Serious question: why don't more smokers switch to using e-cigarettes?
Sunday, June 18, 2017 at 9:00
Simon Clark

Remember The Pleasure of Smoking report, published at the end of last year?

Co-authored by Dr Neil McKeganey, director of the Centre for Substance Use Research in Glasgow, and funded by Forest, it was based on a survey of 650 'confirmed smokers'.

The study found that 95 per cent of confirmed smokers smoke because they take pleasure from the habit. Over 70 per cent had no plans to quit any time soon.

The researchers also asked respondents about e-cigarettes and got some interesting and detailed responses.

That research has now been published in a peer reviewed paper published by the International Journal of Environmental Research and Public Health.

Entitled Why Don’t More Smokers Switch to Using E-Cigarettes: The Views of Confirmed Smokers, it's summarised as follows:

Whilst e-cigarettes have been characterised by Public Health England as being around 95% less harmful than combustible tobacco products, only a minority of current smokers (around 16% within the UK) are using these devices.

In this paper we report the results of an online survey of 650 smokers in contact with a smokers’ rights group in the UK. A total of 91% of the smokers surveyed were smoking on a daily basis. Fifty nine percent reported having used electronic nicotine delivery systems, the majority of whom reported having used e-cigarettes.

Those smokers that had not used these devices principally explained this in terms of the pleasure they derived from smoking. The features smokers liked most about e-cigarettes had to do with the range of settings in which they could be used, the lack of an offensive smell associated with their use, the available flavours and the reduced level of harm.

The elements which smokers liked least about e-cigarettes had to do with the vaping experience, the technology, the chemical nature of e-liquids and the complex technology that was associated with these devices.

If a greater number of smokers are to be encouraged to take up e-cigarettes, it will be necessary not only to convey accurate information on the relative harm of these devices (compared to combustible tobacco products), but to ensure that they are able to be used in a wider range of settings than those within which smoking can currently occur and that the vaping experience more closely resembles the smoking experience.

Aside from the fact that this is the first time, to my knowledge, that Forest has ever been associated with a peer reviewed paper in any publication let alone a leading international journal, I'm delighted the CSUR's research has been recognised in this way.

It's an important piece of work because it's a rare example of the views of committed smokers being listened to and taken seriously.

Smokers are, by and large, dismissed as addicts with little or no willpower over their own behaviour. What the research found is that while 56 per cent of respondants accepted they're addicted to smoking, very few were concerned because they enjoy their habit and don't want to quit.

In other words, far from considering themselves to be unwilling slaves to the evil weed, they happily embrace their addiction.

At the same time, the research found that a substantial minority of confirmed smokers did NOT believe they were addicted.

None of these responses is something the tobacco control industry wants to hear, hence few public health campaigners were willing to acknowledge the existence of the original report.

Using the same research, Neil McKeganey's peer reviewed paper asks an important question: why don't more smokers switch to vaping?

The pleasure many confirmed smokers get from smoking is a major factor but so too is their experience of vaping.

Fifty-nine per cent of those who responded to the CSUR questionnaire provided feedback on their use of reduced risk nicotine products. Interestingly, given that we're talking about smokers who by and large don't want to quit, almost all of this group reported they had used e-cigarettes.

The paper, like the original report, highlights what they liked or disliked about e-cigarettes. It's quite illuminating and should be essential reading for tobacco control campaigners and anyone interested in tobacco harm reduction.

Over the next few days I'll watch with interest to see how many of the leading THR advocates review or tweet a link to Neil McKeganey's paper.

I'm guessing they won't because they're far too busy slapping themselves on the back about the latest ONS figures that show that the smoking rate in the UK has fallen below 16 per cent, a drop they associate almost entirely with the rise in popularity of e-cigarettes.

Inevitably it's a bit more complicated than that. Personally I think the significant reduction in smoking rates since 2012 is due to a combination of factors. Vaping is undoubtedly one of them; so too is the increasingly prohibitive cost of tobacco (which has the knock-on effect of driving some smokers to the black market).

What no-one seems to be addressing is the fact that the sharp rise in the use of e-cigarettes is said to have peaked. If that's true research such as Neil McKeganey's excellent paper is even more important because it offers a valuable insight into why more smokers aren't switching to vaping.

Unfortunately I fear many tobacco harm reduction advocates are living in a bubble, preferring to listen only to those who have quit smoking or switched exclusively to vaping.

A case in point is the Global Forum on Nicotine that concluded in Warsaw yesterday. The organisers were aware of The Pleasure of Smoking report but did they invite Neil or his co-author to address the conference? Did they heck.

To the best of my knowledge there wasn't a single presentation by anyone representing smokers who don't wish to quit or switch to e-cigarettes. Why? Surely, if vaping is to overtake and ultimately replace smoking, the views of confirmed smokers must not only be sought out and acknowledged, they must be acted upon, not sidelined or ignored because some people find them unpalatable or off message.

Yes, consumers were well represented at GFN but they were overwhelmingly (or exclusively) ex-smokers and vaping advocates, not current or confirmed smokers, so the plethora of speakers, most of them from the public health or THR communities, were preaching mostly to the converted.

Would it have been too much to invite someone to speak on behalf of smokers who don't want to quit or switch?

To read 'Why Don’t More Smokers Switch to Using E-Cigarettes: The Views of Confirmed Smokers' in full click here. To download a pdf, click here.

If you're on social media, please share.

PS. According to one tobacco control campaigner, The Pleasure of Smoking report was lightweight and contrived.

A penny for his thoughts now the same research has been peer reviewed and published in a leading international journal.

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