Swap-to-Stop: Smoking to Vaping

• Swap-to-Stop enhances the opportunity to make the most of a golden opportunity

Introduction to Swap-to-Stop

• Swap-to-Stop aims to encourage one million people in England to switch from smoking to vaping
• This is done by providing free vape starter kits with behavioral support
• The Khan Review (2022) inspired this due to its success of nicotine-containing vapes as a smoking cessation aid
• Swap-to-Stop contributes to achieving the Smokefree 2030 ambition
• A briefing is available for commissioners and service leads, complementing the NCSCT online training module
• The briefing summarizes main components/benefits of the Swap-to-Stop scheme and includes case studies

Delivering Swap-to-Stop

• The Swap-to-Stop scheme is deliverable in various settings to reach individuals who may not seek health services for smoking cessation
• Local Stop Smoking Services (LSSS) provides structured behavioral support via the NCSCT Standard Treatment Programme
• Frontline staff can operate the Swap-to-Stop program in organizations that advice and support people who smoke

Getting Involved

• Local Authority Tobacco Teams know how to access vapes to set up a service to operate the Swap-to-Stop scheme
• Services can distribute vapes or voucher codes for online vape orders
• Direct vape supply requires sufficient storage space and a range of e-liquid strengths and flavors
• Voucher code issuance requires consideration of service users' likelihood to use an online ordering system

Requirements

• Swap-to-Stop raises the subject of smoking with people who may have never considered stopping
• It requires conversation skills between frontline staff and clients, service users, and patients
• Knowledge of how vapes can aid in stopping smoking is crucial and there is an NCSCT online training module available

Implementation Locations

• Ideal Swap-to-Stop implementation sites include housing associations and mental health outreach services
• Other places include substance use services, debt management services, and LGBTQI+ support
• Swap-to-Stop is applicable in any location frequented by people who smoke

Why Swap to Vaping?

• Vaping poses only a small fraction of the risks of smoking, due to its lack of combustion
• Vaping doesn't contain the harmful chemicals found in cigarette smoke that cause respiratory disease, heart disease, and cancer
• Switching to vaping results in immediate health benefits for smokers

Pleasure Principle

• People report that the pleasurable nature of vapes makes them more desirable than other licensed stop smoking aids
• Side effects like dry throat and tickly cough can be managed by drinking water
• Patients find vaping more tolerable, and are surprised at the ease of stopping smoking with it

Nicotine Usefulness

• It is not the nicotine in cigarettes that kills, it’s the smoke
• Vaping is a route to stopping smoking, sometimes brings worries to users and healthcare workers
• There is often an expectation that stopping should be hard, as well as concern about swapping one addiction for another
• Nicotine products have been used for decades to treat smoking successfully

Addressing Concerns

• Smokers often anticipate being asked about their habit and appreciate the chance to discuss stopping, especially with a free vape offer
• Despite misinformation, many smokers are eager for effective solutions and vape-curious
• Minimal encouragement is needed to get them to try vaping

Staff Concerns

• Staff who smoke may feel hypocritical discussing smoking with service users
• However, helping others consider quitting aligns with the need to support the health and wellbeing
• This intervention enhances workers' communication skills

Implementation

• The NCSCT Swap-to-Stop online training module explains how to raise the topic and manage conversations
• These approaches are customized based on the person's interest level
• There is no one-size-fits-all approach to helping people stop smoking

Training and Resources

• Swap-to-Stop online module: https://elearning.ncsct.co.uk/swap_to_stop-launch
• Vaping: a guide for healthcare professionals: https://elearning.ncsct.co.uk/vaping-launch
• Swap-to-Stop resources: www.ncsct.co.uk/publications/swap-to-stop
• Vaping: a guide for health and social care professionals: www.ncsct.co.uk/publications/vaping_briefing
• Supporting clients who want to stop vaping: www.ncsct.co.uk/publications/support_stop_vaping

Case Study: Wigan Council

• Wigan's Be Well Stop Smoking Service added vapes to their treatment program through Swap-to-Stop
• Totally Wicked provided workforce training to dispel myths and address challenges
• Governance arrangements involved a project delivery team, opting for voucher codes due to storage and transportation concerns
• December 2023: Vapes were launched as a new addition to our NRT portfolio and offered with behavioural support
• Residents get eight weeks of free vape supply for a total of 12 weeks of support, similar to other NRT products
• 164 quit dates have been set, with an 81.8% quit rate achieved and 51% of the users are from the most deprived areas of Wigan

Wigan Council's Next Phase

• Involves a targeted approach to smoking cessation
• Two webinars were held to engage partner organizations
• Partner organizations will be trained and resourced and gain access to NRT products and vape voucher codes
• Collaboration with providers aimed at fostering a sustainable culture change regarding smoking cessation

Wigan Council's Approach

• Believe in taking services out and understand what success looks like to their residents
• Focus on supporting innovation and ensuring residents feel supported
• Frontline workers are encouraged to complete relevant NCSCT training modules

Wigan Council's Messaging

• Advocates persistence in setting up Swap-to-Stop, highlighting vapes' great success in smoking cessation
• Stresses relying on and supporting people, utilizing Swap-to-Stop vapes like other aids

Wigan Council's Key Learning

• Vapes can increase success in service users, including those who think they have tried everything

Case Study: Calderdale and Huddersfield NHS Foundation Trust

• Kate Frost is the Operations Manager, Resilience, Acute Flow and Transformation
• Vapes distributed in Huddersfield Accident and Emergency Department since early summer 2024
• Four-week quits are submitted to Kirklees Council, and follow-ups occur at six months
• Actual vapes (not vouchers) are given to allow demonstration of use from day one
• Demo vape used, patients are provided with a bag containing everything needed
• Two staff members run the scheme, operating seven days a week for flexible service to individuals admitted at weekends

Responses from Patients

• Vary from positive to negative, with some questioning the inquiry about smoking
• One woman in A&E immediately disposed of her cigarettes
• Of 115 people given a vape, five are still attempting to quit, 24 have successfully, and 44 have reduced smoking

Calderdale and Huddersfield's Messaging

• Encourages trialing and adapting the scheme
• Sees that people are quitting. They recommend keeping it simple to make it work

Calderdale and Huddersfield's Key Learning

• Demonstrating how to use a vape and immediately setting up users can boost their motivation to switch from smoking to vaping

Case Study: Gateshead Council

• Gemma King is the Programme Lead
• Gateshead Council provides actual vapes (not vouchers) from the beginning of the scheme, learning as they went
• Outcomes are good, but reporting was less needed at the time
• Transportation and distribution were challenging, but responsibility was shared with partner organizations
• Reservations about the scheme existed at first, but a quit rate of 58% overcame these which led to wider adoption

Outreach

• GP practices in disadvantaged communities were engaged due to high smoking prevalence
• Swap-to-Stop trial occurred in secondary care with Dr. Ruth Sharrock
• Vouchers were easier to administer than vape devices on wards
• Two factory workplaces were engaged through the Better Health at Work Awards with motivated workers
• With those groups Occupational Health staff partnered to achieve a 36% quit rate
• Vapes were distributed through the homelessness nurse with great enthusiasm
• Community mental health team started issuing vapes during physical health checks

Further Learnings

• Pod devices better for those with shaky hands that struggled filling tanks
• 20mg e-liquid and fruit flavors were found to be the most effective at keeping people smokefree
• Vape suppliers (e.g., Vape Dinner Lady) provided key assistance and knowledge

Gateshead's Messaging

• Urges trying the free resource to engage may never have used the service
• Notes people who smoke need options and should look at quitting
• The messaging encourages those in doubt about vaping to consider what they would be doing other wise

Gateshead's Key Learning

• Service user experience paired with advice from experienced suppliers can advance the learning of practitioners

Case Study: North Somerset Council

• Samuel Hayward is the Consultant in Public Health
• The council set up Smokefree Bristol, North Somerset & South Gloucestershire for strategic direction
• Their main goal was to reduce local smoking rates as tobacco control alliance
• Supporting the national ambition locally to be Smokefree by 2030 the group intended to push the agenda onto other people
• Joined forces to bid for Swap-to-Stop vapes to provide real tools to people who smoke

Slow Downs

• 'Vaping hesitancy' has slowed down the plan
• A clear position statement was created. The new position was - if you smoke, you should switch to vaping
• Lots of organisations have been reached out to support, but time has been a constraint
• It became clearer to focus on distributing vapes among new smokers rather than addressing the inconvinciable

North Somerset Council's Realization

• The Swap-to-Stop programme reduced harm by showing there were safer devices people could potentially buy through illicit suppliers

Challenges Faced

• Capacity limited delivering through partners with contact to people who smoke
• Not all providers had the same approach to Swap-to-Stop
• One organisation understood the process, but another didn't

Methods and Messaging

• Quick training for partner organizations being evaluated
• Vapes offered through core services, but vouchers mean storage is not needed
• When the physical vape offered there is better engagement
• Structure and leadership streamlined quick, effective decisions

North Somerset's Message

• Pushes one to get the vapes into the hands of people that smoke and are given a chance to quit
• Do what works for your organisation and share that around
• Notes that the most significant gains are made by hospital wards

North Somerset's Key Learning

• It's most effective and easiest not to wait until everyone is convinced and ready to make a move
• Working with those interested at that very moment is more important

Conclusion

• The Swap-to-Stop scheme is is innovative with significant potential to save lives
• Administrative blocks to mobilising and waiting for the perfect moment and mindset may let it never get off the ground
• Showing success, working with the willing, adapting, and sharing is sure to help achieve positive results
• Swap-to-Stop will save lives