Perceptions of family physicians in Istanbul on e-cigarettes as smoking cessation aids

Background: E-cigarettes have been growing in popularity in Turkey as smokers search for alternative ways to decrease the consumption or quit smoking. There has been limited studies among family physicians (FPs) in Turkey regarding smoking cessation and their smoking habits however, none have examined FPs perceptions on e-cigarettes for smoking cessation. We aim to examine Turkish FPs knowledge, attitudes, beliefs and recommendations on e-cigarettes as smoking cessation aids.

Methods: An online survey was distributed via email to 3600 FPs in Istanbul, Turkey. Participants were recruited from a list of family practice clinics provided by the Istanbul Provincial Health Directorate. Data was collected from August until October 2022. Survey items were drawn from published literature and were guided by the Theory of Planned Behaviour. Survey questions included assessing knowledge, attitudes, beliefs and recommendations on e-cigarettes as a smoking cessation aid. Data was analysed using SPSS. 

Results: We received 243 responses from males (47.3%) and females (51.9%) with an average age of 42 years and an average of 9 years clinical experience. Majority of FPs believed it is their responsibility to aid patients in getting the correct help to quit smoking (n=159, 73.3%). Most FPs disagreed that e-cigarettes are suitable smoking cessation aids (n=169, 78%) or are safer than regular cigarettes (n=165, 77%). Furthermore, majority of FPs agreed that e-cigarettes are a gateway to smoking (n=153, 70.5%), are addictive (n=166, 76.5%) and harmful to the health of the user (n=162, 75.3%). Over half of FPs stated they are not confident in their level of knowledge (63%), their ability to answer patient questions (59.5%) or talk to patients about e-cigarettes (60.8%). Over half of FPs stated they would not recommend e-cigarettes to patients that refuse to take alternative treatments (n=121, 61.4%) or to patients that have failed to quit using other methods (n=118, 59.9%). 

Conclusion: Our results show that FPs in Istanbul do not recommend e-cigarettes as a form of smoking cessation. They lack knowledge and confidence when speaking to patients in regards to e-cigarettes and do not believe e-cigarettes to be an effective alternative to quit smoking.