Electronic cigarette use and perceptions amongst UK medical students: A cross-sectional study

Abstract

1 Published by European Publishing on behalf of the European Network for Smoking and Tobacco Prevention (ENSP). © 2021 Afzal M. et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial 4.0 International License. (http://creativecommons.org/licenses/by-nc/4.0) Dear Editor, We report a first of its kind survey of medical students in the UK, assessing tobacco and e-cigarette consumption, beliefs about e-cigarettes and smoking cessation curriculum assessment. All healthcare professionals have a role in promoting smoking cessation, with rates improved by the quality of advice offered and by combining pharmacotherapy and behavioral support. Medical students, as future clinicians, will play a critical role in smoking cessation efforts. We conducted a cross-sectional study between 5 December 2019 and 6 February 2020 in which a 20-item (19 multiple choice and 1 free text) questionnaire was distributed to 9 UK medical schools. A total of 188 responses were received encompassing all distributed medical schools. Current or past e-cigarette use was reported by 32.6% with 4.3% (n=8) using e-cigarettes daily and 1.1% (n=2) using e-cigarettes weekly; 8.5% (n=16) reported having tried or regularly using an e-cigarette, having never tried smoking tobacco; and 20% (n=2) of regular e-cigarette users had never smoked tobacco. With regard to smoking cessation and education, e-cigarettes were considered beneficial for reducing traditional cigarette use by 89.9% of respondents and 56.1% would recommend them to patients for this purpose. When asked how addictive e-cigarettes are compared to traditional cigarettes, 64.9% (n=122) felt they were ‘equally addictive’ or ‘more addictive’ than tobacco. Of these, 35.2% (n=43) identified as regular or previous e-cigarette users. Participant responses are detailed in Table 1. When asked if their medical school curriculum provided sufficient education regarding tobacco and e-cigarettes, 46.8% (n=88) of students felt that it did. However, when answering to the question ‘Would you feel comfortable advising a patient about the use of e-cigarettes?’, 60.6% (n=114) responded ‘no, not confident in doing so’. There was a difference in confidence level noted between those at early and late stages of medical school with 52.0% (n=13) of final year students not feeling confident advising patients compared with 73.3% (n=63) of students in their first and second year (p=0.044, χ test). Through this study, we have identified that despite an overwhelming majority believing e-cigarettes are useful for reducing tobacco consumption, many would not recommend them to patients for this purpose and the majority lack confidence to advise patients about their use. This is consistent with US data. We also reveal a belief among medical students that e-cigarettes are harmful with more than 1 in 4 believing e-cigarettes to be at least as harmful as tobacco. Respiratory disease was the most commonly reported perceived health risk, with 81% (n=152) of respondents citing this as a concern. This is at odds with Public Health England’s guidance stating e-cigarettes to be ‘95% less harmful than cigarette smoking’. Many students felt that they have not received sufficient AFFILIATION 1 Hull York Medical School, Hull, United Kingdom 2 Respiratory Research Group, Hull and East Yorkshire Hospitals NHS Trust, Hull, United Kingdom