Purpose Dependent alcohol use is a severe addictive disorder with significant enduring consequences for health and social functioning. This study aims to inductively explore the process of identity change for alcohol dependent people progressing through a “pre-habilitation” intervention, alcohol detoxification and post-detoxification recovery support. Design/methodology/approach Qualitative study as a part of a process evaluation situated within a UK feasibility trial of a group-based intervention in preparation for structured alcohol detoxification. Semi-structured qualitative interviews (face-to-face or telephone) collected self-reported data on experiences of treatment provision as part of the feasibility trial. Thematic analysis of transcripts and iterative categorisation of identity-related themes and concepts was conducted with verification of analysis undertaken by a second coder. Findings Identity change was revealed in participant narratives around the meta themes of external (social-identity) and internal (self-identity) concepts. External influences impacting social identity were key, having influenced initiation into alcohol use, influencing acceptance of the stigmatised “alcoholic” label and then being central to the treatment journey. Internal influences on self-identity also impacted on the process of identity change. In recovery, there was hope in discovering a new “normal” identity or rediscovering normality. Originality/value Analysis demonstrates that moving from regular alcohol use to problematic use is a journey of identity change that is influenced at the macro (cultural), meso (group) and micro (relational) social levels. Throughout the treatment journey, social influences in gaining a new non-drinker identity are key. Findings suggest a need for long-term support through treatment and community-based groups specifically to foster positive identity change that may not have been addressed previously.
The public health response to e-cigarette or vaping associated lung injury (EVALI) has highlighted the widespread misunderstanding of vaping products. We urgently need to clean up the science of e-cigarette and other electronic vaping products to avoid regulatory actions based on erroneous beliefs. Hall et al. [1] provide a detailed account of the US public health response to the e-cigarette or vaping associated lung injury (EVALI) cases, including how a spurious association with the concurrent increases in youth e-cigarette use in the United States meant that e-cigarettes were considered the primary cause of the injuries. Although the US Centre for Disease Control (CDC [2]) has correctly identified illicit tetrahydrocannabinol (THC) vaping as the cause of the injury, research reports are still being published which implicate e-cigarettes. Given the widespread prevalence of nicotine vaping with e-cigarettes and the geographically focused outbreak of the injuries, it is surprising that so many researchers published reports making such claims. This is either deliberate obfuscation or genuine misunderstanding of the products. Either way, it has become clear since the reporting of EVALI incidents that while e-cigarettes are well-researched as a broad category, they are not well-understood products. This is a point that Hall et al. do not offer in-depth explanation for. We offer some perspective and solution in this commentary. There are many products and devices for 'vaping', i.e. inhaling a heated vaporized substance. Heated tobacco products, cannabis and THC vapourizers, waterpipes and hookahs are all 'vaping devices', but are not always correctly classified nor delineated by researchers and policymakers in the published literature or within public statements. Instead, many products are broadly referred to as 'vapes' or electronic vaping devices or misclassified as e-cigarettes. Some of these products contain nicotine, some do not. Some contain tobacco, but most do not. None involve combustion. Use of these products represents a continuum of harm to health. Importantly, each type of device is designed to vapourize a specific substance. As a result, typical e-cigarettes cannot easily or satisfactorily vapourize non-e-liquid substances as, on the most standard and most popular devices, the coils are too delicate. Although there is a counterculture of users who report trying this [3], most e-cigarettes are used for tobacco smoking cessation [4]. Even among adults presenting with substance use disorders, trying to use an e-cigarette to vape other psychoactive substances is not widespread [5], perhaps primarily because this is an inefficient and unsatisfying way to consume other substances. Ontologies are used throughout the sciences and present a shared knowledge database of what is known in an area of research [6]. Within ontologies, entities (e.g. products, behaviours, processes) are represented in position with the entities to which they are most closely related. An e-cigarette ontology (E-CigO) is being developed and will provide scientific consensus on a coherent and systematic way of defining relevant entities, enabling clear indexing of research methods and findings in the field [7]. It will enable more accurate, complete and detailed searching of relevant literature than is currently possible and provide a basis for evidence integration and interpretation. Of particular relevance for the case example here, E-CigO provides explicit definition of terms used within the field and their relationships to each other. Users will be able to query the ontology as a searchable system and filter an index of definitions. Users will also be able to identify how entities are being applied by e-cigarette researchers and policymakers throughout different disciplines, including where divergence exists. Importantly, in the case of the EVALI reporting, each entity is clearly defined in a way that transcends territories. For example, an e-cigarette is defined as 'an electronic vaping device that is hand-held and produces for inhalation an aerosol formed by heating an e-liquid'. The importance here is the definition is based on what the product does, not what it is believed to be or do or how it is regulated. Other types of electronic vaping devices are included in the ontology, including cannabis vapourizers, and they differ based on key device characteristics. Device components are also included and relate specifically to their parent product. While not everyone will engage with the ontology it is hoped that, for those who do, it provides a useful point of reference and at least a starting point for greater clarity than the current status quo. This is important, because smoking continues to be one the leading causes of preventable death and disease and disproportionally affects those from poorer communities [8, 9]. A better foundational knowledge of the range of non-combustible nicotine products that can be used to help reduce the burden of tobacco smoking is needed. Sound, scientific consensus of key terms and product types is a must to avoid the regulatory over-reactions that Hall et al. highlight. This would enable e-cigarettes and other non-combustible products to be available as a harm reduction option for the smokers who could most benefit from their availability. S.C. is a Senior Editor at Addiction. She has also provided expert consultancy to providers of UK life insurance and the pharmaceutical industry on matters on relating smoking cessation. She receives salary support from Cancer Research UK (C1417/A22962). C.N. Notley is an Associate Editor for Addiction.
Relapse to smoking postpartum is a common and important public health problem. Difficulty in adjusting to a non-smoking identity is a key factor prompting relapse. However, postpartum relapse prevention interventions rarely focus upon offering support for identity change. We conducted an exploratory inductive analysis of a dataset from the Prevention of Return to Smoking Postpartum (PReS) study to understand identity constructs and experiences of pre- and postpartum women (smokers and ex-smokers), partners and health professionals. Data were obtained from 77 unique participants via focus groups, interviews, email or online questionnaires, and were analyzed by two researchers independently, using NVivo 12. Four main themes emerged reflecting identity transition from the pre- to the postpartum period: (i) Pregnancy and the categorization of smoking status; (ii) the disruption of motherhood and loss of self; (iii) adapting to a maternal non-smoking identity; and (iv) factors influencing sustained abstinence versus relapse to smoking. Postpartum relapse prevention interventions need to consider support for women, and the whole family unit, in adjusting to a new identity as a non-smoking mother. Smoking status should be revisited throughout pregnancy and into the postpartum period to aid the long-term integration of smoke-free behavior.
Introduction A lapse (any smoking) early in a smoking cessation attempt is strongly associated with reduced success. A substantial proportion of lapses are due to urges to smoke triggered by situational cues. Currently, no available interventions proactively respond to such cues in real time. Quit Sense is a theory-guided just-in-time adaptive intervention smartphone app that uses a learning tool and smartphone sensing to provide in-the-moment tailored support to help smokers manage cue-induced urges to smoke. The primary aim of this randomised controlled trial (RCT) is to assess the feasibility of delivering a definitive online efficacy trial of Quit Sense. Methods and analyses A two-arm parallel-group RCT allocating smokers willing to make a quit attempt, recruited via online adverts, to usual care (referral to the NHS SmokeFree website) or usual care plus Quit Sense. Randomisation will be stratified by smoking rate (<16 vs ≥16 cigarettes/day) and socioeconomic status (low vs high). Recruitment, enrolment, baseline data collection, allocation and intervention delivery will be automated through the study website. Outcomes will be collected at 6 weeks and 6 months follow-up via the study website or telephone, and during app usage. The study aims to recruit 200 smokers to estimate key feasibility outcomes, the preliminary impact of Quit Sense and potential cost-effectiveness, in addition to gaining insights on user views of the app through qualitative interviews. Ethics and dissemination Ethics approval has been granted by the Wales NHS Research Ethics Committee 7 (19/WA/0361). The findings will be disseminated to the public, the funders, relevant practice and policy representatives and other researchers. Trial registration number ISRCTN12326962 .
E-cigarettes are considered a disruptive technology [1], evidencing rapid growth in the financial market and attracting a distinct new customer base of would-be quitters, especially in Great Britain and the USA. Where use is permitted, and regulation is favourable to users [2], e-cigarettes have become the most popular method of smoking cessation [3] and for many are a long-term alternative to smoking [4]. Outside of a medical lens, vaping can be recreational, not just a smoking cessation aid [5]. Simply trying vaping has, for many, had the happy side effect of encouraging smoking cessation through a non-medicalised route. Despite the lack of early research endorsement and the absence of health messaging on e-cigarette use, smokers experimented with them anyway, with many making the switch and quitting smoking completely of their own accord. As the evidence supporting their use as a reduced risk product and a substitute for smoking grew, so too have the endorsements, such that the UK now leads the way in a ‘cautiously permissive’ stance towards the use of e-cigarettes [6, 7].
Introduction Many people quit smoking during pregnancy, but postpartum smoking relapse is common. Maintaining smoking abstinence achieved during pregnancy is key to improving maternal and child health. There are no evidence-based interventions for preventing postpartum smoking relapse. This trial aims to determine whether an intervention to prevent postpartum relapse is effective and cost-effective. Methods and analysis A randomised controlled trial of a complex intervention to prevent postpartum smoking relapse (BabyBreathe), with internal pilot, economic and process evaluations. Participants are adults who are pregnant and who report having quit smoking in the 12 months before, or during pregnancy. Participants are eligible if they read and understand English, and provide informed consent. Following consent and biochemical validation of smoking abstinence, participants are randomised to intervention or usual care/control (no specific relapse prevention support). The BabyBreathe intervention consists of manualised advice from a trained member of the health visiting service, health information leaflets for participants and partners, access to the BabyBreathe website and app. At the time of birth, participants are posted the BabyBreathe box and support is provided by text message for up to 12 months postpartum. Target sample size is 880, recruiting across midwifery services at four hubs in England and Scotland and through remote advertising in England, Scotland, Wales and Northern Ireland. Outcomes are collected at 6 and 12 months. The primary outcome is self-reported sustained smoking abstinence at 12 months, carbon monoxide verified. Secondary outcomes include self-reported abstinence, time to relapse, partner smoking status and quality of life. Ethics and dissemination The trial was approved by the North West Preston Research Ethics committee (21/NW/0017). Dissemination will include publication in peer-reviewed journals, presentation at academic and public conferences including patient and public involvement and to policymakers and practitioners. Trial registration number ISRCTN70307341
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