Electronic cigarettes for smoking cessation in pregnancy: a nation–wide mixed methods study

Background/Aims The use of electronic cigarettes for smoking cessation during pregnancy is supported by Public Health England and the Royal College of Midwives. However, their long-term effects remain largely unknown. The aim of this study was to explore midwives’ knowledge of and attitudes to electronic cigarette use in pregnancy, and whether this affected their recommendation for their use in smoking cessation. Methods An online survey was distributed to 122 qualified midwives in England. Participants were scored on their knowledge of and attitude to electronic cigarettes and their use in pregnancy. The study was cross-sectional and responses were subjected to analytical and descriptive statistical analysis. Results There was a significant indirect association between knowledge and attitude, where an increase in knowledge was associated with a more negative attitude (P≤0.001). There was a significant association between attitude, knowledge and personal practice. Categories identified from qualitative data were ‘not enough or no training/information/resources provided’ and ‘not enough research has been done’. Conclusions Midwives’ practice in supporting electronic cigarette use as a smoking cessation strategy is influenced by their knowledge and attitude, as well as by challenges in implementing recommendations in practice. This highlights the perceived need for more research on the potential risks and benefits, as well as more resources.