The research involved the collection of qualitative data. Twelve focus groups and eleven individual interviews were conducted with a range of purposively selected smoker groups. The project focussed particularly on groups who may benefit most from tobacco harm reduction approaches including disadvantaged groups. Young adults were also included as they have low quit rates and may be particularly interested in novel technologies such as e-cigarettes. Smokers and recent ex-smokers (quit in previous twelve months) were recruited for focus groups and interviews from community and interest groups in disadvantaged areas. Background: Smoking is the most important cause of preventable death and disease in the UK. The UK is at the forefront in implementing comprehensive tobacco control policies designed to prevent smoking initiation and to help smokers to quit, having employed various successful population-level interventions and developed internationally unique NHS stop smoking services. However, there are growing concerns that the decline in adult smoking prevalence may be levelling off. Whilst most smokers try to quit, the majority are not successful. Some experts have therefore argued for the use of harm reduction approaches to reduce smokers' health risks. Generally, harm reduction approaches suggest that smokers who are unable to or do not want to quit should be advised to switch from smoking cigarettes to less harmful nicotine delivery devices - devices that deliver nicotine without inhaling tobacco smoke, such as nicotine replacement therapies or electronic cigarettes (ecigarettes). Despite the fact that harm reduction approaches have divided the international tobacco control community, they have recently become influential in the UK, particularly in English tobacco control policy. However, we know very little about how smokers view harm reduction. Aims: To explore how tobacco harm reduction approaches and alternative nicotine delivery devices, including e-cigarettes, are understood and experienced by smokers and recent ex-smokers, and to consider the implications for tobacco control policy and practice. Methods: This qualitative study focuses particularly on groups of smokers who either may find it harder to quit or for whom quitting is particularly important and are, therefore, considered most likely to benefit from harm reduction i.e. those with low socio-economic status, smoking-related diseases, mental health issues and young adults. Focus groups and semi-structured individual interviews were undertaken with purposively selected smoker groups. The analysis explored what considerations and criteria smokers draw upon when evaluating health risks and smoking-related choices. We examined how smokers conceptualise nicotine as a substance and how they understand the risks and benefits of different nicotine delivery devices.
Twelve focus groups and 11 individual interviews were carried out with a range of purposively selected smoker groups. The project focussed particularly on groups who may benefit most from tobacco harm reduction approaches including disadvantaged groups (low socio-economic status, mental health problems). Young adults (16-25) were also included as they have low quit rates and may be particularly interested in novel technologies such as e-cigarettes. Smokers and recent ex-smokers (quit in previous 12 months) were recruited for focus groups and interviews from community and interest groups in disadvantaged areas, such as National Health Service (NHS) stop smoking groups, employment and retraining programmes for young adults, support groups for parents or older adults, and a community resource centre for people with mental health problems. Six interview participants were recruited via an advert on the classified website Gumtree. Focus groups were hosted in community venues where participants ordinarily met. Interviews took place in a university office, at the interviewee’s home or workplace, or in a café. The data were gathered in central Scotland, between September 2013 and February 2014. Ethics approval was obtained from the Research Ethics Committee of the Centre for Population Health Sciences, University of Edinburgh. Focus group topic guides were used flexibly. Discussion was initiated by asking what sorts of products participants had heard of or come across. Pictures and examples of different products were then used as prompts to explore experiences with products, price and sources of information. Examples of the three main types of e-cigarettes – disposable, rechargeable and refillable – with a variety of packaging were used. Questions explored the uses, advantages and disadvantages of products and views on regulation. Interview topic guides followed a similar pattern but started off exploring the interviewee’s smoking history and previous attempts to change or stop smoking. The focus groups and interviews were recorded and transcribed verbatim.
