"Ongoing nervousness" about the use of e-cigarettes in stop-smoking services can be a "significant" barrier to people finding support, research revealed during "Stoptober" shows. New research by the University of Exeter and University of Melbourne, funded by Cancer Research UK, suggests stop smoking services which are e-cigarette friendly should advertise this more openly, and says greater use of e-cigarettes has the potential to make considerable impact in helping people give up smoking.
England has led the way internationally by proposing that stop smoking services become 'e-cigarette friendly', but many services fail to advertise this and consequently smokers, particularly those in deprived groups, may miss out on valuable behavioural support that may make the difference between success and failure in quitting.
The research shows strong leadership from organisations such as Public Health England has made a difference in changing attitudes. But the nervousness among some working in public health services and local councils about the use of e-cigarettes is preventing the widespread establishment of stop smoking services which support vapers.
As part of the study, published in the journal Harm Reduction, academics interviewed staff from eight different stop smoking services in the South-West of England. They found many services are becoming more e-cigarette friendly, welcoming e-cigarette users into their service, however they often fail to advertise this.
Dr. Hannah Farrimond, from the University of Exeter, who led the research with Professor Charles Abraham, said: "There are real opportunities for stop smoking services to use e-cigarettes more actively to help people give up smoking, but for this to happen policies around the country need to be consistent, and people need to share best practice and know what others are doing. This is particularly important given cuts to the council budget which have significantly reduced services."
The experts found although some stop smoking services labelled themselves "e-cigarette friendly", there was no consensus over what this should entail. Some were actively incorporating e-cigarettes, working with local vape shops, and in the case of one service, offering e-cigarettes through a voucher scheme to disadvantaged groups because they wanted to do things differently and help those in poorer communities and people with mental health problems. However, some of the 25 staff interviewed were worried about using e-cigarettes because they felt they were addictive and not medically licensed, and they didn't want to be seen as "wedded" to the vaping industry. Currently, e-cigarettes are not available on prescription within the NHS. Nobody reported turning away e-cigarette users from services.
MPs in the recent Commons report, Public Health England (PHE) and the National Centre for Smoking Cessation and Training (NCSCT) have all suggested vaping may have a role to play in stop-smoking services. Giving people behavioural support and pharmacotherapy has been shown to be the most effective method of helping people give up smoking.
Dr. Farrimond said: "It is arguable that for smoking cessation work to succeed, it is going to have to move beyond specialist clinics which few smokers attend, and engage with vulnerable populations in their communities. Initiatives to support smoking cessation could occur in psychiatric units, community mental health settings, in addiction clinics, in community centres and smoke-free hospitals. E-cigarettes have the potential to allow stop smoking services to do things differently for marginalized and harder to treat smokers."
Only one stop smoking service in this sample was currently offering e-cigarettes to users. Staff worked with local vaping shops to offer clients a combination of nicotine replacement therapy, NRT, and medication to treat nicotine addiction, and an e-cigarette voucher with behavioural and social support. Advisors noted the positive experience of working with the vape shops. One said: 'I think they're just really, really professional and really caring and really genuinely want to help people quit smoking alongside me'.
George Butterworth, Cancer Research UK's senior policy manager, said: "The evidence so far suggests that e-cigarettes are far less harmful than tobacco cigarettes. But this study shows attitudes to vaping vary.
"Smokers are much more likely to quit with the support of a Stop Smoking Service. And 'e-cigarette friendly' services help smokers who try to quit by vaping with behavioural support from a professional, giving them the best chance of quitting tobacco for good.
"It's vital that everyone across the country is aware of the options available to them as e-cigarettes may have a particularly important role in helping vulnerable or disadvantaged groups to quit."
Developing E-cigarette friendly smoking cessation services in England: staff perspectives, is published in the journal Harm Reduction.
Cancer Research UK requested a widening of the original sample of staff prior to issuing funding, but had no involvement in the collection, analysis and interpretation of data or writing the manuscript.
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Hannah Farrimond et al, Developing E-cigarette friendly smoking cessation services in England: staff perspectives, Harm Reduction Journal (2018). DOI: 10.1186/s12954-018-0244-8