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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