E-cigarettes are popular commercial products that are marketed as safe and effective aids to smoking cessation. The present study describes beliefs of Italian smoking cessation service providers about e-cigarettes, interest in e-cigarettes among their clients, and the type of inquiries they receive from their clientele about e-cigarettes. The number of inquiries about e-cigarettes in public smoking cessation clinics in Italy increased compared to previous years indicating increased public interest. Most inquiries about e-cigarettes related to their safety and effectiveness as smoking cessation aids. Interestingly, most Italian service providers believed that e-cigarettes are safe and as effective as conventional pharmacotherapy.
Although the settings differ, our data can be compared with a recent survey of service providers in the UK (Hiscock et al. 2014). More than 60 % of Italian service providers believed that e-cigarettes are safe products that can help smokers quit, and that they are as effective as pharmacotherapy. In contrast, the UK study (Hiscock et al. 2014) showed that, although attitudes about e-cigarettes have become more favourable, most service providers remained sceptical, maintaining that there is little empirical evidence to support effectiveness or safety, and that e-cigarette use increases visibility of public smoking and may therefore undermine existing tobacco control policies.
This difference aligns with the current debate among public health professionals, with some scholars recommending that e-cigarettes should be integrated in clinical practice, and others stating that e-cigarettes should be viewed with caution until more evidence becomes available (Grana et al. 2014; McKee 2014). Our findings underscore the need for more concerted action to improve knowledge among service providers in Italy with respect to the safety and efficacy of e-cigarettes. They must be better informed about recent evidence and incorporate this knowledge into their practice.
The present study showed that 25.8 % of service providers reported that a ‘quarter to half’ of their clients had used e-cigarettes (among clients who visited smoking cessation clinics, only 12 % reported e-cigarette use) and only 5.1 % reported that ‘quarter to half’ used e-cigarettes regularly. Hiscock et al. (2014) presented similar findings, and reported that compared to measures 1 year earlier, more UK service providers reported that a ‘quarter to half’ of their clients had used (40 %), or regularly used e-cigarettes (23.5 %). Based on our findings, the prevalence of e-cigarette use in Italy in 2014 seems to be lower than that reported in the UK by Hiscock et al. (2014). Our data in fact align with those reported in the annual report commissioned by the National Health Institute of Italy (Istituto Superiore di Sanita 2014), which showed a decrease of e-cigarette use between 2013 and 2014.
Our findings showed that 44 % of service providers reported that, compared to 2013, more clients asked about e-cigarettes, suggesting increased public interest in these products. In the UK, there was also an increase in client inquiries about e-cigarettes—90 % of providers reported that more clients made inquiries in 2013 compared to previous years (Hiscock et al. 2014).
Concordant with a recent study among Dutch smokers (Hummel et al. 2015), the most common types of inquiry received about e-cigarettes pertained to their efficacy and safety. Clients may be more concerned about the effects of e-cigarettes on their own health, than about the effects of e-cigarette vapour on others. This is not unexpected, but should be highlighted because it relates to questions about the public safety.
The public health policy implications of the present study are simple, but profound. First, policy-makers should consider if the public use of e-cigarettes undermines existing smoke-free policies that aim to prevent smoking among young people, protect non-smokers from the harmful exposure to second-hand smoke and possibly from exposure to e-vapour, and to de-normalize tobacco use in public places. These concerns are echoed among public health researchers in other countries. Commenting on the increase of e-cigarette use in South Korea, Zhu et al. (2014) argued that the unregulated use of e-cigarettes in public places may be a way for smokers to circumvent smoke-free policies. Based on our findings, we argue that smoking cessation service providers should keep in mind the potential effects of their advice on the wider public about exposure to e-vapour and the possibility that e-cigarette use may act as a gateway to smoking initiation among young people. Additionally, our study indicates that there is a need for comprehensive training of service providers about the safety and effectiveness of e-cigarettes as a smoking cessation treatment. Such training will improve smoking cessation service providers’ knowledge about e-cigarettes, and, accordingly, help them in making informed decisions about e-cigarettes in the course of treating their patients. Currently, there is a noted expansion of e-cigarette products and most of the available information about e-cigarettes comes from the promotional campaigns of the e-cigarettes industry (Zhu et al. 2014). If smoking cessation service providers serve the purpose of impartially informing the public about e-cigarette use, then comprehensive evidence-based training about e-cigarettes will provide a significant added value to their daily practice.