Together, public involvement (PI) and qualitative methods can provide insights into nicotine and tobacco use that are not easily ascertained from researchers acting alone. This study was co-produced with members of the UCL tobacco and alcohol research PI group. The aim was to qualitatively explore lay perspectives on the changing landscape of tobacco and nicotine use in England, and perceptions of tobacco control policies of the past and ideas for the future.
The PI group (n=9, 5 female; mean age = 44.2 years) shaped the research questions, topic guide and assisted with data analysis. Sixty-five participants formed of never, former and current smokers and current vapers (Mean age=39.7 years) took part in a series of online focus groups. Groups were facilitated by a topic guide; discussion was prompted using slides on the changing trends in smoking and nicotine use in England from the Smoking Toolkit Study (STS). Groups were audio-recorded and transcribed. Data were analysed deductively and inductively via Iterative Categorization.
UK smoking prevalence was overestimated; the groups were surprised by the 15% figure. Vaping was commonly confused with smoking and may have contributed to this overestimation. Smoking and vaping were linked to specific age groups - smoking believed to be more prevalent within older adults and vaping within youth, as part of a 'permissive bygone era' and a passing trend, respectively. There was a consensus that credible evidence on vaping was lacking, and the 'post truth era' meant information sources were questioned. Although the NHS and some cancer charities were seen as trusted sources of information because of a lack of financial investment in smoking. There was support for past tobacco control policies (e.g., adverts) but concern about the stigmatisation these caused for loved ones. There was less consensus on what would work in the future, higher taxation was especially divisive.
The inclusion of PI alongside qualitative methods and data from the STS allowed for the triangulation of several data sources. The main results suggest incongruence between population level data and participant observations. Participants viewed themselves as 'passive observers' to tobacco science, lacking trusted sources of information.
Dr Sharon Cox is a psychologist with over 15 years' academic and clinical experience studying substance addictions and harm reduction. Her research has a particular focus on tobacco dependence treatment within communities facing severe and multiple disadvantage. She is interested in addressing how social determinants of health influence uptake and use of mainstream smoking cessation treatments and act as wider barriers to tobacco harm reduction. She co-leads a programme of work on smoking and homelessness, including the first trial to test e-cigarettes versus usual care among this population. She also lead the wider public involvement activities at UTARG, with the aim of including the public more formally in to their work. Her research is funded by Cancer Research UK, the Medical Research Council and the National Institute of Health Research.