Views from the Coalface: What Do English Stop Smoking Service Personnel Think about E-Cigarettes?
Abstract
:1. Introduction
- Reported extent and efficacy of e-cigarette use among Stop Smoking Service clients
- SSS personnel’s knowledge and attitudes towards e-cigarettes and which groups are more likely to be positive about e-cigarettes
- Whether SSS personnel view e-cigarettes as having an impact on the recent reduction in SSS use by smokers wishing to quit
2. Experimental Section
2.1. Data
2.1.1. Local Stop Smoking Services Quarterly Returns
2.1.2. Online Survey
2.2. Analysis
2.2.1. Local Stop Smoking Services Quarterly Returns
2.2.2. Online Survey
2.2.3. Multivariate Analysis—Which Variables Affect the Association between Role in the Service and Opinion of E-Cigarettes
3. Results and Discussion
3.1. Local Stop Smoking Services Quarterly Returns
Type of Pharmacotherapy | Set Quit Date | Quit at 4 Weeks | % Quit |
---|---|---|---|
Total | 207,883 | 103,899 | 50% |
Single NCP only | 60,513 | 28,954 | 48% |
Combination of licensed NCPs concurrently | 62,771 | 28,728 | 46% |
Bupropion (Zyban) only | 1047 | 582 | 56% |
Varenicline (Champix) only | 53,215 | 32,002 | 60% |
Licensed NCP and/or Bupropion (Zyban) and/or Varenicline (Champix) consecutively | 3542 | 1674 | 47% |
Combination of a licensed medication and an unlicensed NCP concurrently | 3122 | 1756 | 56% |
Licensed medication and an unlicensed NCP consecutively | 754 | 464 | 62% |
Unlicensed NCP only | 874 | 570 | 65% |
Did not use any licensed medication or unlicensed NCP | 11,716 | 6314 | 54% |
Not known | 10,329 | 2855 | 28% |
Unlicensed NCP with and without other medication | 4750 | 2790 | 59% |
% Total clients using NCP | 2% | 3% |
3.2. Online Survey
3.2.1. Respondent Knowledge and Attitudes
3.2.2. Spread of Service Providers Stances on E-Cigarettes (Bivariate Analyses)
Variable | Distribution | Role in Services | Opinion on E-Cigs | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Manager/Commissioner | Practitioner | Sig. | Agree “A Good Thing” | Neutral/Disagree | Sig. | |||||||
Sources of information on e-cigs | ||||||||||||
NCSCT briefing and website | 1155 | 65.6 | 126 | 78.8 | 821 | 68.2 | p = 0.009 | 281 | 65.5 | 863 | 65.9 | p = 0.933 |
The news and media | 797 | 45.3 | 74 | 46.3 | 549 | 45.6 | p = 0.951 | 203 | 47.3 | 586 | 44.7 | p = 0.380 |
Training courses | 670 | 38.0 | 56 | 35.0 | 496 | 41.2 | p = 0.155 | 165 | 38.5 | 501 | 38.2 | p = 0.982 |
ASH briefing and website | 585 | 33.2 | 109 | 68.1 | 383 | 31.8 | p < 0.001 | 173 | 40.3 | 407 | 31.1 | p = 0.001 |
WHO report on electronic cigarettes | 517 | 29.4 | 74 | 46.3 | 320 | 26.6 | p < 0.001 | 143 | 33.3 | 369 | 28.2 | p = 0.048 |
Experienced electronic cigarette users | 457 | 26.0 | 54 | 33.8 | 302 | 25.1 | p = 0.025 | 169 | 39.4 | 285 | 21.8 | p < 0.001 |
The websites of electronic cigarette companies | 189 | 10.7 | 20 | 12.5 | 122 | 10.1 | p = 0.436 | 61 | 14.2 | 127 | 9.7 | p = 0.011 |
The websites of vaping organisations | 114 | 6.5 | 26 | 16.3 | 63 | 5.2 | p < 0.001 | 39 | 9.1 | 74 | 5.6 | p = 0.017 |
Respondents agreed or strongly agreed (compared with neither agreed or disagreed, disagreed or strongly disagreed) that: | ||||||||||||
E-cigs are a good thing? | 429 | 24.4 | 60 | 38.0 | 264 | 22.2 | p < 0.001 | |||||
Over the past 12 months I've become less positive about e-cigs | 495 | 28.1 | 31 | 19.5 | 362 | 30.7 | p = 0.005 | 34 | 8.0 | 457 | 35.2 | p < 0.001 |
E-cigs should not be recommended by SSS until there is good evidence on safety & effectiveness | 1342 | 76.2 | 118 | 74.7 | 944 | 79.7 | p = 0.180 | 234 | 54.9 | 1101 | 84.9 | p < 0.001 |
If an e-cig was a licensed medication, I would definitely recommend them to clients | 1148 | 65.2 | 121 | 76.6 | 790 | 66.5 | p = 0.014 | 375 | 88.0 | 765 | 58.9 | p < 0.001 |
E-cigs should only be available as a licensed medication | 1036 | 58.8 | 97 | 61.0 | 752 | 63.5 | p = 0.597 | 164 | 38.7 | 863 | 66.6 | p < 0.001 |
E-cigs should be able to be bought anywhere by smokers as a consumer product | 325 | 18.5 | 34 | 21.7 | 203 | 17.2 | p = 0.202 | 193 | 45.7 | 130 | 10.0 | p < 0.001 |
E-cigs normalise cigarette smoking | 950 | 53.9 | 88 | 55.7 | 670 | 57.2 | p = 0.791 | 140 | 33.3 | 804 | 62.4 | p < 0.001 |
E-cigs denormalise cigarette smoking | 190 | 10.8 | 29 | 19.5 | 118 | 10.3 | p = 0.001 | 66 | 15.9 | 124 | 9.9 | p = 0.001 |
Client groups to which respondents would recommend e-cigarettes | ||||||||||||
All my clients | 82 | 4.7 | 10 | 6.3 | 45 | 3.7 | p = 0.193 | 58 | 13.5 | 23 | 1.8 | p < 0.001 |
Clients who are already using e-cigs | 324 | 18.4 | 40 | 25.0 | 219 | 18.2 | p = 0.051 | 138 | 32.2 | 184 | 14.0 | p < 0.001 |
Clients wishing to cut down but not stop | 215 | 12.2 | 24 | 15.0 | 139 | 11.6 | p = 0.258 | 104 | 24.2 | 111 | 8.5 | p < 0.001 |
Clients wanting to use electronic cigarettes at times when they cannot smoke (temporary abstinence) | 212 | 12.0 | 31 | 19.4 | 131 | 10.9 | p = 0.003 | 105 | 24.5 | 107 | 8.2 | p < 0.001 |
Clients who wish to cut down before they stop | 204 | 11.6 | 22 | 13.8 | 129 | 10.7 | p = 0.312 | 101 | 23.5 | 102 | 7.8 | p < 0.001 |
Clients who have tried and failed to quit many times | 355 | 20.2 | 34 | 21.3 | 236 | 19.6 | p = 0.703 | 167 | 38.9 | 187 | 14.3 | p < 0.001 |
More dependent smokers | 199 | 11.3 | 23 | 14.4 | 118 | 9.8 | p = 0.100 | 98 | 22.8 | 100 | 7.6 | p < 0.001 |
None of my clients | 983 | 55.8 | 82 | 51.2 | 693 | 57.6 | p = 0.150 | 122 | 28.4 | 850 | 64.9 | p < 0.001 |
Variable | Role in Services | Opinion of E-Cigs | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Total | Manager/Commissioner | Practitioner | Agree “A Good Thing” | Neutral/Disagree | ||||||
Region | p = 0.026 | p = 0.015 | ||||||||
North East | 64 | 3.6 | 5 | 10.4 | 43 | 89.6 | 10 | 15.6 | 54 | 84.4 |
North West | 230 | 13.1 | 23 | 12.6 | 159 | 87.4 | 47 | 20.6 | 181 | 79.4 |
Yorkshire & Humberside | 132 | 7.5 | 7 | 7.0 | 93 | 93.0 | 24 | 18.5 | 106 | 81.5 |
East Midlands | 159 | 9.0 | 6 | 5.1 | 112 | 94.9 | 40 | 25.2 | 119 | 74.8 |
West Midlands | 224 | 12.7 | 19 | 10.8 | 157 | 89.2 | 50 | 22.9 | 168 | 77.1 |
East of England | 151 | 8.6 | 14 | 12.5 | 98 | 87.5 | 35 | 23.5 | 114 | 76.5 |
London | 290 | 16.5 | 32 | 14.5 | 189 | 85.5 | 94 | 32.6 | 194 | 67.4 |
South East | 303 | 17.2 | 40 | 16.9 | 196 | 83.1 | 81 | 27.1 | 218 | 72.9 |
South West | 208 | 11.8 | 14 | 8.2 | 156 | 91.8 | 48 | 23.5 | 156 | 76.5 |
Total | 1761 | 100.0 | 160 | 11.7 | 1203 | 88.3 | 429 | 24.7 | 1310 | 75.3 |
Organisation | p < 0.001 | p < 0.001 | ||||||||
General Practice | 477 | 27.1 | 5 | 1.3 | 377 | 98.7 | 78 | 16.6 | 393 | 83.4 |
Pharmacy | 334 | 19.0 | 25 | 8.9 | 257 | 91.1 | 83 | 25.2 | 247 | 74.8 |
Acute / Foundation Hospital Trust | 255 | 14.5 | 29 | 16.3 | 149 | 83.7 | 47 | 18.8 | 203 | 81.2 |
Employed directly by the Local Authority | 163 | 9.3 | 33 | 24.6 | 101 | 75.4 | 53 | 32.9 | 108 | 67.1 |
Mental Health Trust | 105 | 6.0 | 16 | 21.3 | 59 | 78.7 | 45 | 43.7 | 58 | 56.3 |
Private company | 104 | 5.9 | 15 | 18.8 | 65 | 81.3 | 36 | 35.0 | 67 | 65.0 |
Social enterprise | 56 | 3.2 | 8 | 16.0 | 42 | 84.0 | 16 | 28.6 | 40 | 71.4 |
Other | 267 | 15.2 | 29 | 15.9 | 153 | 84.1 | 71 | 26.8 | 194 | 73.2 |
Total | 1761 | 100.0 | 160 | 11.7 | 1203 | 88.3 | 429 | 24.7 | 1310 | 75.3 |
Role | p < 0.001 | |||||||||
Commissioner | 23 | 1.3 | 14 | 63.6 | 8 | 36.4 | ||||
Manager | 137 | 7.8 | 46 | 33.8 | 90 | 66.2 | ||||
Other | 398 | 22.6 | 105 | 26.9 | 286 | 73.1 | ||||
Stop Smoking Practitioner | 1203 | 68.3 | 264 | 22.2 | 926 | 77.8 | ||||
Total | 1761 | 100.0 | 429 | 24.7 | 1310 | 75.3 |
3.2.3. Why might Commissioners and Managers be more Positive about E-Cigarettes than Practitioners? (Multivariate Analysis)
Variable | aOR of Manager/Practitioner When Variables Added in Forward Stepwise | Significance of Role | aOR of Manager/Practitioner When Variables Removed from Full Model Individually (Backwards Stepwise) |
---|---|---|---|
Role (manager/commissioner vs practitioner) only | 2.15 (1.50 to 3.08) | ||
Organisation | 1.82 (1.24 to 2.65) | p = 0.002 | 1.60 (1.07 to 2.37) |
Agree less positive in the last year | 1.59 (1.07 to 2.36) | p = 0.022 | 1.57 (1.05 to 2.35) |
Recommend e-cigs for temporary abstinence | 1.47 (0.98 to 2.20) | p = 0.064 | 1.49 (0.99 to 2.23) |
Agree would recommend if licenced | 1.39 (0.91 to 2.10) 1 | p = 0.124 | 1.47 (0.98 to 2.20) |
3.2.4. Role of E-Cigarettes in Decline in SSS Uptake
Reason | N | % |
---|---|---|
Smokers choosing to use e-cigs | 1461 | 83.0 |
Remaining smokers in the population are harder to reach | 947 | 53.8 |
Reduced mass media health campaigns | 527 | 29.9 |
Reduced funding of services | 488 | 27.7 |
SSS moved from NHS to LA | 389 | 22.1 |
Put out to tender | 299 | 17.0 |
Few specialist practitioners available | 243 | 13.8 |
4. Conclusions
4.1. Limitations
4.2. Summary
Acknowledgments
Author Contributions
Conflicts of Interest
References
- Etter, J.F.; Bullen, C. Saliva cotinine levels in users of electronic cigarettes. Europ. Respir. J. 2011, 38. [Google Scholar] [CrossRef] [PubMed]
- Goniewicz, M.L.; Kuma, T.; Gawron, M.; Knysak, J.; Kosmider, L. Nicotine levels in e-cigarettes. Nicotine Tob. Res. 2012. [Google Scholar] [CrossRef]
- McNeill, A.; Brose, L.S.; Calder, R.; Hitchman, S.C.; Hajek, P.; McRobbie, H. RE: Leading journal questions Public Health England’s stance on e-cigarettes. BMJ 2015, 351. [Google Scholar] [CrossRef]
- McNeill, A.; Brose, L.S.; Calder, R.; Hitchman, S.C.; Hajek, P.; McRobbie, H. E-Cigarettes: An Evidence Update—A Report Commissioned by Public Health England. Available online: https://www.gov.uk/government/publications/e-cigarettes-an-evidence-update (accessed on 16 October 2015).
- Hajek, P.; Etter, J.-F.; Benowitz, N.; Eissenberg, T.; McRobbie, H. Electronic cigarettes: Review of use, content, safety, effects on smokers and potential for harm and benefit. Addiction 2014, 109. [Google Scholar] [CrossRef] [PubMed]
- Hitchman, S.C.; Brose, L.S.; Brown, J.; Robson, D.; McNeill, A. Associations between e-cigarette type, frequency of use, and quitting smoking: Findings from a longitudinal online panel survey in Great Britain. Nicotine Tob. Res. 2015. [Google Scholar] [CrossRef] [PubMed]
- McRobbie, H.; Bullen, C.; Hartmann-Boyce, J.; Hajek, P. Electronic cigarettes for smoking cessation and reduction. Cochrane Database Syst. Rev. 2014, 12. [Google Scholar] [CrossRef]
- ASH. Use of Electronic Cigarettes (Vapourisers) among Adults in Great Britain. Available online: http://ash.org.uk/files/documents/ASH_891.pdf (accessed on 14 December 2015).
- Brown, J.; West, R.; Beard, E.; Michie, S.; Shahab, L.; McNeill, A. Prevalence and characteristics of e-cigarette users in Great Britain: Findings from a general population survey of smokers. Addict. Behav. 2014, 39, 1120–1125. [Google Scholar] [CrossRef] [PubMed]
- West, R.; Brown, J. STS120720 Latest Trends on Smoking in England from the Smoking Toolkit Study. 2015. Available online: http://www.smokinginengland.info/latest-statistics/ (accessed on 24 November 2015).
- HSCIC. Statistics on NHS Stop Smoking Services in England—April 2014 to March 2015. Available online: http://www.hscic.gov.uk/article/2021/Website-Search?productid=18388&q=stop+smoking&sort=Relevance&size=10&page=1&area=both#top (accessed on 13th October 2015).
- NCSCT. Local Stop Smoking Services: Service and Delivery Guidance 2014. Available online: http://www.ncsct.co.uk/usr/pub/LSSS_service_delivery_guidance.pdf (accessed on 23 November 2015).
- Dobbie, F.; Hiscock, R.; Leonardi, B.J.; Murray, S.; Shahab, L.; Aveyard, P.; Coleman, T.; McEwen, A.; McRobbie, H.; Purves, R.; et al. Evaluating long term outcomes of NHS Stop Smoking Services (ELONS): A prospective cohort study. Available online: http://www.ncbi.nlm.nih.gov/books/NBK327140/ (accessed on 14 December 2015).
- West, R. Stop Smoking Services: Increased Chances of Quitting. Available online: http://www.ncsct.co.uk/publication_Stop_smoking_services_impact_on_quitting.php (accessed on 21 January 2014).
- Piné-Abata, H.; McNeill, A.; Murray, R.; Bitton, A.; Rigotti, N.; Raw, M. A survey of tobacco dependence treatment services in 121 countries. Addiction 2013, 108, 1476–1484. [Google Scholar] [CrossRef] [PubMed]
- Ferguson, J.; Bauld, L.; Chesterman, J.; Judge, K. The English smoking treatment services:One-year outcomes. Addiction 2005, 100, 59–69. [Google Scholar] [CrossRef] [PubMed]
- NCSCT. Electronic Cigarettes. Available online: http://www.ncsct.co.uk/usr/pub/e-cigarette_briefing.pdf (accessed on 5 June 2015).
- Gilmore, A.; Peeters, S. E-cigarettes and the marketing push that surprised everyone-response. BMJ 2013, 347. [Google Scholar] [CrossRef]
- West, R.; Beard, E.; Brown, J. STS140122 Trends in Electronic Cigarette Use in England. Available online: http://www.smokinginengland.info/latest-statistics/ (accessed on 9 June 2015).
- MacGuill, S. E-Cigarette Use in England is Plateauing—Why? Available online: http://www.portal.euromonitor.com (accessed on 9 June 2015).
- Hiscock, R.; Goniewicz, M.; McEwen, A.; Murray, S.; Arnott, D.; Dockrell, M.; Bauld, L. E-cigarettes: Online survey of UK smoking cessation practitioners. Tob. Induced Dis. 2014, 12. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- West, R.; Hajek, P.; Stead, L.; Stapleton, J. Outcome criteria in smoking cessation trials: Proposal for a common standard. Addiction 2005, 100, 299–303. [Google Scholar] [CrossRef] [PubMed]
- Gilmore, A.B.; Tavakoly, B.; Hiscock, R.; Taylor, G. Smoking patterns in Great Britain: The rise of cheap cigarette brands and roll your own (RYO) tobacco. J. Public Health 2015, 37, 78–88. [Google Scholar] [CrossRef] [PubMed]
- Amos, A.; Bauld, L.; Clifford, D.; Fidler, J.; Hill, S.; Hiscock, R.; Laverty, L.; Platt, S.; Robinson, J. Tobacco Control, Inequalities in Health and Action at a Local Level. Available online: http://phrc.lshtm.ac.uk/project_2005-2011_a910r.html (accessed on 16 December 2014).
- McDermott, M.S.; Beard, E.; Brose, L.S.; West, R.; McEwen, A. Factors associated with differences in quit rates between “specialist” and “community” stop-smoking practitioners in the english stop-smoking services. Nicotine Tob. Res. 2013, 15, 1239–1247. [Google Scholar] [CrossRef] [PubMed]
- Vaping Links. Medical Professionals Speak Out on E-Cigarettes. Available online: https://vapinglinks.wordpress.com/2015/10/18/medical-professionals-speak-out-on-e-cigarettes/ (accessed on 23 October 2015).
- Saari, E.; Lehtonen, M.; Toivonen, M. Making bottom-up and top-down processes meet in public innovation. Serv. Indust. J. 2015, 35, 325–344. [Google Scholar] [CrossRef]
- Pepper, J.K.; McRee, A.-L.; Gilkey, M.B. Healthcare providers’ beliefs and attitudes about electronic cigarettes and preventive counseling for adolescent patients. J. Adolesc. Health 2014, 54, 678–683. [Google Scholar] [CrossRef] [PubMed]
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Share and Cite
Hiscock, R.; Bauld, L.; Arnott, D.; Dockrell, M.; Ross, L.; McEwen, A. Views from the Coalface: What Do English Stop Smoking Service Personnel Think about E-Cigarettes? Int. J. Environ. Res. Public Health 2015, 12, 16157-16167. https://doi.org/10.3390/ijerph121215048
Hiscock R, Bauld L, Arnott D, Dockrell M, Ross L, McEwen A. Views from the Coalface: What Do English Stop Smoking Service Personnel Think about E-Cigarettes? International Journal of Environmental Research and Public Health. 2015; 12(12):16157-16167. https://doi.org/10.3390/ijerph121215048
Chicago/Turabian StyleHiscock, Rosemary, Linda Bauld, Deborah Arnott, Martin Dockrell, Louise Ross, and Andy McEwen. 2015. "Views from the Coalface: What Do English Stop Smoking Service Personnel Think about E-Cigarettes?" International Journal of Environmental Research and Public Health 12, no. 12: 16157-16167. https://doi.org/10.3390/ijerph121215048
APA StyleHiscock, R., Bauld, L., Arnott, D., Dockrell, M., Ross, L., & McEwen, A. (2015). Views from the Coalface: What Do English Stop Smoking Service Personnel Think about E-Cigarettes? International Journal of Environmental Research and Public Health, 12(12), 16157-16167. https://doi.org/10.3390/ijerph121215048