Electronic cigarettes: a survey of perceived patient use and attitudes among members of the British thoracic oncology group.

BACKGROUND: Smoking cessation following lung cancer diagnosis has been found to improve several patient outcomes. Electronic cigarette (e-cigarette) use is now prevalent within Great Britain, however, use and practice among patients with lung cancer has not as yet been explored. The current study aims to explore e-cigarette use among patients and examine current practice among clinicians. The results have important implications for future policy and practice. METHODS: Members of The British Thoracic Oncology Group (BTOG) were contacted via several e-circulations (N = 2,009), requesting them to complete an online survey. Of these, 7.7 % (N = 154) completed the survey, which explored participant demographics and smoking history, perceptions of patient e-cigarette use, practitioner knowledge regarding sources of guidance pertaining to e-cigarettes, and practitioner advice. RESULTS: Practitioners frequently observed e-cigarette use among patients with lung cancer. The majority of practitioners (81.4 %) reported responding to patient queries pertaining to e-cigarettes within the past year; however, far fewer (21.0 %) felt confident providing patients with e-cigarette advice. Practitioner confidence was found to differentiate by gender (p = 0.012) and employment speciality (p = 0.030), with nurses reporting particularly low levels of confidence in advising. The results also demonstrate extensive variability regarding the practitioner advice content. CONCLUSIONS: The results demonstrate that patients refer to practitioners as a source of e-cigarette guidance, yet few practitioners feel confident advising. The absence of evidence-based guidance may have contributed towards the exhibited inconsistencies in practitioner advice. The findings highlight that training should be delivered to equip practitioners with the knowledge and confidence to advise patients effectively; this could subsequently improve smoking cessation rates and patient outcomes

Predicting smoking cessation and health risk perceptions: Exploring the utility of the Liverpool Lung Project risk model

The Liverpool Lung Project (LLP) risk model predicts an individual’s five-year absolute lung cancer risk. Smoking cessation has been identified as the most effective strategy for reducing lung cancer incidence, whilst tailored communications have been considered to be one of the most promising approaches to smoking cessation. The primary aim of this PhD project was therefore to examine whether the LLP intervention was associated with smoking cessation success and lung cancer risk perceptions among Stop Smoking Service (SSS) users. The LLP intervention was developed using the LLP risk model and involves calculation and communication of projected lung cancer risk, based on both smoking and non-smoking behaviour. A number of secondary aims pertaining to risk perceptions and smoking cessation are also considered and described in the main body of the thesis. The project adopted a mixed methods approach, integrating both quantitative and qualitative research components. In relation to the quantitative component, two randomised controlled trials were employed to evaluate the LLP intervention effect on smoking cessation success and lung cancer risk perceptions; baseline current smokers (n = 302) and baseline recent former smokers (n = 219) were recruited from a SSS in Liverpool, UK. All participants completed a baseline questionnaire, which considered socio-demographics, smoking behaviour, and lung cancer risk perceptions. Two separate single-blinded randomised controlled designs were implemented for baseline current and recent former smokers, whereby participants allocated to the intervention arm received the LLP intervention (based upon the LLP risk model). Follow-up smoking status and lung cancer risk perceptions were established at six months. Bivariate and multivariate analyses were undertaken to explore the strength of any associations. Qualitative interviews were additionally undertaken with a sub-set of participants derived from the quantitative research component (n = 30). These interviews intended to explore factors implicated in smoking cessation success and smoking-related risk perception, thus complementing the additional findings of the quantitative research component. Interviews were transcribed and analysed using thematic analysis techniques. The analysis of baseline current smokers revealed that the LLP intervention failed to predict follow-up smoking status or lung cancer risk perceptions; however, the LLP intervention was found to predict follow-up smoking status among baseline former smokers (OR 1.91, 95% CI 1.03-3.55), but not lung cancer risk perceptions. This suggests that those who received the intervention were more likely to be classified as former smokers at follow-up. The qualitative results also provided insight regarding smoking-related risk perception and communication; issues such as perceived lack of control, risk contextualisation, and poor health literacy, were identified to be relevant components to smoking-related risk perception and communication. The results suggest that the intervention may predict follow-up smoking status among recent former smokers, although the trials entailed insufficient statistical power and therefore, an extension of recruitment or implementation of a larger trial is now required to build upon the results. Nevertheless, the current results contribute towards tobacco control research, practice and policy in various ways. For example, the delivery of the LLP intervention among recent former smokers in SSS, and potentially other healthcare settings, could improve smoking cessation rates and would require little time and financial resources. In turn, improved smoking cessation success rates would lead to reduced smoking-related disease and associated deaths

Electronic cigarette use and risk perception in a Stop Smoking Service in England

Introduction: Electronic cigarette (e-cigarette) use rose substantially within the UK in recent years but currently, Stop Smoking Services in England do not prescribe them due to a lack of regulation. Previous research has examined e-cigarette use and attitudes within English Stop Smoking Services using samples of practitioners and managers; the current study recruited a sample of service users. Methods: Participants (N¼319) aged 18–60 years old were recruited from Roy Castle FagEnds, Liverpool, England (Stop Smoking Service). A cross-sectional questionnaire was completed, which recorded demographic variables, e-cigarette use alongside risk perception, and lastly, smoking behaviour i.e. smoking duration, cigarettes per day, and nicotine dependence. Results: Most participants were female (57.1%), current smokers (53.0%), and current or former e-cigarette users (51.7%). Participants who perceived e-cigarettes as less harmful than smoked tobacco were more likely to have smoked fewer cigarettes per day (p¼0.008). Furthermore, those who felt uncertain whether e-cigarettes were safer than smoked tobacco, were less likely to have tried them (p50.001). Conclusion: This study suggests that e-cigarette use is becoming common among users of Stop Smoking Services (despite e-cigarettes being unavailable from such services) and that e-cigarette risk perception is related to e-cigarette status. The results highlight the importance of providing smokers intending to quit smoking with current and accurate e-cigarette information. Findings may inform future Stop Smoking Services provision and the results demonstrate that further research is warranted

Inequalities, harm reduction and non-combustible nicotine products:A meta-ethnography of qualitative evidence

BACKGROUND: We sought to review qualitative evidence on how smokers in different socioeconomic groups engage with non-combustible nicotine products (NCNP), including electronic cigarettes and nicotine replacement therapies, in order to provide insight into how these products might impact on smoking inequalities. METHODS: We searched ten electronic databases in February 2017 using terms relating to NCNP and socioeconomic status. We included qualitative studies that were published since 1980 and were available in English. We used guidelines adapted from the Critical Appraisal Skills Programme for appraising qualitative research. RESULTS: The review only identified studies exploring the attitudes of socioeconomically disadvantaged smokers towards NCNP for harm reduction or cessation purposes (i.e. we did not identify any relevant studies of more advantaged socioeconomic groups). Using a lines-of-argument meta-ethnographic approach, we identified a predominantly pessimistic attitude to NCNP for harm reduction or cessation of smoking due to: wider circumstances of socioeconomic disadvantage; lack of a perceived advantage of alternative products over smoking; and a perceived lack of information about relative harms of NCNP compared to smoking. Optimistic findings, although fewer, suggested the potential of NCNP being taken up among smokers experiencing socioeconomic disadvantage. CONCLUSIONS: Overall, our review highlights the importance of considering the social, cultural and economic circumstances that influence experiences of smoking and of alternative product use

Images of Eyes Enhance Investments in a Real-Life Public Good

A key issue in cooperation research is to determine the conditions under which individuals invest in a public good. Here, we tested whether cues of being watched increase investments in an anonymous public good situation in real life. We examined whether individuals would invest more by removing experimentally placed garbage (paper and plastic bottles) from bus stop benches in Geneva in the presence of images of eyes compared to controls (images of flowers). We provided separate bins for each of both types of garbage to investigate whether individuals would deposit more items into the appropriate bin in the presence of eyes. The treatment had no effect on the likelihood that individuals present at the bus stop would remove garbage. However, those individuals that engaged in garbage clearing, and were thus likely affected by the treatment, invested more time to do so in the presence of eyes. Images of eyes had a direct effect on behaviour, rather than merely enhancing attention towards a symbolic sign requesting removal of garbage. These findings show that simple images of eyes can trigger reputational effects that significantly enhance on non-monetary investments in anonymous public goods under real life conditions. We discuss our results in the light of previous findings and suggest that human social behaviour may often be shaped by relatively simple and potentially unconscious mechanisms instead of very complex cognitive capacities

Social norms of cooperation in small-scale societies

Indirect reciprocity, besides providing a convenient framework to address the evolution of moral systems, offers a simple and plausible explanation for the prevalence of cooperation among unrelated individuals. By helping someone, an individual may increase her/his reputation, which may change the pre-disposition of others to help her/him in the future. This, however, depends on what is reckoned as a good or a bad action, i.e., on the adopted social norm responsible for raising or damaging a reputation. In particular, it remains an open question which social norms are able to foster cooperation in small-scale societies, while enduring the wide plethora of stochastic affects inherent to finite populations. Here we address this problem by studying the stochastic dynamics of cooperation under distinct social norms, showing that the leading norms capable of promoting cooperation depend on the community size. However, only a single norm systematically leads to the highest cooperative standards in small communities. That simple norm dictates that only whoever cooperates with good individuals, and defects against bad ones, deserves a good reputation, a pattern that proves robust to errors, mutations and variations in the intensity of selection.This research was supported by Fundacao para a Ciencia e Tecnologia (FCT) through grants SFRH/BD/94736/2013, PTDC/EEI-SII/5081/2014, PTDC/MAT/STA/3358/2014 and by multi-annual funding of CBMA and INESC-ID (under the projects UID/BIA/04050/2013 and UID/CEC/50021/2013 provided by FCT). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.info:eu-repo/semantics/publishedVersio

Utilizing Lung Cancer Risk Prediction Models to Promote Smoking Cessation: Two Randomized Controlled Trials.

PURPOSE: The current project sought to examine whether delivery of lung cancer risk projections (calculated using the Liverpool Lung Project [LLP] risk model) predicted follow-up smoking status. DESIGN: Two single-blinded randomized controlled trials. SETTING: Stop Smoking Services in Liverpool (United Kingdom). PARTICIPANTS: Baseline current smokers (N = 297) and baseline recent former smokers (N = 216) were recruited. INTERVENTION: Participants allocated to intervention groups were provided with personalized lung cancer risk projections, calculated using the LLP risk model. MEASURES: Baseline and follow-up questionnaires explored sociodemographics, smoking behavior, and lung cancer risk perceptions. ANALYSIS: Bivariate analyses identified significant differences between randomization groups, and logistic regression models were developed to investigate the intervention effect on the outcome variables. RESULTS: Lung cancer risk projections were not found to predict follow-up smoking status in the trial of baseline current smokers; however, they did predict follow-up smoking status in the trial of baseline recent former smokers (odds ratio: 1.91; 95% confidence interval: 1.03-3.55). CONCLUSION: The current study suggests that lung cancer risk projections may help maintain abstinence among individuals who have quit smoking, but the results did not provide evidence to suggest that lung cancer risk projections motivate current smokers to quit