1. E-Cigarettes: Practitioners Views, Beliefs, Experiences and Concerns 12 June 2015 Tina Williams, Head of Development and Training Tobacco Free Futures

2. Tobacco Free Futures is a social enterprise, and our mission is to Make Smoking History for Children. The North West Office of Tobacco Control; we are leading experts in tackling tobacco and our vision is to change the way children, young people and adults think about tobacco and help future generations to be tobacco free. We support regional and national tobacco control activity at a local level enabling local authorities, NHS and any organisation we work with to tackle tobacco issues in their area.

3. Overview TFF commissioned by Greater Manchester PHE to develop and deliver a workshop 12 May 2015 – Identify and measure the views, beliefs, experiences, concerns and attitudes of stop smoking (ss) practitioners to e-cigarettes – Support stop smoking practitioners to understand and apply the evidence Event took place on May 12 th 2015 – 44 SS practitioners from GM and NW attended

4. Objectives To understand of SS practitioners perceptions of e-cigarettes: – Explore perceived benefits, risks and concerns – Tease out perceived opportunities and potential – To gather experiences of working with e-cigarettes as a quit tool, both positive and negative – To gauge awareness of current evidence of e-cigarettes as a quit aid

5. Objectives To identify and address any barriers to effective working with e-cigarettes: – What factors are inhibiting practitioners? – Are there knowledge gaps and if so how these might be addressed ?

6. Objectives To inform the development of a guidance resource for SS practitioners – What does this need to include? – How and where should it be presented? – At what level local national?

7. Workshop Format Pre-workshop online survey Welcome Focus Groups Expert Presentations / discussion Second post-workshop online survey Feedback of top-line findings / Q&A / discussion

8. Expert Presentations -Professor Ann McNeill, King’s College London, E-cigarettes: setting the scene -Sue Cumming, Liverpool City Council, Public perceptions of e-cigarettes insight -Lisa Williams, Roy Castle FagEnds, Electronic cigarette use and risk perception in a stop smoking service -Karen House, Leicester Stop Smoking Service, Developing an e-cigarette friendly service -Dr Heide Weishaar, University of Glasgow, Understanding teenagers’ experiences and attitudes of e-cigarettes -Andrea Crossfield, Tobacco Free Futures, What can North West data tell us?

9. Pre-event Survey Most felt under-informed, confused and ambivalent about e- cigarettes as a quit aid Few were working with e-cigarettes as part of their offer to clients – Not part of local delivery specification Therefore limited scope to discern experiences of effective or ineffective use as a quit aid Widespread concerns about long term health impact, efficacy as a quit aid, risk of re-normalising smoking, appeal to children and young people and impact on service footfall

10. Findings pre-workshop survey Pre survey completed by 43 delegates

11. How well informed do you feel? Source: TFF/PHE research among workshop delegates before workshop; EBR: Evidence based research

12. Where do you look for information on e-cigs? Source: TFF/PHE research among workshop delegates before workshop; EBR: Evidence based research

13. E-cigs often seen as an effective quit aid Source: TFF/PHE research among workshop delegates before workshop; EBR: Evidence based research

14. But less keen to promote them as a quit aid evidence not yet clear; lack of regulation and guidance Source: TFF/PHE research among workshop delegates before workshop; EBR: Evidence based research

15. Benefits and drawbacks of e-cigs as quit aid Source: TFF/PHE research among workshop delegates before workshop; EBR: Evidence based research

16. Findings - focus group work Seven focus groups were carried out with a total of 44 delegates

17. How well informed did you feel? Focus group outcomes: Research sometimes conflicting about health and safety Media noise No clear guidance Uncertain how to advise service users Much more confident about other quit aids Source: TFF/PHE research among workshop delegates

18. Benefits of e-cigs as quit aid Focus group outcomes: Harm reduction – on balance is the biggest benefit Innovative new way to encourage smokers with idea of quitting An alternative for remaining ‘hardcore’ smokers Potentially more cost-effective Source: TFF/PHE research among workshop delegates

19. How to make e-cigs more useful as a quit aid Source: TFF/PHE research among workshop delegates Focus group outcomes: Develop and communicate a firm evidence base about safety and efficacy Promote the SSS offer of support and advice alongside quit aid

20. Drawbacks of e-cigs as quit aid Broad range of drawbacks /barriers emerged in focus groups – Impossible to harness without clear evidence / regulation – Lack of clear guidance  uncertainty (risk) – Bypassing SSS – Shifting focus away from behavioural support – maintains or even reinforces addiction Source: TFF/PHE research among workshop delegates

21. Feelings about promoting e-cigarettes Wide spread concern – Tobacco Industry involvement – Future role of SSS Potential to feel really positive – If licensed / evidenced / approved – Reduction of health inequalities Source: TFF/PHE research among workshop delegates

22. Findings post-workshop survey Post survey completed by 42 delegates

23. How well informed do you feel now? Source: TFF/PHE research among workshop delegates post workshop

24. How effective do e-cigs seem now? Source: TFF/PHE research among workshop delegates post workshop

25. How keen to promote as quit aid now?

26. How to make e-cigs more useful as a quit aid Source: TFF/PHE research among workshop delegates post workshop Nobody said ‘nothing would make them useful’

27. Post-event survey Revealed an increased understanding of the current evidence base A greater level of support for offering e-cigarettes as one of a range of quit aids – with the strong proviso that definitive information and guidance, product regulation/licensing and a clear commissioning position must all be in place to support their work

28. Summary The outcomes of the workshop clearly demonstrated value of an interactive, face to face learning experience in – eliciting views – assessing and increasing knowledge – and teasing out practitioners needs The format used for the workshop provides a potential model for future practitioner training

29. Recommendations There is a clear need for continued assessment and communication of evidence base An expressed need for one statement of evidence, and one set of guidance on service use of e-cigarettes, ideally at a national level, or at the highest possible geographical level, to offer the reassurance of consistency A need consistent guidance across all health care professional groups, based on ‘best current evidence’ Information resource for SSSAs needs to be developed

30. Acknowledgments Commissioned by Greater Manchester PHE, Delivered by Caroline Midmore & Ansa Hussain