How a sample of English stop smoking services and vape shops adapted during the early COVID-19 pandemic: a mixed-methods cross-sectional survey

Background The COVID-19 pandemic in England led to major changes in the delivery of support via stop smoking services (SSS) and to the widespread temporary closure of bricks and mortar e-cigarette retailers (vape shops herein). The impact of disruptions across the smoking cessation support landscape has not been fully documented. The purpose of this study was to capture how SSS and vape shops in England were affected and adapted their ‘business as usual’ during the early months of the COVID-19 pandemic. Method An online cross-sectional survey was conducted between March and July 2020. Surveys were disseminated through online networks, professional forums and contacts. Open-ended qualitative responses were coded using thematic analysis. Results Responses from 46 SSS and 59 vape shops were included. SSS were able to adapt during this period, e.g. offering a remote service. A high percentage (74.6%) of vape shops had to close and were unable to make changes; 71.2% reported business declining. For both vape shops and SSS qualitative data revealed practical challenges to adapting, but also new pathways to support and co-working. Conclusion The closure of vape shops appears to have most impacted smaller bricks and mortar shops affecting businesses by decline in customers and impacting staff (furlough). For those services that could stay open there may be lessons learned in how to support vulnerable and disadvantaged people who smoke by considering new pathways to support.

A digital behaviour change intervention to increase booking and attendance at Stop Smoking Services: the MyWay feasibility RCT

Background Smoking remains a leading cause of illness and preventable death. NHS Stop Smoking Services increase quitting, but, as access is in decline, cost-effective interventions are needed that promote these services. StopApp™ (Coventry University, Coventry, UK) is designed to increase booking and attendance at Stop Smoking Services. Design A two-arm feasibility randomised controlled trial of StopApp (intervention) compared with standard promotion and referral to Stop Smoking Services (control) was conducted to assess recruitment, attrition and health equity of the design, alongside health economic and qualitative process evaluations. Setting Smokers recruited via general practitioners, community settings and social media. Participants Smokers aged ≥ 16 years were recruited in one local authority. Participants had to live or work within the local authority area, and there was a recruitment target of 120 participants. Interventions StopApp to increase booking and attendance at Stop Smoking Services. Main outcome measures Participants completed baseline measures and follow-up at 2 months post randomisation entirely online. Objective data on the use of Stop Smoking Services were collected from participating Stop Smoking Services, and age groups, sex, ethnicity and socioeconomic status in baseline recruits and follow-up completers/non-completers were assessed for equity. Results Eligible participants (n = 123) were recruited over 116 days, with good representation of lower socioeconomic status groups; black, Asian and minority ethnic groups; and all age groups. Demographic profiles of follow-up completers and non-completers were broadly similar. The attrition rate was 51.2%, with loss to follow-up lowest in the social media setting (n = 24/61; 39.3%) and highest in the general practitioner setting (n = 21/26; 80.8%). Most measures had < 5% missing data. Social media represented the most effective and cost-efficient recruitment method. In a future, definitive, multisite trial with recruitment driven by social media, our data suggest that recruiting ≥ 1500 smokers over 12 months is feasible. Service data showed that five bookings for the Stop Smoking Services were scheduled using StopApp, of which two did not attend. Challenges with data access were identified. A further five participants in the intervention arm self-reported booking and accessing Stop Smoking Services outside StopApp compared with two control arm participants. Event rate calculations for the intervention were 8% (Stop Smoking Services data), 17% (including self-reports) and 3.5% from control arm self-reports. A conservative effect size of 6% is estimated for a definitive full trial. A sample size of 840 participants would be required to detect an effect for the primary outcome measure of booking a Stop Smoking Services appointment in a full randomised controlled trial. The process evaluation found that participants were satisfied with the research team contact, study methods and provision of e-vouchers. Staff interviews revealed positive and negative experiences of the trial and suggestions for improvements, including encouraging smokers to take part. Conclusion This feasibility randomised controlled trial found that, with recruitment driven wholly or mainly by social media, it is possible to recruit and retain sufficient smokers to assess the effectiveness and cost-effectiveness of StopApp. The study methods and measures were found to be acceptable and equitable, but accessing Stop Smoking Services data about booking, attendance and quit dates was a challenge. A full trial may be feasible if service data are accessible. This will require careful planning with data controllers and a targeted social media campaign for recruitment. Changes to some study measures are needed to avoid missing data, including implementation of a more intensive follow-up data collection process. Future work We plan a full, definitive randomised controlled trial if the concerns around data access can be resolved, with adaptations to the recruitment and retention strategy. Limitations Our trial had high attrition and problems with collecting Stop Smoking Services data, which resulted in a reliance on self-reporting. Trial registration Research Registry: 3995. The trial was registered on 18 April 2018. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 5. See the NIHR Journals Library website for further project information.

How a Sample of English Stop Smoking Services and Vape Shops Adapted During the Early Covid-19 Pandemic: a Mixed-methods Cross Sectional Survey

Background: The early 2020 Covid-19 outbreak in England led to major changes in delivery of support via stop smoking services (SSS) and to the widespread temporary closure of bricks and mortar e-cigarette retailers, indicating serious disruption to the overall level of support available for smokers trying to quit. At the same time, there was a publicised public health campaign calling for smokers to ‘Quit for Covid’. The impact of disruptions across the smoking cessation support landscape has not been fully documented. The purpose of this study was to capture how SSS and vape shops in England were affected and adapted their ‘business as usual’ during the early months of Covid-19 outbreak.Method: An online cross-sectional survey was conducted between March-July 2020. Surveys were disseminated through online networks, professional forums and contacts. Open-ended qualitative responses were coded using thematic analysis.Results: SSS were able to adapt during this period. A high percentage (74.6%) of vape shops had to close and were unable to make changes; 71.2% report business declining. For both services qualitative data revealed practical challenges to adapting, but also new pathways to support and co-working. Conclusion: The closure of vape shops appears to have most impacted smaller bricks and mortar shops affecting businesses by decline in customers and impacting staff (furlough). For those services that could stay open there may be lessons learned in how to support vulnerable and disadvantaged smokers by considering new pathways to support.

Midwives' recommendation of electronic cigarettes as a smoking cessation strategy in pregnancy

Introduction Electronic cigarettes have been described as a public health crisis. Approximately 10.6% of pregnant women smoke conventional cigarettes at the time of delivery, but the prevalence of e-cigarette use during pregnancy is unknown. Objectives To assess the extent of midwives' current knowledge and attitudes on electronic cigarettes as a smoking cessation strategy during pregnancy. Methods Electronic databases were searched. These were supplemented by manual searches, which were completed to include reports from Public Health England and the Royal College of Midwives. Results A total of 22 papers were identified, reviewed and are presented as a narrative literature review. Topics such as epidemiology, organisational stances, opinions of smoking cessation in pregnancy and opinions from stop smoking services were explored. There have been conflicting ideas regarding the use of electronic cigarettes in pregnancy and women who have recently given birth. Conclusions Whilst the current literature regarding electronic cigarettes as a smoking cessation strategy during pregnancy is well explored, there is no literature that investigates the attitudes of midwives and how this may affect their recommendation of e-cigarettes. The results of this study could serve as a point of reference for future clinical research, as well as clinical practice, by bringing to light the knowledge and attitudes midwives have regarding electronic cigarette use in pregnancy, and may be able to suggest some changes to improve the current practices.

Are Heated Tobacco Product Users Less Likely to Quit than Cigarette Smokers? Findings from THINK (Tobacco and Health IN Korea) Study

Since the advent of heated tobacco products in June 2017 in South Korea, the sale of heated tobacco products accounted for 10.5% of total tobacco sales in 2019. However, the decreasing trend in total tobacco sales is gradually weakening and the number of visitors using stop smoking services has also dropped. This study examines the association between the use of new tobacco products and related products and cessation behaviors. A cross-sectional study using a self-administered questionnaire was conducted from March 2019 to July 2019 for 2831 adult tobacco users. The difference in rates of quit attempts using the type of tobacco products and related products in the past year were noted (55.6% (any cigarette smoker), 46.7% (any e-cigarette user), and 39.6% (any heated tobacco product user)). About a 30% increase in quit attempts was observed for the triple users of either conventional cigarette or heated tobacco product than exclusive users. Exclusive heated tobacco product and e-cigarette users were approximately 40% and 20% less likely to quit the product they used than exclusive cigarette smokers, respectively. These findings can explain recent occurrences in South Korea, such as the reduction of visitors at smoking cessation clinics and the attenuation of the decline in tobacco sales.

An Exploration of Pregnant Women Smokers Knowledge of Accessing ‘Stop Smoking’ Services in Wales

The problem of smoking in pregnancy has remained a challenge to both public health professionals and Welsh Government with the low uptake of stop smoking services by pregnant women. Despite the evidence base for stop smoking, services have neither been implemented consistently nor robustly across Wales. Hence the need to develop a service improvement project like ‘Models for Access to Maternal Stop Smoking Support’ (MAMSS) to provide new ways of supporting pregnant women who smoke, alongside the current national Stop Smoking Services. The study explored the experiences and views of pregnant women smokers accessing stop smoking services in Wales. The need for suitable training was reported amongst public health professionals involved in providing stop smoking service for pregnant women. Most women wanted to reduce and not stop smoking; also available opportunities were important in determining the ability to access and deliver services, with the use of carbon monoxide (CO) monitors positively influencing the receptiveness of the pregnant women. Midwives were however reluctant to create an image of enforcing stop smoking and a holistic approach was advocated by some staff members to encourage health education and promotion. Overall, a specialist service such as that provided by the MAMSS project was viewed as appropriate. Public health professionals understood their roles and the advantages of the CO monitors in encouraging quitting/stop smoking in pregnancy. Specialist midwives made positive impacts on the pregnant smoker’s receptiveness to stop smoking support. Both staff and pregnant women acknowledged that accessibility and flexibility of service were key determinants of service delivery and service uptake, whilst incorporating an approach that is supportive rather than enforcing. This electronic document is a “live” template and already defines the components of your paper [title, text, heads, etc.] in its style sheet

‘It's a bit of a grey area’: challenges faced by stop smoking practitioners when advising on e-cigarettes

IntroductionAccording to UK guidelines, stop smoking practitioners are expected to be open and supportive towards e-cigarette users. As adequate support from practitioners can be instrumental for smokers to successfully quit smoking, it is crucial to explore the challenges that stop smoking practitioners face when advising on e-cigarette use.AimThis qualitative study explores the challenges that stop smoking practitioners face when advising patients on e-cigarettes.MethodsA qualitative study was conducted with semi-structured interviews with 10 stop smoking practitioners from four stop smoking services in London. Face to face interviews were recorded and transcribed verbatim. Inductive thematic analysis was conducted to explore practitioners' experiences when advising on e-cigarettes.FindingsTwo themes were noted: practitioners' concerns and practitioner–patient interactions. Practitioners were particularly concerned regarding the lack of information, safety issues and the maintenance of addiction linked with e-cigarettes. They emphasised the difficulty of advising on a product that they cannot prescribe. Overall, practitioners expressed the lack of confidence when advising on e-cigarettes since they were often unprepared and not able to answer patients' questions on e-cigarettes.ConclusionsStop smoking practitioners' lack of confidence and limited knowledge regarding e-cigarettes emphasises the necessity for training and guidance on e-cigarettes to improve their interactions with patients on this subject. In particular, practitioners need to be provided with clear guidance on how to counsel patients about how and where to buy e-cigarettes.