very well

fairly well

not very well

not at all well

0

10

20

30

40

50

60

Before workshopNow

Source: TFF/PHE research among workshop delegates post workshop

How effective do e-cigs seem now?

very fairly not very not at all0

10

20

30

40

50

60

70

Before todayNow

Source: TFF/PHE research among workshop delegates post workshop

How keen to promote as quit aid now?

very fairly not very not at all0

10

20

30

40

50

60

Before todayNow

How to make e-cigs more useful as a quit aid

better info for SSSAs

greater regulation

better info for service users

present as step to quit nicotine

allow SSS to provide on prescription

0 10 20 30 40 50 60 70 80 90

Source: TFF/PHE research among workshop delegates post workshop

Nobody said ‘nothing would make

them useful’

Post-event survey

• Revealed an increased understanding of the current evidence base

• A greater level of support for offering e-cigarettes as one of a range of quit aids

– with the strong proviso that definitive information and guidance, product regulation/licensing and a clear commissioning position must all be in place to support their work

Summary

• The outcomes of the workshop clearly demonstrated value of an interactive, face to face learning experience in – eliciting views– assessing and increasing knowledge – and teasing out practitioners needs

• The format used for the workshop provides a potential model for future practitioner training

Recommendations

• There is a clear need for continued assessment and communication of evidence base

• An expressed need for one statement of evidence, and one set of guidance on service use of e-cigarettes, ideally at a national level, or at the highest possible geographical level, to offer the reassurance of consistency

• A need consistent guidance across all health care professional groups, based on ‘best current evidence’

• Information resource for SSSAs needs to be developed

Acknowledgments Commissioned by Greater

Manchester PHE, Delivered by Caroline

Midmore & Ansa Hussain