Israeli smoking cessation practitioner’s knowledge, attitudes and practices regarding electronic cigarettes

Abstract

Background Fewer than 2.5% of people who smoke in Israel use evidence based smoking cessation support each year. Electronic cigarettes (e-cigarettes( role in smoking cessation remains debated, with some clinical guidelines from other countries, albeit not in Israel, promoting it as a harm-reduction tool for people who smoke and are unable or unwilling to quit smoking. E-cigarettes are currently regulated in Israel as all other tobacco products, with restrictions on marketing and use. This study explored knowledge, attitudes, and practices of smoking cessation counselors in Israel towards e-cigarettes. Methods Online cross-sectional survey (March-May 2020) assessed Israeli smoking cessation counselors’ knowledge (10 true/false questions), attitudes (personal, general and regulation toward e-cigarettes, using 1–5 Likert scale), and recommendation practices (primary outcome: "do not use e-cigarettes" vs. recommending them in all or some circumstances). Logistic regression explored factors associated with recommending not to use e-cigarettes for smoking cessation. Results Overall, 90 Israeli smoking cessation counselors responded to the questionnaire. Mean knowledege score was 65.4% (SD 22.5), with only half correctly identifying e-cigarettes as tobacco-free. Mean personal attitude score was 3.5 (SD 0.9), with 78.9% agreeing that discussing e-cigarettes is part of their role. Mean general attitude score was 2.2 (SD 0.5), with 93.3% concerned about e-cigarettes as a gateway to tobacco use. Mean e-cigarettes regulation attitude score was 4.3 (SD 0.7), with 91.1% supporting a ban under age 21. A third of respondents (36.7%) recommended not to use e-cigarettes. Having a medical background (aOR = 6.6), stricter regulation attitudes (aOR = 4.9), and less positive general attitudes (aOR = 0.2) were associated with recommending not to use e-cigarettes. Conclusion Navigating the controversy surrounding e-cigarettes is crucial for optimal smoking cessation care. Negative counselors’ attitudes in Israel, linked to knowledge gaps and regulation framework, may hinder their use as a harm reduction tool for people who are unable or unwilling to quit smoking. Educational programs and clear guidelines are essential to facilitate evidence-based practices in smoking cessation.