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Tobacco and electronic cigarette products: awareness, cessation attitudes, and behaviours among general practitioners

  • Faraz Mughal (a1) (a2), Ahmed Rashid (a3) and Mohammed Jawad (a4)

Little is known around how general practitioners (GP) approach tobacco products beyond traditional cigarettes.


To examine GP perceptions of tobacco and electronic cigarette (EC) products, and their attitudes and behaviours towards product cessation.


A 13-item self-completed anonymous questionnaire measured awareness of waterpipe tobacco smoking (WTS) and smokeless tobacco (ST). Cessation advice provision, referral to cessation services, and the harm perception of these products were asked using five-point Likert scales that were dichotomised on analysis. Correlates of cessation advice were analysed using regression models.


We analysed 312 responses, of whom 63% were aware of WTS and between 5–32% were aware of ST products. WTS and ST were considered less harmful than cigarettes by 82 and 68% of GPs, respectively. WTS, ST, and EC users were less advised (P<0.001) and referred (P<0.001) to cessation services compared to cigarette users. Ethnic minority and senior GPs were more likely to provide cessation advice for WTS and ST users compared to younger white GPs. GPs who were recent tobacco users were less likely to give cessation advice to cigarette users (adjusted odds ratios 0.17, 95% confidence interval 0.03–0.99, P<0.049).

Conclusions (implications for practice and research)

GPs had lower harm perception, gave less cessation advice, and made less referrals for WTS and ST users compared to cigarettes. Our findings highlight the need for targeted tobacco education in general practice. More research is needed to explore GP perceptions in depth as well as patient perspectives.

Corresponding author
Author for correspondence: Faraz Mughal, NIHR In-Practice Fellow, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK. E-mail:
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Primary Health Care Research & Development
  • ISSN: 1463-4236
  • EISSN: 1477-1128
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