ESRC Postdoctoral Fellowship 2020 - Electronic cigarettes: role in smoking cessation and potential risks for children and young people

我的博士研究了为什么电子烟被证明在社会上具有如此广泛的吸引力，以及这是否会以吸烟者使用更有效的方法戒烟为代价。到目前为止，电子烟是吸烟者戒烟途径中最常见的选择，当他们试图结束对传统香烟的依赖时，他们不希望简单地“突然停止”。然而，与电子烟受欢迎程度的大幅上升形成对比的是，当地戒烟服务（SSSs，由训练有素的戒烟顾问提供一对一支持）的参加人数连续七年下降。鉴于这些服务一再被证明比任何其他戒烟途径都有效得多，我的博士试图更好地了解电子烟的兴起是否会影响服务出席率的下降，并调查在吸烟者权衡使用哪种戒烟途径时，哪些问题会影响吸烟者。我已经发表了两篇博士论文。我的系统综述整理了世界范围内关于哪些人群最有可能使用电子烟的科学文献，填补了一个重要的研究空白。与此同时，一篇关于我的46次访谈结果的定性论文描述了在吸烟者决定是否使用电子烟或SSSs等戒烟途径时发挥作用的复杂因素。它还强调了不同社会保险机构对电子烟的不同态度，以及这如何影响了向其客户提供的支持类型。这项奖学金将使我有机会再发表两篇论文，帮助我最大限度地发挥博士研究的潜力。首先是一篇进一步的定量论文，显示我调查的2000名吸烟者中哪些知识和信念与他们使用ssss和电子烟有关。因此，这将为我已经发表的采访结果提供一个自然的补充，使我的研究更多地触及那些最喜欢定量分析的受众。第二个是对我的定性数据集的进一步分析。我发现社会服务提供者对电子烟提供了不同程度的支持和建议，有鉴于此，我的第二篇论文将进一步深入研究我的采访数据，以梳理出决定服务机构对电子烟采取何种政策的关键影响因素。因此，这将为PHE， ASH， NCSCT和其他有兴趣确保为全国不同地区的吸烟者提供平等支持的组织提供重要见解。最后，该奖学金还将允许我制定一项资助提案，以便在接下来的几年里将我的调查转移到关键的、相关的研究问题上。具体来说，未来的竞标将涉及分析“Juul”电子烟设备对儿童和青少年吸电子烟和吸烟习惯的影响，这一年龄组的态度和行为从根本上决定了吸烟在社会中造成的健康危害。毕竟，大多数吸烟者是在青少年时期染上这个习惯的，那时他们对尼古丁上瘾的持久性还不太了解；在之前的研究中，90%的人在18岁之前开始吸烟，95%的人在21岁之前开始吸烟。制造商Juul多年来一直主导着美国的电子烟市场，但直到最近才进入英国海岸。这些特定的设备已被证明是导致美国青少年吸电子烟率高得多的原因，但到目前为止，它们对英国青少年吸电子烟和吸烟习惯的影响尚不清楚。我的博士系统综述显示，年龄较大的青少年和年轻人吸电子烟的比例最高，而我的定性实地调查发现，年轻的受访者经常表达自己被电子烟营销瞄准的感受，或者谈到电子烟在同龄人中很受欢迎。

My PhD investigated why e-cigarettes have proved to hold such a broad appeal across society, and whether this could be at the cost of smokers using more effective ways to try to quit tobacco. E-cigarettes are now by far the most common choice of quit route for smokers who do not wish to simplygo 'cold turkey' when trying to end their addiction to conventional tobacco cigarettes. However, in contrast to the huge rise in e-cigarettes' popularity, attendances at local stop smoking services (SSSs, which offer one-to-one support from trained smoking cessation advisors) have declined for sevenconsecutive years. Given these services have repeatedly been shown to be considerably more effective than any other routes for quitting smoking, my PhD sought to better understand whether the rise of e-cigarettes could be influencing this drop in service attendance, as well as investigating what kinds of issues influenced smokers when they were weighing up which quit route to use.I have already published two papers of PhD findings. My systematic review filled an important research gap by collating the worldwide scientific literature on which demographic groups were most likely to use e-cigarettes. Meanwhile, a qualitative paper with the results of my 46 interviews delineated the complex range of factors that play a role in smokers' decision-making about whether to use quit routes such as e-cigarettes or SSSs. It also highlighted the diverse attitudes towards e-cigarettes shown by different SSSs and how this influenced the kinds of support offered to their clients.This fellowship would allow me the opportunity to publish two further papers of findings, helping to maximise the potential of my PhD research. The first would be a further quantitative paper showing what kinds of knowledge and beliefs amongst the 2000 smokers that I surveyed were related to their use ofSSSs and e-cigarettes. This would therefore provide a natural complement to my already-published interview findings, giving my research more reach to those audiences who are most comfortable with quantitative analyses. The second would be a further piece of analysis from my qualitative dataset. Inlight of my finding that SSSs offer very varying levels of support and advice around e-cigarettes, my second paper would drill down further into my interview data to tease out what the key influences are that determine what policy a service arrives at regarding e-cigarettes. This would thus provide important insights for PHE, ASH, NCSCT and other organisations with an interest in ensuring equal provision of support to smokers in different parts of the country.Finally, the fellowship would also allow me to develop a funding proposal to move my investigations on to crucial, related research questions in the years following. Specifically, this future bid would involve analysing the impact of 'Juul' e-cigarette devices on vaping and smoking habits amongst children andyoung people, an age group whose attitudes and behaviours fundamentally determine the health harms caused by smoking within society. Most smokers, after all, take up the habit in adolescence, when they have less understanding about the tenacity of nicotine addiction; in previous research, 90% of smokers had started by age 18 and 95% by age 21. The manufacturer Juul have dominated the vaping market for years in the US but have only arrived on UK shores much more recently. These specific devices have been shown to be driving the far higher rates of teenage vaping seen in the US but, as yet, their impact on UK youngsters' vaping and smoking habits are unknown. This line of enquiry has been sparked both by my PhD's systematic review, which showed the highest rates of vaping were amongst older adolescents and younger adults, and by my qualitative fieldwork, where younger interviewees often relayed experiences of feeling targeted by e-cigarette marketing or spoke of the popularity of vaping amongst their peer groups.