Understanding patterns and perceptions of non-cigarette tobacco use and barriers and facilitators for cessation: a mixed-methods study in England

Background In England, cigarette smoking is the most common form of tobacco use, but evidence suggests non-cigarette tobacco smoking has risen substantially since 2020. In addition, some people do not smoke tobacco at all but use smokeless or heated tobacco products.

The health risks associated with these products vary – with combustible products more harmful than non-combustibles – but all expose users to greater risk compared to using no tobacco products at all.

Aims To understand patterns and perceptions of non-cigarette tobacco use across different sociodemographic groups in England, and to identify the barriers and facilitators of non-cigarette tobacco cessation from the perspective of users and health care professionals (HCPs).

Methods Work package 1 (WP1) will use the Smoking Toolkit Study to identify key demographic groups using different forms of non-cigarette tobacco in England, the appeal and accessibility of these products to different sociodemographic groups, perceptions of harm, and the extent to which users engage with cessation services.

WP2 will use data from the ITC Youth survey to compare time trends (overall and by sociodemographics) in use of different non-cigarette tobacco products in England with other countries (US/Canada) that have different tobacco control policies. WP3 will be a survey with HCPs and people working in stop smoking services in England.

WP4 will be a qualitative focus group study with people who use non-cigarette tobacco (purposively sampled to represent key user groups identified in WP1/WP2) and HCPs.

These will explore experiences and perceptions of non-cigarette tobacco products; what cessation support is currently offered, how it varies across product categories and geographic regions, and the extent to which users are aware of it; barriers and enablers to providing/engaging with support for non-cigarette tobacco use; and identify opportunities to improve the support offered and reduce inequalities.

What value will the programme of work deliver?

The project will use data from two well-established surveys to provide a detailed understanding of who uses different types of non-cigarette tobacco products and how these differ across territories.

We will use these data to feed into two studies on how users and HCPs perceive the harms of these products, the support currently being offered by cessation services and how this could be improved to help more people quit.

Based on our findings, we will recommend ways in which policy and practice can be improved to reduce the health burden and inequalities associated with non-cigarette tobacco use in England.