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E-cig uptake linked to official drop in quitters

Exclusive An increasing uptake of e-cigarettes could be to blame for fewer people using NHS Stop Smoking services. 

Figures released by the Health and Social Care Information Centre (HSCIC) show that for the first time, the number of people using the health service to quit has fallen two years in a row. 

Last year just 586,000 people made a commitment to quit with the NHS in England, compared to more than 724,000 in 2012/13. 

Speaking exclusively to Nursing in Practice, Public Health England's tobacco control programme lead Martin Dockrell said the “emerging popularity of e-cigarettes” as a way to quit could be one of the reasons for fewer people using NHS Stop Smoking Services. 

And Wendy Preston, the nurse consultant who led the Royal College of Nursing's call to improve research into e-cigarette use, agrees. 

“We think that's why we've had a dip [in people accessing NHS stop smoking services] - because many people are self-medicating. Some think they don't need to go for help, they just use an e-cigarette instead,” she said. 

However, Dockrell and Preston both said that official stop smoking services are the most effective way for a smoker to quit “completely, immediately and forever”. 

In her practice at George Eliot Hospital and in conversations with her general practice colleagues, Preston has found that many people are starting to become “stuck” on e-cigarettes. 

Preston told Nursing in Practice: “We're starting to get people coming forward saying that they want to have help to get off their e-cigarettes. It's hard to say how many, but it's widely acknowledged that there's a lull where people start to become fed up of e-cigarettes and want to stop using them.” 

Around 2.1 million adults in Great Britain currently use electronic cigarettes. The majority of e-cigarette 'vapers' are continuing to use tobacco (66%) while the rest categorise themselves as ex-smokers, according to Action on Smoking and Health (ASH). 

In a major survey carried out by ASH, most smokers (38%) reported that they had been using e-cigarettes “to help stop smoking entirely” while many (29%)  wanted “an aid to help keep off tobacco” or “to help reduce the amount of tobacco smoked but not stop completely” (25%). 

HSCIC's figures show that the success rate of quitting for people using NHS services has remained steady at around 50%.

'Highly addicted'

Nine in ten people who successfully quit had used pharmacotherapies such as nicotine replacement therapy while one to one support was used by 82% of those who set a quit date.

“Nurses are well placed to make every contact count and offer very brief advice to smokers every time,” said Dockrell.  

“Nurses should feel confident that referring a patient to a Stop Smoking Service is the best way to help them stop smoking and is four times more effective than using willpower alone. Even smokers considering e-cigarettes as a quitting aid should speak to their Stop Smoking Service to see what support they can offer.” 

However Dockrell did concede that the nationwide reorganisation of stop smoking services last year, as well as reduced local publicity could also be to blame for the drop in attendees. 

Tracy Kirk, primary care respiratory nurse consultant said that there is “no doubt” that increasing e-cigarette use is driving people away from NHS Stop Smoking Services. 

But she echoed Dockrell's concern that other reasons could also be affecting use of the health services' smoking cessation services.  

Kirk, who has run innovative pilot projects on smoking cessation, said there are many more questions to be asked about the link. For example, she questioned whether referrals from healthcare professionals to stop smoking services have started to drop because of all of the patients who have already used the service to quit. 

“The service itself has been going on for many years now and maybe this is part of the problem. My own feeling is that the patients who are still smoking are the ones who are highly addicted to nicotine and who are actually scared to even contemplate the thought of stopping smoking.” 

A review of studies into e-cigarette use published earlier this month suggests that e-cigarettes could be far less harmful than regular tobacco. 

The scientists, published in the journal Addiction, said that although the long-term effects of e-cigarette use is unknown, using them in the place of conventional cigarettes could reduce smoking-related deaths

However, the safety of e-cigarettes is under scrutiny from the World Health Organization. A recently released report warned that the vapour exhaled from some e-cigarettes could increase the levels of nicotine, aluminium and other chemicals, in the air. 

E-cigarette manufacturers should cease claims that they can help smokers quit until there is firm evidence, WHO said. 

Referencing the report, Preston said: “We need to be careful because we can't just tell patients that e-cigarettes are fine. They're not fine. There is still some evidence that they're toxic and do possess risks. 

“Those risks are not fully known yet and that's why research is so important.”