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E-Cigarettes:
Practitioners Views,
Beliefs, Experiences
and Concerns
12 June 2015
Tina 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 ecigarettes 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?
60
50
40
30
20
10
0
very well
fairly well
not very well not at all well
Source: TFF/PHE research among workshop delegates
before workshop; EBR: Evidence based research
Where do you look
for information on e-cigs?
80
70
60
50
40
30
20
10
0
Source: TFF/PHE research among workshop delegates
before workshop; EBR: Evidence based research
E-cigs often seen
as an effective quit aid
70
60
50
40
30
20
10
0
very
fairly
not very
not at all
Source: TFF/PHE research among workshop delegates
before workshop; EBR: Evidence based research
But less keen to promote
them as a quit aid
60
50
40
30
20
10
0
very
fairly
not very
not at all
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
Appeal to young people
May normalise smoking
Long term risks not known
drawbacks
New opp for SSS to engage
benefits
Stepping stone to stop smoking
Less toxins than tobacco
0
20
40
60
80
100
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
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
Source: TFF/PHE research
among workshop delegates
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?
60
50
40
30
Before workshop
Now
20
10
0
very well fairly
well
not very not at all
well
well
Source: TFF/PHE research among
workshop delegates post workshop
How effective do e-cigs
seem now?
70
60
50
40
Before today
30
Now
20
10
0
very
fairly
not very not at all
Source: TFF/PHE research among workshop
delegates post workshop
How keen to promote
as quit aid now?
60
50
40
Before today
30
Now
20
10
0
very
fairly
not very
not at all
How to make e-cigs
more useful as a quit aid
Nobody said
‘nothing would make
them useful’
allow SSS to provide on prescription
present as step to quit nicotine
better info for service users
greater regulation
better info for SSSAs
0
10
20
30
40
50
60
70
80
90
Source: TFF/PHE research among
workshop delegates post workshop
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