Harm reduction and smoking: interviews and focus groups

The research involved the collection of qualitative data. Twelve focus groups and eleven individual interviews were conducted with a range of purposively selected smoker groups. The project focussed particularly on groups who may benefit most from tobacco harm reduction approaches including disadvantaged groups. Young adults were also included as they have low quit rates and may be particularly interested in novel technologies such as e-cigarettes. Smokers and recent ex-smokers (quit in previous twelve months) were recruited for focus groups and interviews from community and interest groups in disadvantaged areas.
<p>Background: Smoking is the most important cause of preventable death and disease in the UK. The UK is at the forefront in implementing comprehensive tobacco control policies designed to prevent smoking initiation and to help smokers to quit, having employed various successful population-level interventions and developed internationally unique NHS stop smoking services. However, there are growing concerns that the decline in adult smoking
prevalence may be levelling off. Whilst most smokers try to quit, the majority are not successful. Some experts have therefore argued for the use of harm reduction approaches
to reduce smokers' health risks. Generally, harm reduction approaches suggest that smokers who are unable to or do not want to quit should be advised to switch from smoking
cigarettes to less harmful nicotine delivery devices - devices that deliver nicotine without inhaling tobacco smoke, such as nicotine replacement therapies or electronic cigarettes (ecigarettes). Despite the fact that harm reduction approaches have divided the international tobacco control community, they have recently become influential in the UK, particularly in English tobacco control policy. However, we know very little about how smokers view harm reduction.
Aims: To explore how tobacco harm reduction approaches and alternative nicotine delivery devices, including e-cigarettes, are understood and experienced by smokers and recent ex-smokers, and to consider the implications for tobacco control policy and practice.
Methods: This qualitative study focuses particularly on groups of smokers who either may find it harder to quit or for whom quitting is particularly important and are, therefore,
considered most likely to benefit from harm reduction i.e. those with low socio-economic status, smoking-related diseases, mental health issues and young adults. Focus groups and semi-structured individual interviews were undertaken with purposively selected smoker groups. The analysis explored what considerations and criteria smokers draw upon when evaluating health risks and smoking-related choices. We examined how smokers conceptualise nicotine as a substance and how they understand the risks and benefits of different nicotine delivery devices.
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本研究开展定性数据采集工作，通过目的性抽样招募多类吸烟者群体，完成12场焦点小组访谈（focus groups）与11次个人访谈。本项目重点关注最能从烟草减害（tobacco harm reduction）策略中获益的群体，其中包括弱势人群。同时纳入年轻成年吸烟者群体，因其戒烟率偏低，且对电子烟（e-cigarettes）等新兴烟草替代技术表现出较高兴趣。研究招募的对象为弱势社区与兴趣社群中的吸烟者及近12个月内戒烟的前吸烟者，用于焦点小组访谈与个人访谈。

背景：吸烟是英国可预防死亡与疾病的首要诱因。英国始终走在全面烟草控制政策的前沿，通过推行多项成功的人群级干预措施，并建立具有国际特色的英国国民保健服务（National Health Service，NHS）戒烟服务，旨在预防吸烟起始与帮助吸烟者戒烟。然而，成人吸烟患病率的下降趋势正逐渐趋于平缓，引发了越来越多的担忧。尽管多数吸烟者尝试戒烟，但绝大多数均未能成功。因此，部分专家呼吁采用减害策略以降低吸烟者的健康风险。通常而言，减害策略建议无法或不愿戒烟的吸烟者改用危害更低的尼古丁递送产品——即无需吸入烟草烟雾即可递送尼古丁的装置，例如尼古丁替代疗法产品或电子烟（e-cigarettes）。尽管减害策略在国际烟草控制界尚存争议，但近年来已在英国获得影响力，尤其在英格兰的烟草控制政策中得到应用。然而，目前学界对吸烟者如何看待烟草减害策略的认知仍十分有限。

研究目标：探究吸烟者与近12个月内戒烟的前吸烟者对烟草减害策略及包括电子烟在内的新型尼古丁递送装置的认知与使用体验，并探讨其对烟草控制政策与实践的启示。

方法：本定性研究重点关注两类吸烟者群体：一类是戒烟难度更高的人群，另一类是戒烟对其尤为重要的人群，即被认为最能从减害策略中获益的群体，包括社会经济地位较低者、患有吸烟相关疾病者、存在心理健康问题者以及年轻成年人。研究通过目的性抽样招募吸烟者群体，开展焦点小组访谈与半结构化（semi-structured）个人访谈。分析环节旨在探究吸烟者在评估健康风险与吸烟相关选择时所依据的考量因素与评判标准，同时考察吸烟者对尼古丁这一物质的认知，以及他们对不同尼古丁递送装置的风险与收益的理解。