SRNT Europe Debate: The use of nicotine oral products in adults may be a rationale behaviour

No abstract - this is a commentar

A qualitative exploration of consumers’ perceived impacts, behavioural reactions, and future reflections of the EU Tobacco Products Directive (2017) as applied to electronic cigarettes

Background: Electronic cigarette regulations included in the Tobacco Products Directive (TPD), Article 20, implemented in Europe by May 2017, aimed to improve safety for e-cigarette consumers, and prevent uptake among non-smokers, particularly young people. Before implementation, there were significant concerns from consumers, industry, and some in the scientific community about the potential negative impact of the TPD on people using e-cigarettes to stay stopped from smoking. To date, there is limited evidence on how the TPD has affected consumers. This study aimed to add insight into how consumers perceived and experienced the regulations. Methods: Qualitative data, collected between March 2018 and March 2019, relating to participant views of the TPD were extracted from 160 interviews/extended surveys of e-cigarette consumers as part of a wider study into e-cigarette use trajectories (ECtra study). Data were thematically analysed. Results: Awareness of the TPD amongst consumers was not universal. Participants’ smoking behaviour did not appear to be influenced by the legislation. Participants were reassured by manufacturing regulations and requirements for ingredients labels. Participants responded negatively to changes perceived to cause inconvenience and extra plastic waste. The product restrictions prompted some participants to purchase non-compliant products illegally, potentially putting their safety at risk. Conclusions: E-cigarette regulation should focus on ensuring product safety. Raising awareness of the TPD amongst consumers and smokers could be beneficial

Medicalisation of vaping in the UK? E-cigarette users' perspectives on the merging of commercial and medical routes to vaping

Background: In the UK, most smokers choosing e-cigarettes to quit smoking will access vaping via commercial routes. In recent years, however, a shift towards medicalisation of vaping has become apparent, with public health guidance supporting e-cigarettes for smoking cessation and increased partnership working between healthcare professionals and the vaping industry. To achieve the UK’s Smokefree 2030 target, the UK Government has set out measures to utilise e-cigarettes in NHS settings and to move towards streamlining processes to make e-cigarettes available to a million smokers. This paper aims to understand acceptability of different approaches by seeking perspectives of people with lived experience of e-cigarette use for smoking cessation. Methods: Mixed methods data, collected between March 2018 and March 2019 as part of a broader study of e-cigarette use trajectories (ECtra study). Data here relate to views of partnership working and medicalisation of vaping extracted from 136 interviews/extended surveys of people who had used e-cigarettes to try to stop smoking. Qualitative data were thematically analysed. Participant ratings of interventions were presented descriptively and differences in participant characteristics and ratings were reported. Results: Three qualitative themes were identified: pro-partnership, anti-partnership and medicalisation dissonance. Medicalisation was discussed for its potential to reassure smokers about e-cigarette harms and its potential to reach smokers from disadvantaged backgrounds. Concerns were raised about cost-effectiveness, quality of support, conflicts of interest, and limiting product choice. Most participants rated interventions involving partnership working as potentially helpful in switching from smoking to vaping. There were no statistically significant associations between age, gender and socio-economic status and helpfulness ratings. Conclusions: Both commercial and medical routes to vaping offer perceived benefits to vapers and may complement and reinforce each other to support smoking cessation

Innovations that Address Socioeconomic, Cultural, and Geographic Barriers to Preventive Oral Health Care

This report focuses on nine oral health innovations that integrate service delivery and workforce models in order to reduce or eliminate socioeconomic, geographic, and cultural barriers to care. Two additional reports in this series describe the remaining programs that provide care in non-dental settings and care to young children. Although the programs are diverse in their approaches as well as in the specific characteristics of the communities they serve, a common factor among them is the implementation of multiple strategies to increase the number of children from low-income families who access preventive care, and also to engage families and communities in investing in and prioritizing oral health. For low-income children and their families, the barriers that must be addressed to increase access to preventive oral health care are numerous. For example, even children covered by public insurance programs face a shortage of dentists that accept Medicaid and who specialize in pediatric dentistry.(Guay, 2004).The effects of poverty intersect with other barriers such as living in remote geographic areas and community-wide history of poor access to dental care in populations such as recent immigrants . Overcoming these barriers requires creative strategies that address transportation barriers; establish welcoming environments for oral health care; and are linguistically and culturally relevant. Each of these nine programs is based on such strategies, including:-Expanding the dental workforce through training new types of providers or adding new providers to their workforce to increase reach and community presence;-Implementing new strategies to increase the cost-effectiveness of care so that more oral health care services are available and accessible;-Providing training and technical assistance that increase opportunities for and competence in delivering oral health education and care to children;-Developing creative service delivery models that address transportation and cultural barriers as well as the fear and stigma associated with dental care that may arise in communities with historically poor access.The findings from the EAs of these programs are synthesized to highlight diverse and innovative strategies for overcoming barriers to access that have potential for rigorous evaluation that could emerge as best practices. If proven effective, these innovative program elements could then be disseminated and replicated to increase access for populations in need of preventive oral health care

A multi-centre cluster randomised controlled trial evaluating the effectiveness of e-cigarettes compared with usual care for smoking cessation when offered to smokers accessing homeless services: methodological challenges and experiences of collaboration.

Around 80% of people experiencing homelessness smoke. E-cigarettes (ECs) are an effective quitting aid, but they have not been widely tested in this population. Project SCeTcH aims to evaluate the offer of an EC or usual care (UC) to smokers accessing homeless centres. A multi-centre two-arm cluster randomised controlled trial (RCT), including 32 homeless centres across Great Britain (480 participants). Randomisation includes either an EC with weekly allocations of e-liquid for 4-weeks or UC comprising very brief advice and signposting to a stop smoking service. After year 1, 27 centres and 240 participants have been recruited and retention rates at 4- and 24- weeks are 67% and 70% respectively. Challenges include working with multiple centres with different structures, provision, and client needs; reconciling risk of bias with the practicalities of working in this sector; the ongoing impact of Covid; changing models of care and practice; and juggling the needs of different collaborators researchers and health and social care organisations This is the first cluster RCT to assign smokers experiencing homelessness to an EC and UC intervention to measure smoking abstinence and risky smoking practices. Running trials in this population requires the need to understand the realistic needs of these individuals and services, and to work pragmatically and flexibly within the remit of the trial protocol. Ultimately, if effective, the results will be used to inform the larger scale implementation of supporting homeless centres to aid smoking cessation

Vaping’ profiles and preferences: an online survey of electronic cigarette users

Aims to characterize e-cigarette use, users, and effects, in a sample of Electronic Cigarette Company (TECC) and Totally Wicked E-Liquid (TWEL) users. Design and Setting Online survey hosted at the University of East London with links from TECC/TWEL websites between September 2011 to May 2012. Measurements Online questionnaire. Participants 1347 respondents from 33 countries (72% European), mean age 43 years, 70% male, 96% Causacian, 44% educated to degree level or above. Findings 74% reported not smoking for at least a few weeks since using the e-cigarette and 70% reported reduced urge to smoke. 72% of participants used a ‘tank’ system, most commonly, the eGo-C (23%). Mean duration of use was 10 months. Only 1% reported exclusive use of non-nicotine (0mg) containing liquid. E-cigarettes were generally considered to: be satisfying to use; elicit few side effects; be healthier than smoking; improve cough/breathing; and be associated with low levels of craving. Among ex-smokers, ‘time to first vape’ was significantly longer than ‘time to first cigarette’(t1104=11.16, P <0.001) suggesting a lower level of dependence to e-cigarettes. Ex-smokers reported significantly greater reduction in craving than current smokers (χ21 =133.66, P<0.0007) although few other differences emerged between these groups. Compared to males, females opted more for chocolate/sweet flavours (χ21 =16.16, P< 0.001) and liked the e-cigarette because it resembles a cigarette(χ23 = 42.65, P< 0.001). Conclusions E-cigarettes tend to be used for smoking cessation but for a longer duration than NRT and were generally regarded as efficacious. Future research should focus on possible long-term health risks, abuse liability and cessation efficacy

The electronic-cigarette: effects on desire to smoke, withdrawal symptoms and cognition

Electronic cigarettes (e-cigarettes) are battery operated devices that deliver nicotine via inhaled vapour. Few studies have evaluated acute effects on craving and mood, and none have explored effects on cognition. This study aimed to explore the effects of the White Super e-cigarette on desire to smoke, nicotine withdrawal symptoms, attention and working memory. Eighty-six smokers were randomly allocated to either: 18mg nicotine e-cigarette (nicotine), 0mg e-cigarette (placebo), or just hold the e-cigarette (just hold) conditions. Participants rated their desire to smoke and withdrawal symptoms at baseline (T1), and five (T2) and twenty (T3) minutes after using the e-cigarette ad libitum for five minutes. A subset of participants completed the Letter Cancellation and Brown-Peterson Working Memory Tasks. After 20 minutes, compared with the just hold group, desire to smoke and some aspects of nicotine withdrawal were significantly reduced in the nicotine and placebo group; the nicotine e-cigarette was superior to placebo in males but not in females. The nicotine e-cigarette also improved working memory performance compared with placebo at the longer interference intervals. There was no effect of nicotine on Letter Cancellation performance. To conclude, the White Super e-cigarette alleviated desire to smoke and withdrawal symptoms 20 minutes after use although the nicotine content was more important for males. This study also demonstrated for the first time that the nicotine e-cigarette can enhance working memory performance. Further evaluation of the cognitive effects of the e-cigarette and its efficacy as a cessation tool is merited