Beliefs and practices regarding electronic cigarettes in smoking cessation among healthcare professionals in Slovenia
Helena Koprivnikar 1  
Tina Zupanič 2
More details
Hide details
National Institute of Public Health, Ljubljana, Slovenia
General Hospital Murska Sobota, Murska Sobota, Slovenia
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Helena Koprivnikar   

Analysis and Development of Health Department, National Institute of Public Health, Trubarjeva 2, 1000 Ljubljana, Slovenia
Publication date: 2020-01-14
Submission date: 2019-09-26
Final revision date: 2019-11-22
Acceptance date: 2019-12-03
Tob. Prev. Cessation 2020;6(January):3
Electronic cigarettes (ECs) have generated extensive discussion about their role in smoking cessation. The Slovenia National Institute of Public Health’s recommendations state that ECs are not to be recommended for smoking cessation or reduction. The aim of this study was to explore how healthcare professionals working in the field of preventive healthcare and smoking cessation in Slovenia communicate with and counsel patients regarding electronic cigarettes and smoking cessation or reduction.

A cross-sectional, web-based survey was conducted among healthcare professionals working in the field of preventive healthcare and smoking cessation in Slovenia. A total of 479 healthcare professionals were included in the analysis.

While a minority of participants (12.7%) do or would recommend electronic cigarettes for smoking cessation or reduction in general, a higher proportion of participants (33.1%) would recommend electronic cigarettes to specific groups of patients. Knowledge on electronic cigarettes was the key determinant of differences in recommendations. Only a minority of participants (9.1%) reported availability of workplace guidelines/recommendations regarding counselling about electronic cigarettes.

Training programmes, educational materials and existing guidelines/ recommendations regarding counselling about electronic cigarette use should be provided and distributed among healthcare professionals, together with efforts to ensure compliance to official guidelines/recommendations.

We thank Monika Azman, president of Nurses and Midwives Association of Slovenia, Andreja Krajnc, president of Professional group of nurses and health technicians in community care at Nurses and Midwives Association of Slovenia, Sanja Vrbovsek, National Coordinator for Health Education, Tadeja Hocevar, National Coordinator of Quitline telephone in 2018, Karmen Henigsman and Sanja Krusic, all from National Institute of Public Health for helping with inviting healthcare professionals from respective groups to participate in the study. We also thank Borut Jug for his assistance in obtaining data from healthcare professionals working in Outpatient Cardiac Rehabilitation Units and Antonija Poplas Susic for her advice regarding possible approaches to include healthcare professionals from Family Medicine Practices in the study.
The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
The authors acknowledge the project ‘Assessment of attitudes, knowledge and current practices related to electronic cigarettes among healthcare professionals working in the field of preventive healthcare and smoking cessation, with preparation of educational material for unified and evidence-based counselling to patients’ (ID V3-1729) which was financially supported by the Slovenian Research Agency and Ministry of Health of the Republic of Slovenia.
All three authors contributed to the design and implementation of the study, to the analysis of the results and to the writing of the manuscript.
Not commissioned; externally peer reviewed.
Bhatnagar A, Payne TJ, Robertson RM. Is There A Role for Electronic Cigarettes in Tobacco Cessation? J Am Heart Assoc. 2019;8(12):e012742. doi:10.1161/JAHA.119.012742
McDonald CF. E-cigarettes for smoking cessation: Current state of play. Respirology. 2019;24(8):722-723. doi:10.1111/resp.13630
Bush A, Bhatt J, Grigg J. E cigarettes: Tar Wars: The (Tobacco) Empire Strikes Back. Arch Dis Child. 2018;104(11):1027-1039. doi:10.1136/archdischild-2018-315820
National Academies of Sciences, Engineering, and Medicine. Public health consequences of e-cigarettes. Washington, DC: The National Academies Press; 2018.
Hartmann-Boyce J, McRobbie H, Bullen C, Begh R, Stead LF, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev. 2016;9:CD010216. doi:10.1002/14651858.CD010216.pub3
Brown-Johnson CG, Burbank A, Daza EJ, Wassmann A, Chieng A, Rutledge GW, Prochaska JJ. Online Patient-Provider E-cigarette Consultations: Perceptions of Safety and Harm. Am J Prev Med. 2016;51(6):882-889. doi:10.1016/j.amepre.2016.06.018
Steinberg MB, Giovenco DP, Delnevo CD. Patient-physician communication regarding electronic cigarettes. Prev Med Rep. 2015;2:96-98. doi:10.1016/j.pmedr.2015.01.006
Erku DA, Gartner CE, Morphett K, Steadman KJ. Beliefs and self-reported practices of healthcare professionals regarding electronic nicotine delivery systems (ENDS): a mixed-methods systematic review and synthesis. Nicotine Tob Res. 2019:ntz046. doi:10.1093/ntr/ntz046
Koprivnikar H, Farkaš Lainščak J. Znanje, stališča, prepričanja in trenutne prakse glede elektronskih cigaret med svetovalci za pomoč pri opuščanju kajenja in zdravstvenimi delavci [Knowledge, attitudes, beliefs and current practices related to electronic cigarettes among smoking cessation advisors and healthcare professionals]. ANALI PAZU. 2018;8(1-2):40-49. Accessed September 26, 2019.
Livingston CJ, Freeman RJ, Costales VC, Westhoff JL, Caplan LS, Sherin KM, Niebuhr DW. Electronic Nicotine Delivery Systems or E-cigarettes: American College of Preventive Medicine's Practice Statement. Am J Prev Med. 2019;56(1):167-178. doi:10.1016/j.amepre.2018.09.010
Bhatnagar A, Whitsel LP, Blaha MJ, et al. New and Emerging Tobacco Products and the Nicotine Endgame: The Role of Robust Regulation and Comprehensive Tobacco Control and Prevention: A Presidential Advisory from the American Heart Association. Circulation. 2019;139(19):e937-e958. doi:10.1161/CIR.0000000000000669
Bals R, Boyd J, Esposito S, et al. Electronic cigarettes: a task force report from the European Respiratory Society. Eur Respir J. 2019;53(2). doi:10.1183/13993003.01151-2018
Barua RS, Rigotti NA, Benowitz NL, et al. 2018 ACC Expert Consensus Decision Pathway on Tobacco Cessation Treatment: A Report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol. 2018;72(25):3332-3365. doi:10.1016/j.jacc.2018.10.027
Brady BR, De La Rosa JS, Nair US, Leischow SJ. Electronic Cigarette Policy Recommendations: A Scoping Review. Am J Health Behav. 2019;43(1):88-104. doi:10.5993/AJHB.43.1.8
Koprivnikar H, Stepan D, Kukec A, Farkaš Lainščak J. Uporaba elektronskih cigaret med študenti Medicinske in Zdravstvene fakultete Univerze v Ljubljani. Medicinski razgledi. 2018;57(2):169-186.
Koprivnikar H. Kajenje. Kako skrbimo za zdravje? In: Z zdravjem povezan vedenjski slog prebivalcev Slovenije, 2016. Ljubljana: Nacionalni inštitut za javno zdravje; 2018.
Singh B, Hrywna M, Wackowski OA, Delnevo CD, Jane Lewis M, Steinberg MB. Knowledge, recommendation, and beliefs of e-cigarettes among physicians involved in tobacco cessation: A qualitative study. Prev Med Rep. 2017;8:25-29. doi:10.1016/j.pmedr.2017.07.012
Kanchustambham V, Saladi S, Rodrigues J, Fernandes H, Patolia S, Santosh S. The knowledge, concerns and healthcare practices among physicians regarding electronic cigarettes. J Community Hosp Intern Med Perspect. 2017;7(3):144-150. doi:10.1080/20009666.2017.1343076
Nickels AS, Warner DO, Jenkins SM, Tilburt J, Hays JT. Beliefs, Practices, and Self-efficacy of US Physicians Regarding Smoking Cessation and Electronic Cigarettes: A National Survey. Nicotine Tob Res. 2017;19(2):197-207. doi:10.1093/ntr/ntw194
Hiscock R, Bauld L, Arnott D, Dockrell M, Ross L, McEwen A. Views from the Coalface: What Do English Stop Smoking Service Personnel Think about E-Cigarettes? Int J Environ Res Public Health. 2015;12(12):16157-16167. doi:10.3390/ijerph121215048
Sherratt FC, Newson L, Field JK. Electronic cigarettes: a survey of perceived patient use and attitudes among members of the British thoracic oncology group. Respir Res. 2016;17(1):55. doi:10.1186/s12931-016-0367-y
Shin DW, Kim YI, Kim SJ, et al. Lung cancer specialist physicians' attitudes towards e-cigarettes: A nationwide survey. PLoS One. 2017;12(2):e0172568. doi:10.1371/journal.pone.0172568
Pepper JK, Gilkey MB, Brewer NT. Physicians' Counseling of Adolescents Regarding E-Cigarette Use. J Adolesc Health. 2015;57(6):580-586. doi:10.1016/j.jadohealth.2015.06.017
Kandra KL, Ranney LM, Lee JG, Goldstein AO. Physicians' attitudes and use of e-cigarettes as cessation devices, North Carolina, 2013. PLoS One. 2014;9(7):e103462. doi:10.1371/journal.pone.0103462
El-Shahawy O, Brown R, ElstonLafata J. Primary Care Physicians' Beliefs and Practices Regarding E-Cigarette Use by Patients Who Smoke: A Qualitative Assessment. Int J Environ Res Public Health. 2016;13(5):445. doi:10.3390/ijerph13050445
Egnot E, Jordan K, Elliott JO. Associations with resident physicians' early adoption of electronic cigarettes for smoking cessation. Postgrad Med J. 2017;93(1100):319-325. doi:10.1136/postgradmedj-2016-134058
Van Gucht D, Baeyens F. Health professionals in Flanders perceive the potential health risks of vaping as lower than those of smoking but do not recommend using e-cigarettes to their smoking patients. Harm Reduct J. 2016;13(1):22. doi:10.1186/s12954-016-0111-4
Bascombe TM, Scott KN, Ballard D, Smith SA, Thompson W, Berg CJ. Primary healthcare provider knowledge, beliefs and clinic-based practices regarding alternative tobacco products and marijuana: a qualitative study. Health Educ Res. 2016;31(3):375-83. doi:10.1093/her/cyv103