Understanding decisions to use e-cigarettes or behavioural support to quit tobacco: a qualitative study of current and ex-smokers and stop smoking service staff.

Introduction:
This article reports on a qualitative study examining the factors influencing current and ex-smokers' decisions to use e-cigarettes or behavioral support to quit smoking, as well as the potential impact of any differences in perspectives between smokers and their local stop smoking services (SSSs). The study uses the COM-B model of behavior change to frame these factors thematically and understand any interrelations between them.

Key Points:

* The study conducted semi-structured interviews with 46 current or recent smokers and SSS staff or stakeholders in England.
* The study found that smokers and SSS professionals display diverse views about potential risks from e-cigarettes, which has relevance for the provision of behavioral support as well as the uptake of vaping.
* The study identified a simple typology of vaping behavior among interviewees, including Finite vapers, Forever vapers, Sceptical non-vapers, and Supportive non-vapers.
* The study found that along with a difference in intention to quit e-cigarettes, vaping interviewees showed varying confidence and willingness to use evidence from experts to inform their assessments of risk.
* The study found that many smokers were confident they could identify local SSSs to attend if desired, but some had not appreciated that such services were available in their local area.
* The study found that smokers' perceptions of their own time resources emerged as a common barrier limiting opportunities to access SSSs.
* The study found that SSS staff reported routinely asking smokers about their knowledge or past use of e-cigarettes and describing vape shops as sources of expert advice.
* The study found that smoker interviewees who had accessed SSSs generally did not feel their service was particularly forthcoming on the topic of vaping.

Main Message:
The study highlights the importance of understanding smokers' decisions to use e-cigarettes or behavioral support to quit smoking, as well as the potential impact of any differences in perspectives between smokers and their local SSSs. The study found that smokers and SSS professionals display diverse views about potential risks from e-cigarettes, which has relevance for the provision of behavioral support as well as the uptake of vaping. The study also identified a simple typology of vaping behavior among interviewees and found that smokers' perceptions of their own time resources emerged as a common barrier limiting opportunities to access SSSs. Overall, the study suggests that there is a need for credible, consistent communication to non-service attending smokers about the likely size of risk reduction seen with e-cigarettes versus smoking, and that SSSs may wish to offer clearer reassurances to prospective clients about what support they can provide to help them quit nicotine-containing products after quitting smoking.

hartwell G, Egan M, Petticrew M. Understanding decisions to use e-cigarettes or behavioural support to quit tobacco: a qualitative study of current and ex-smokers and stop smoking service staff. addiction (abingdon, England). 2020;115(3):518-526. doi:10.1111/add.14844