Vaping, smoking cessation and emergency departments: the SSA talks to Caitlin Notley
Professor Caitlin Notley was recently awarded NIHR funding to conduct a study on delivering smoking cessation using vaping products across five hospital emergency departments. The SSA caught up with Professor Notley to find out more:
SSA: Why did you focus on hospital emergency departments as an opportunity to give smoking cessation advice?
Prof. Notley: “Well, this is a collaboration between Dr Ian Pope and me as co-leads on the trial. Dr Pope is clinician working in the emergency department at the Norfolk and Norwich University Hospital departments and is very interested in public health interventions in that setting. We were having a coffee one day, and he said that he really wanted to do something in the emergency department and obviously with my background I suggested smoking cessation and e-cigarettes.”
“I just thought that this was a perfect opportunity to combine my interests in smoking cessation and in e-cigarettes with his interest in improving public health through accessing patients in the emergency department. We then conducted a brief literature review looking for trials in that setting. There have been no trials of smoking cessation interventions in emergency departments in the UK. There are some US trials, but none of those had used e-cigarettes as the intervention. So, it seemed like an ideal opportunity to bring together our interests.”
“If someone has got a broken bone, we can talk about improved healing times. If someone’s there with a long-term respiratory illness we can talk about the benefits of quitting smoking.”
You will go into emergency departments and talk to people who might be there for quite serious reasons. Will it be difficult talking people about smoking cessation in those potentially quite intense situations?
“Yeah, it’s going to be challenging, that’s undeniable. But it will also be an exciting opportunity to make a difference in people’s lives. We did a lot of PPI [Patient and Public Involvement] work when we were writing the application. First, we looked at the smoking prevalence of people coming into emergency departments and found that around 24% of patients were active smokers at the time of coming in. This is higher than the general population, which is possibly not that surprising. I guess that people coming into A&E are more likely to have complex lives and other vulnerabilities, so more likely to be the smokers that we are trying to offer support to.”
“And yes, many people attend A&E for very serious reasons, but many also attend for less serious reasons. Most people are waiting a long time when they go into an emergency department and are therefore willing to listen to doctors and health professionals’ advice. They’re often sitting there looking at their phones, so it’s an opportunity to give them some evidence-based health advice.”
“Many people are not aware of the implications of tobacco smoking on their recovery. We want to offer a tailored package of support on switching to e-cigarettes and are going to tailor that depending on the presenting condition. So, for example, if someone has got a broken bone, we can talk about improved healing times. If someone’s there with a long-term respiratory illness we can talk about the benefits of quitting smoking. So, really trying to tailor the quitting advice around the presenting condition to make it meaningful and relevant.”
“I’m particularly interested in trying to understand how the intervention’s working. So, we’ll be doing interviews with participants but also with staff delivering the intervention”
What outcomes are you looking at?
“It’s a definitive trial and we’re interested in whether the intervention works. So, our primary outcome will be sustained smoking abstinence at 6 months. The idea is that we encourage people to switch and that they stay switched and don’t go back to tobacco smoking. There are secondary outcomes of course. We’ll be interested in smoking reduction and whether people are on a pathway to smoking cessation, and also quality of life and other health outcomes, but ultimately we’re interested in whether people quit smoking completely.”
Are you taking any qualitative data from this study?
“Yes, that’s really important. The process evaluation will run alongside the trial. It’s expected these days with trials that you have a mixed-methods approach. That’s my expertise and I’m particularly interested in trying to understand how the intervention’s working. So, we’ll be doing interviews with participants but also with staff delivering the intervention, looking at how it’s delivered, how acceptable it is, what parts of the intervention people seem to like and what parts they don’t. This will allow us to really unpick the eventual trial findings and allow us to make recommendations for future implementation if we are able to roll it out as something that health services routinely offer.”
When do you start recruitment?
“We start recruiting in the Autumn, so October – November time is our planned recruitment open date. We should then start to see results in a couple of years. We plan to recruit within 12 months, so then we should have findings to report a year later than that. Hopefully it will be quite quick, because we’re only looking at 6-month follow-up rather than 12 months, it means that our time to reporting will be a bit quicker.”
“You can’t give people a kit and a week’s worth of products and then they can’t afford to carry on using it and can’t go to a shop where the vaping products are for sale”
Which vaping product will you use?
“There’s been a huge amount of interest in this, and we don’t know yet. We have a panel of smokers testing our shortlist of kits. We’re keen to use a product that’s independently funded, so not produced by the tobacco industry. It’s got to cheap, easy to use, able to be used straight away and satisfying for smokers. It really has to be something that smokers think and feel that they can switch to.”
“One of the most important things is that it’s got to be accessible to people in their environment, so we’re looking at the distribution of vape supplies, because you can’t give people a kit and a week’s worth of products and then they can’t afford to carry on using it, or can’t go to a shop where the vaping products are for sale.”
“I guess particularly with this population – to encourage people to quit who aren’t intending to quit, it is vital to give them something that they really like and that works, otherwise it’s a non-starter, so yes, that’s really important.”
Caitlin Notley is Professor of Addiction Sciences at the University of East Anglia (UEA).
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