Perceptions of harm, addiction, and cessation support among people who use non-cigarette tobacco products in England: a qualitative study

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INTRODUCTION: England provides comprehensive support for cigarette smoking cessation, and some services also assist people who use non-cigarette tobacco products (e.g., cigars/cigarillos, shisha, and chewing tobacco). Little is known about whether users are interested in quitting, their willingness to engage with cessation services, or beliefs shaping these intentions. METHODS: Five semi-structured focus groups and two interviews were conducted with adults who use non-cigarette tobacco in England (N=25). Topic guides covered harm perceptions, interest in quitting, and knowledge of, interest in, and barriers to using services for quitting. Data were prepared and analysed using iterative categorisation and abductive thematic analysis. RESULTS: Participants often recognised health harms and some reported experiencing addiction. Many participants had never considered quitting, whereas others described multiple attempts. Interest in quitting was shaped by perceptions of addiction and socio-cultural roles of non-cigarette tobacco. Participants were rarely asked about non-cigarette tobacco use by healthcare professionals and were unaware of whether cessation services could support non-cigarette tobacco use. Although some expressed interest in using services, many preferred to rely on willpower and online support, or felt insufficiently dependent to use services. Participants suggested improving awareness of support through community outreach and routinely asking about all forms of tobacco use in healthcare settings. CONCLUSIONS: People who use non-cigarette tobacco show varied interest in quitting, which appears to be shaped by perceived addiction and social factors. Limited awareness of cessation support and low engagement by healthcare professionals may represent missed opportunities for intervention.

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