Is it the nicotine? Australian smokers’ accounts of nicotine addiction and the implications for smoking cessation

Since the 1980s, it has been widely accepted that nicotine is an addictive drug. While discussions of smoking inevitably lead smokers to reflect on their addiction, smokers’ perceptions of nicotine addiction specifically are rarely studied. Smokers’ understandings of nicotine addiction are increasingly relevant in light of the emergence of electronic cigarettes and other cessation aids containing nicotine, and their potential use as long-term replacements for cigarettes. This article is based on a thematic discourse analysis of interviews with 29 smokers from a large metropolitan city in Australia. We explore how smokers negotiate the concept of nicotine addiction in relation to themselves and other smokers, and how this influences their views of smoking cessation methods. Starting with the image of a nicotine addict, we show how participants accept or distance themselves from this image by re-framing the source of their addiction as habit-addicted, rather than nicotine-addicted. We also discuss the function of ‘habit talk’ as a way of contextualising their addiction, and report on how notions of addiction shape participants' views of cessation methods. Finally, we discuss the implications of these findings for future research and for health professionals working with smokers

Why don’t smokers want help to quit? A qualitative study of smokers’ attitudes towards assisted versus unassisted quitting

The development of prescription medication for smoking cessation and the introduction of evidence-based guidelines for health professionals has increasingly medicalised smoking cessation. There are debates about whether medicalisation is a positive development, or whether it has devalued unassisted quitting. In this debate the views of smokers have been neglected. This study explored the attitudes of smokers towards a range of quitting methods, and their considerations when judging their value. We conducted semi-structured interviews with 29 smokers and analysed data using thematic analysis. The results show that the perceived nature of an individual smoker's addiction was central to judgments about the value of pharmacological cessation aids, as was personal experience with a method, and how well it was judged to align with an individual's situation and personality. Unassisted quitting was often described as the best method. Negative views of pharmacological cessation aids were frequently expressed, particularly concerns about side effects from prescription medications. Smokers' views about the value of different methods were not independent: attitudes about cessation aids were shaped by positive attitudes towards unassisted quitting. Examining smokers' attitudes towards either assisted or unassisted quitting in isolation provides incomplete information on quitting preferences

Differential access to health care and support? A qualitative analysis of how Australian smokers conceptualise and respond to stigma

Scholarship on stigma, originally theorised as a ‘mark’ of social disgrace or difference, has since moved away from individual-level analyses to consider the socio-cultural context in the ‘marking’ of groups of people. In response to this theoretical shift, scholars have demonstrated how extensive tobacco denormalisation policies have contributed to the stigmatisation of smokers, documenting smokers’ experiences of stigma across a number of developed countries. We extend this analysis to the Australian context, examining smokers’ constructions of stigma and their reactions to policies that would give smokers differential access to healthcare. Based on 29 interviews with Australian smokers, we focus on what constitutes evidence of stigma and how participants use social comparisons to respond to stigma. We then explore an assumption underpinning participants’ accounts of stigma: that only smokers committed to cessation are ‘deserving’ of treatment. We close by discussing theoretical perspectives and opportunities in stigma research and the need to extend a stigma lens to study emerging public health issues, such as electronic cigarettes

Public attitudes toward the treatment of nicotine addiction

Introduction: The increasing use of medications for smoking cessation has concerned some commentators, who believe that emphasizing medications for smoking cessation may lead to a belief that there are "magic bullets" for nicotine dependence, or alternatively that unassisted quitting is very difficult, thereby discouraging such quit attempts. There is little evidence on which to test these speculations. This article aims to address this gap by examining public understandings of nicotine addiction in order to assess the extent to which medical explanations of smoking have permeated public beliefs about treatments for smoking cessation

Framing tobacco dependence as a “brain disease”: implications for policy and practice

Like other forms of drug dependence, tobacco dependence is increasingly being described as a "chronic brain disease." The potential consequences of this medical labelling have been examined in relation to other addictions, but the implications for tobacco control have been neglected. Some have posited that biomedical conceptions of addiction will reduce stigma and increase uptake of efficacious treatments. Others have countered that it could increase stigma, reduce treatment seeking, and deter unassisted quitting. We explored how smokers respond to the labelling of smoking as a brain disease

Framing and scientific uncertainty in nicotine vaping product regulation: An examination of competing narratives among health and medical organisations in the UK, Australia and New Zealand

Aims To compare the policy positions of health and medical organisations across Australia, New Zealand, and the UK as they relate to sale and supply of nicotine vaping products (NVPs) and evaluate factors that have informed the differences in policy recommendations among these countries. Methods We used mixed methods to analyse data from position or policy statements published by health and medical organisations regarding NVPs (n = 30) and consultation documents submitted to government committees regarding policy options for the regulation of NVPs (n = 26). Quality assessment of included documents was conducted using the six-item Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Text and Opinion Papers, and findings were presented narratively. Qualitative data were coded using NVivo 12 software and analysed using thematic analysis. Results An overwhelming majority of health bodies, charities and government agencies in the UK and New Zealand portrayed NVPs as a life-saving harm reduction tool. In contrast, concerns about addicting non-smoking youth to nicotine, a perceived lack of clear and convincing evidence of safety and efficacy and the potential to undermine tobacco control progress continues to define attitudes and recommendations towards NVPs among Australian health and medical organisations. Although the profoundly divided views among stakeholders seem to arise from empirical uncertainties and disagreements over the level and credibility of evidence, the source of most of these disagreements can be traced back to the fundamental and irreconcilable differences in the framing of the NVP debate, and varied tolerability of risk trade-offs associated with NVPs. Conclusion Progress in resolving the controversy surrounding NVP policy requires stakeholders to be frame-reflective and engage in a meaningful dialogue of risk trade-offs, as well as both intended and unintended consequences of proposed policies

Nicotine vaping product use, harm perception and policy support among pharmacy customers in Brisbane, Australia

Despite regulatory barriers for accessing nicotine liquid, use of nicotine vaping products (NVPs) has increased rapidly in Australia. Legal use of NVPs to aid smoking cessation requires a prescription, and pharmacies report receiving enquiries about the use of and access to NVPs. In this study, we assessed vaping product use, harm perception and policy support among community pharmacy customers.A cross-sectional survey was conducted among customers (n = 470) from a large community pharmacy chain in Brisbane, Australia. Multivariable logistic regression was used to examine perception of NVPs as less harmful than combustible cigarettes and regulatory recommendations in relation to demographics, smoking status and NVP use.Almost one-third of the sample (31%) had either tried NVPs in the past (16%) or were current vapers (15%), the majority of them being current smokers (67%) who are trying to quit (31%) or substitute smoking (41%). Vapers primarily depended on family/friends as a source of information (76%). Current smokers and vapers were more likely to perceive NVPs as less harmful than cigarettes than non-smokers and non-vapers. Perceiving NVPs as safer than cigarettes was correlated with a recommendation to regulate as a tobacco product.There was widespread misperception about relative risk of nicotine-containing products, with 37% of respondents perceiving nicotine-containing NVPs to be as harmful as combustible cigarettes. Community pharmacies represent an ideal setting for educating smokers about smoking and vaping. Thus, pharmacy staff needs educational support to ensure that they are equipped to provide current evidence-based information to customers

A first pass, using pre-history and contemporary history, at understanding why Australia and England have such different policies towards electronic nicotine delivery systems, 1970s-c. 2018.

AIMS: The United Kingdom and Australia have developed highly divergent policy responses to electronic nicotine delivery systems (ENDS). To understand the historical origins of these differences, we describe the history of tobacco control in each country and the key roles played in setting ENDS policy in its early stages by public health regulations and policy networks, anti-smoking organizations, 'vaper' activist networks and advocates of harm reduction policies towards injecting drug use. METHODS: We analysed key government reports, policy statements from public health bodies and non-government organizations (e.g. cancer councils and medical organizations) on ENDS; submissions to an Australian parliamentary inquiry; media coverage of policy debates in medical journals; and the history of tobacco control policy in Australia and England. Key discourses about ENDS were identified for each country. These were compared across countries during a multi-day face-to-face meeting, where consensus was reached on the key commonalities and divergences in historical approaches to nicotine policy. This paper focuses on England, as different policy responses were apparent in constituent countries of the United Kingdom, and Scotland in particular. RESULTS: Policymakers in Australia and England differ markedly in the priority that they have given to using ENDS to promote smoking cessation or restricting smokers' access to prevent uptake among young people. In understanding the origins of these divergent responses, we identified the following key differences between the two countries' approaches to nicotine regulation: an influential scientific network that favoured nicotine harm reduction in the United Kingdom and the absence of such a network in Australia; the success of different types of health activism both in England and in Europe in opposing more restrictive policies; and the greater influence on policy in England of the field of illicit drug harm reduction. CONCLUSIONS: An understanding of the different policy responses to electronic nicotine delivery systems (ENDS) in England and Australia requires an appreciation of how actors within the different policy structures, scientific networks and activist organizations in each country and region have interpreted the evidence and the priority that policymakers have given to the competing goals of preventing adolescent uptake and encouraging smokers to use ENDS to quit smoking

What does 'acceptance' mean? Public reflections on the idea that addiction is a brain disease

Public responses to the dissemination of neuroscientific explanations of addiction and other mental disorders are an interesting sociocultural phenomenon. We investigated how 55 members of the Australian public deliberated on the idea that 'addiction is a brain disease'. Our findings point to the diverse ways in which the public understands and utilises this proposition. Interviewees readily accepted that drugs affect brain functioning but were ambivalent about whether to label addiction as a 'disease'. Contrary to the prediction of neuroscientific advocates and social science critics, acceptance of a neurobiological conception of addiction did not necessarily affect beliefs about addicted persons' responsibility for their addiction. We discuss the theoretical and applied implications of these findings. Theoretically, we examine the complexity surrounding how people adopt new knowledge and its role in reshaping ethical beliefs. We also discuss the implications of these findings for the ethics of communication of neuroscientific information to reduce stigma and enhance social support for the treatment of addicted individuals