Views and Preferences for Nicotine Products as an Alternative to Smoking: A Focus Group Study of People Living with Mental Disorders
Abstract
:1. Introduction
Current Evidence on the Long Term Use of Nicotine Products for Smoking Cessation for People with Mental Disorders
2. Methods
2.1. Sample and Data Collection
2.2. Analysis
3. Results
3.1. Participant Characteristics
3.2. Experiences and Use of Nicotine Products
“Actually, well, I did three days in detox and didn’t have a cigarette while I was in there and I used the patches and that was fuckin’ crazy. […] I was thinking about rolling it up and chewing it and start smoking it, so I couldn’t do that.”[FG3P1]
“I find a lot of the time I’m buying the quit smoking products other [sic] than cigarettes merely because they might get me through a little bit longer than the smokes will, because I tend to smoke more if I have cigarettes. But in the same point, a lot of the time the price of the cigarettes and the price of the nicotine replacement products are very similar.”[FG2P1]
“I started on the very small ones, which I think was probably the one that (name) was on, one that looked like a cigarette and they don’t actually give you enough bang for your buck. So for quitting smoking from a 16-a-day smoker, I have moved to … I think it’s like a third stage e-cigarette […] you’re still getting the deep feeling of the nicotine going in, you’re still getting the nicotine, so on a harm reduction it’s been fantastic.”[FG4P7]
3.3. Views on Nicotine Products
3.3.1. Vaping Devices
“It looks like smoke coming out and it doesn’t taste that bad. It’s sort of like you’re getting … because you can see the smoke and it is psychological in the brain.”[FG1P3]
“When you took a drag it would look like those lollies you bought that used to have the red stuff on them.”[FG3P2]
“The thing is they’re not trying to look like a cigarette. They are clearly something different. You can personalise them and they come in different colours. You can get some that are a bit quirky. They treat you like an adult with something you might want.”[FG4P7]
“It doesn’t look like a cigarette should, would not make me want to smoke it.”[FG1P4]
“I think just from experience I think you start off on the smaller one [e-cigarettes] because the ones that are like a cigarette, but as a smoker you’ll find they don’t quite give you enough and that is probably where you progress [to a nicotine vaporiser], it’s more like going for a larger tube. So it’s a bit of a culture around that. I think it’s about having more than one so people can go onto them.”[FG1P7]
“I think you would have to be organised and organise your finances and make sure that when it does run out you’ve got something to fill it up with, because that would be the time when you go, “Oh bugger I’ve run out of this” and you would go and buy a packet of cigarettes or whatever. Do you know what I mean?”[FG1P5]
“I found a problem with them and I tried them for a while and I get a bit of asthma and I found with the vapour it would make my lungs rattle a bit, so I would worry that long term you might get pleurisy or something from taking in the moisture, a bit of fluid on the lungs”.[FG1P7]
“The cigarette thing I would not be interested in because all you’re doing is you’re still doing the same thing, basically […]. You’ve got to get away from that mindset of having to have something in your hand, you know.”[FG1P6]
3.3.2. Nicotine Aerosol Inhaler
“That would be alright and I could sit there with that in my hand I’d be alright. […] and it looks like a packet of cigarettes […] I like that you’re still holding the smoke.”[FG1P5]
“Everybody else thinks it’s the smoking, I’m not really sure that […] Yeah but I’m not really sure that is why I smoke so having something like that really doesn’t attract me at all. […] [I want to get] rid of the habit.”[FG3P3]
“I’d put it in the Quit thing or whatever. I don’t know, I think people would use it if it was financially viable. But if you’re having to give up things, [for] the same price as the cigarettes then the smoker is going to go for the cigarettes every time.”[FG2P3]
“If it’s marketed as something cool party people want to use or that kind of thing I reckon it could work but that’s it. If it’s associated with losing something or giving something up then it’s got more nostalgia attached to it but if it’s seen as the new thing and everybody is doing this, have your XXXX Gold and your aerosol nicotine inhaler.”[FG1P7]
3.3.3. Mouth Spray
“I tend to think that because it’s just something that you spray in your mouth or whatever you don’t have the same effect of picking up a cigarette and putting it in your mouth like ordinary cigarette that might have a better chance of working.”[FG1P4]
3.3.4. Lozenge
“Yeah, I’ve tried the lozenges and I went for about five weeks without smoking in conjunction with an e-cigarette that didn’t have nicotine in it at that stage. I couldn’t find any that did, but I went for five weeks on the lozenges and that was quite good, and it was a bit of a distraction having them in your mouth too, you can sort of roll them around. […] so I still get the feeling of having a cigarette.”[FG1P7]
“I’ve tried the Nicabate [lozenges] which is now off the market. […] They’re off the market now and they were really good but they were very expensive and very addictive. I found that there was something, I was saying maybe there was something in them that Australia wouldn’t allow and so they took it off the market. It just, it would really give you a fix. [...] Yeah, and it was too full on because I needed them more than I needed a cigarette ... really badly. It was terrible.”[FG2P1]
3.3.5. Inhalator
“I don’t mind those, it gives me the drawing, […] It gives you that feeling of smoking, that sensation which is something to do with your hands side of things and if you are sitting around a bunch of smokers or you’re in a situation then you’ve got something that’s not quite, that’s similar to what having a cigarette might be tempted to be able to do instead of it, yeah.”[FG1P2]
“No good […] because the vapour you see the smoke coming out and you’re drawing on something, the vapour is going to work.”[FG1P1]
“You do feel crap using those. They are alright to use at home but they look so ridiculous when you’re outside.”[FG4P7]
3.3.6. Strips
3.3.7. Snus
“Might take off, I don’t know about other smokers, but for a person that likes the draw, no, but for other people, yes, because other people like the chewing gum or it works for them, so it possibly could.”[FG2P3]
“You can use it on the bus, health concerns. You’re not dragging tar into your lungs.”[FG1P7]
3.3.8. Patch
“When I was there it lasted the whole five days and I didn’t have a craving whatsoever.”[FG3P2]
“If you ask me the patches all they do is give you nightmares, if you put them on while you are asleep you get nightmares.”[FG1P1]
“I think I must have been allergic to the adhesive because I would pull the damn thing off and there would be these really itchy red, angry red you know like a rash.”[FG1P3]
“The patches don’t do anything because they aren’t addressing that to do with your hand and the psychological…”[FG2P3]
3.3.9. Gum
“The chewing gum is useless. […] I’ve tried once the gum and like you said it’s like licking an ashtray. It is absolutely putrid.”[FG1P3]
“You are supposed to chew it and then park it. But I didn’t know that when I’d done it too so it was 15 s it was like hard. […] No, disgusting. I wouldn’t recommend it to somebody.”[FG3P1]
3.4. Views on the Use of Nicotine Products as a Long Term Substitution for Smoking
3.4.1. Swapping One Addiction for Another
“It would be like swapping smoking to take up gambling or something. It’s about, it’s about… being able to condition yourself into not requiring anything as a crutch.”[FG2P1]
“[…] long term habit? No. […] You may as well just keep smoking if it’s just going to be another habit”.[FG2P3]
“I haven’t had a drink for three months now it has been for me, but I find I’m using these cigarettes to substitute the alcohol more.”[FG1P6]
3.4.2. What It Means to Quit
“If you’re going to quit smoking then you’re quitting a lifestyle [later in the interview] I think what would work for me [to quit] is going to a day spa for two days and getting completely cleansed internally and externally and then coming out like a butterfly.”[FG2P4]
3.4.3. Health Risks
“I love a cigarette. If I can’t have one in the morning when I wake up then I just go back to bed. I’m starting to feel like that often now too, so … but yeah. No I would be happy to die of lung cancer.”[FG3P1]
“I recently just found out a very close friend of mine […] got lung cancer and […] tumours on the brain. […] it hasn’t stopped me smoking, but every time I have a smoke I think about it. […] to be honest I don’t want to quit at the moment, and I think it will probably take something like where you’ve got cancer for you to quit.”[FG1P5]
“Because it’s phosphorous, like 43 different chemicals to make it taste better.”[FG1P8]
“If it had no health risks to it, yes. […] I wouldn’t be interested if it was a pill and if it was going to affect my heart, my liver, my kidneys then I wouldn’t be interested at all.”[FG2P3]
3.4.4. Appeal
“I think that not every nicotine product needs to be marketed as a quit aid. I think some nicotine products can be marketed as part of a lifestyle …”[FG2P4]
3.4.5. Cost
“When you say “long term” the objective is to give up isn’t it? You wouldn’t want to be smoking them [inhalator] for the rest of your life would you? […] I’m thinking of the expense which is the big drawback for smoking.”[FG1P4]
“Well we don’t earn a $1,000 a week so we can’t afford to get something unless you’re absolutely 100% it works. We haven’t got time for gimmicks. […] I can’t even go to McDonalds to buy take-away, let alone buy something that is $38.”[FG1P1]
4. Discussion
4.1. Implications for Communication
4.2. Implications for Behaviour Change
4.3. Policy and Practice Implications
4.4. Strengths and Limitations
5. Conclusions
Supplementary Materials
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Nicotine Product | Product Description | Product Availability | Willingness to Try | Have Used Previously | ||
---|---|---|---|---|---|---|
n | % | n | % | |||
Tank style vaporiser | Nicotine (tank) vaporisers are an electronic vaporising device that resembles a large fountain pen. It is a similar technology to, but more powerful than, an e-cigarette. The user must regularly refill the “tank“ with liquid containing nicotine. | Devices and nicotine-free liquids for nicotine vaporisers are available legally in most Australian jurisdictions or with nicotine by blackmarket. | 19 | 65.5% | N/A 1 | |
E-cigarette | E-cigarettes are a small disposable electronic vaporising device that delivers nicotine in a visible mist. Visually resembles a cigarette. | Devices and nicotine-free liquids for nicotine vaporisers are available legally in most Australian jurisdictions or with nicotine by blackmarket. | 19 | 65.5% | N/A 1 | |
Nicotine aerosol inhaler | A stick device resembling a cigarette that is filled with an aerosol containing nicotine from a canister similar to an asthma inhaler. Aerosol is released from the stick when user draws on mouthpiece. | Not available for public sale. | 17 | 58.6% | N/A | |
Mouth spray | Liquid containing nicotine that is sprayed directly into the mouth. | For sale in Australia. | 16 | 55.2% | 5 | 17.2% |
Lozenge | Resembles a small mint lozenge but contains nicotine. Slowly dissolves in the mouth. | For sale in Australia. | 14 | 48.3% | 8 | 27.6% |
Inhalator | Cylindrical plastic device (shorter and wider than a cigarette) into which a small cartridge containing nicotine is placed. Nicotine is released as a vapour on inhaling from the mouthpiece. | For sale in Australia. | 13 | 44.8% | 8 | 27.6% |
Dissolvable strips | A dissolvable clear film containing nicotine which is placed on the tongue and pressed to the roof of the mouth where it dissolves to release nicotine. | For sale in Australia. | 13 | 44.8% | 3 | 10.3% |
Snus | A small pouch of tobacco resembling a teabag that is placed in the mouth, usually between the top lip and gums. | Not for sale in Australia. | 12 | 41.4% | N/A | |
Patch | Adhesive film containing nicotine that is applied to skin. Nicotine absorbs through the skin. | For sale in Australia, government subsidised if prescribed. | 12 | 41.4% | 16 | 55.2% |
Gum | Resembles regular chewing gum, but contains nicotine. Nicotine is absorbed through the lining of the mouth. | For sale in Australia. | 12 | 41.4% | 13 | 44.8% |
NRT ever used 2 | N/A | 16 | 55.2% |
Product | Strengths | Weaknesses |
---|---|---|
Vaping devices (tank vaporisers and e-cigarettes) |
|
|
Nicotine Aerosol Inhaler |
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Mouth spray |
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Nicotine inhalator |
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Dissolvable oral strips |
| |
Snus |
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Patch |
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Gum |
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|
Lozenges |
|
|
Theme | Facilitators to Long Term Use of Nicotine Products | Barriers and Risks to Long Term Use of Nicotine Products |
---|---|---|
Swapping one addiction for another |
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What it means to quit |
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Appraisal of health risks |
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Consumer Appeal |
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Cost |
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© 2016 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Meurk, C.; Ford, P.; Sharma, R.; Fitzgerald, L.; Gartner, C. Views and Preferences for Nicotine Products as an Alternative to Smoking: A Focus Group Study of People Living with Mental Disorders. Int. J. Environ. Res. Public Health 2016, 13, 1166. https://doi.org/10.3390/ijerph13111166
Meurk C, Ford P, Sharma R, Fitzgerald L, Gartner C. Views and Preferences for Nicotine Products as an Alternative to Smoking: A Focus Group Study of People Living with Mental Disorders. International Journal of Environmental Research and Public Health. 2016; 13(11):1166. https://doi.org/10.3390/ijerph13111166
Chicago/Turabian StyleMeurk, Carla, Pauline Ford, Ratika Sharma, Lisa Fitzgerald, and Coral Gartner. 2016. "Views and Preferences for Nicotine Products as an Alternative to Smoking: A Focus Group Study of People Living with Mental Disorders" International Journal of Environmental Research and Public Health 13, no. 11: 1166. https://doi.org/10.3390/ijerph13111166