Exploring Prevalence of Discussions of e-Cigarettes Use During Tobacco Cessation Counseling and Smokers' Understanding of e-Cigarette Use

Background: E-cigarettes are increasingly popular among smokers who are using these products to reduce or quit smoking cigarettes completely. The purpose of this study is to explore the prevalence of discussions during tobacco cessation counseling at a Midwestern integrated health system’s tobacco intervention program (TIP), topics discussed, and smokers’ understanding of e-cigarettes use for cessation. Methods: Two tobacco treatment counselors recorded logs of e-cigarette discussions, which occurred during cessation counseling calls, between May and August 2016. We conducted phone interviews with a purposive sample of 17 smokers (age range: 29 to 70 years; sex: 16 female; race: 6 African American, 4 white, 7 race not indicated) within 3 days of counseling sessions. Of the 17, 11 participants had not discussed e-cigarettes and 6 had discussed e-cigarettes with their counselors. We analyzed interview transcripts and summarized topics discussed, information sources, information needs and opinions about e-cigarette use for cessation. Results: Among 460 counseling sessions, 24 (5%) included discussions about e-cigarettes. Ten of these 24 sessions (42%) occurred during initial enrollment and the remainder occurred during follow-up counseling sessions. All discussions about e-cigarettes were initiated by smokers. Of the 6 smokers who discussed e-cigarettes, the topics discussed were current and previous e-cigarette use, side effects, lack of evidence of safety and effectiveness, addictiveness and counselor’s recommendation against using e-cigarettes. Sources of information about e-cigarettes included television, convenience stores or gas stations, word-of-mouth, news/magazines/online articles and smoke shops. Participants expressed information needs including side effects, efficacy to help quit smoking and how to use e-cigarettes. They also perceived advantages (more socially acceptable, lack of secondhand smoke) and disadvantages of e-cigarette use (cost, not helpful to quit smoking, potential health risks and other dangers including explosions, addictiveness). Conclusion: Discussion about e-cigarettes was not common among smokers and tobacco treatment counselors. Smokers undergoing cessation counseling expressed confusion and need for information about e-cigarette use, generally, and the use of e-cigarettes for quitting smoking. Further research is needed to develop tools to improve patient-provider discussions about cessation and e-cigarette use and to increa