Survey Backgrounder – 26 October 2016 This survey was conducted to better understand the ways in which stop-smoking services across the UK are interacting with smokers that ask about e-cigarettes. Specifically, we wanted to assess their views on vaping, whether or not they spontaneously recommend e-cigarettes, and also the extent to which landmark reports from Public Health England, the NHS, the Royal College of Physicians etc. are filtering down to cessation services and are influencing the advice smokers receive on the ground. To do this, the survey was conducted in two parts:

1. We contacted a database of 152 cessation clinics across England, told them we were running a survey and then asked them a set of questions; 32 clinics responded to our questions, so roughly 20% of all stop-smoking services in England.

2. We contacted 30 of the 152 cessation clinics as a ‘smoker looking to quit’ and waited to see if they spontaneously mentioned e-cigarettes as a helpful cessation aid alongside other products, then asked them more directly: ‘should I try an e-cigarette?’

Phase 1: asking formal survey questions The questions: • Do you consider e-cigarettes to be more or less harmful than conventional cigarettes? • Do you consider them to be an effective cessation tool for smokers looking to quit? • If so, why? • If not, why not? • What are the main sources of information you use to learn about e-cigarettes? Percentage of respondents: 21 percent engaged in the survey (32 clinics) Phase 2: asking for advice as a smoker The questions: • What tools do you recommend I use in order to quit smoking? • Should I use e-cigarettes to try to quit smoking? • If so, why? • If not, why not? Percentage of respondents: 100 percent (20 clinics) Notes on aggregating the responses

In all cases we tried to speak to the most senior person available. This was not always possible though, so answers were also provided by less senior, non-management members of staff that were willing to speak on behalf of the clinic.

Many of the responses were highly qualitative but also very informative. For the purposes of collating our results we have summarised this feedback through the use of key words. We then used these key words to work out percentages for individuals who did, or did not, mention certain aspects about the product.

Results Summary Phase 1:

Information on EVPs comes from a wide range of sources (respondents could name more than one source):

o 55% of clinics get information from Public Health England o 36% from the National Centre for Smoking Cessation and Training o 32% from ASH o 27% from the media o 23% from ‘first hand sources’ – EVP companies and vape shops, smokers

themselves, conferences, etc.

100% of respondents answered that e-cigarettes are less harmful than conventional cigarettes

A majority (73%) believe EVPs are a successful cessation tool; 14% did not, with the rest unable to say.

Of those who supported the role of EVPs in tobacco harm reduction, nearly half explained their view was because of the reported efficacy of EVPs in smoking cessation – i.e. based on the feedback they had received from smokers.

However, even many of the clinics who believed EVPs could be a very useful harm reduction call, went on to report concerns about the category, which our second survey showed is passed on to smokers (see below).

Across all respondents – so both those who believe, and did not believe, that EVPs were effective cessation aids - 32% cited concerns about ‘continuation of addictive behaviour’, 30% felt there was still insufficient research and 18% were worried about the quality of products and liquids

There is strong demand for a medically regulated e-cigarette product – 25% of respondents explained their inability to recommend EVPs to smokers as a result of the lack of a medically licensed product, many also expressing frustration that they were not able to refer smokers to a category about which they had heard good things.

No respondents mentioned any concerns about e-cigarettes acting a gateway to tobacco, or that EVPs in any way normalise tobacco.

Phase 2: We phoned 30 stop-smoking clinics across England and asked the following questions: What tools do you recommend I use in order to quit smoking?

Use NRTs - 85%

Speak to an advisor - 75%

Get behavioural support - 30%

Use Champix - 20%

Use E Cigarettes - 5% Should I use e-cigarettes to quit smoking? (yes / no)

Yes, absolutely - 45%

Yes, but with some reservations - 15%

No - 20%

Don’t know/not sure - 35% Clinics who responded positively were then asked ‘Why should I use them?

They offer significant harm reduction 35%

They report high success rates 20%

They are 95% safer than tobacco 15%

Other/don’t know 30%

Clinics who responded negatively were then asked ‘Why should I not use them’?

Lack of adequate research 60%

Because they do not solve addiction 20%

Poor product quality 20%