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
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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