Non-cigarette tobacco cessation support in England: current provision, confidence, and barriers identified in a cross-sectional survey of healthcare professionals involved in smoking cessation support

Introduction While cigarette smoking remains the dominant form of tobacco use in England, a range of other tobacco products are also used. Evidence on demand for non-cigarette tobacco cessation support – and on providers’ preparedness and barriers to offering such support – remains limited. Methods We conducted a cross-sectional online survey of professionals involved in smoking cessation support in England (n = 96). For each specific non-cigarette tobacco products (cigars, cigarillos, shisha, pipes, bidis, chewing tobacco, dry snuff, moist snuff/dip, and heated tobacco), the survey assessed awareness, perceived harms, demand for cessation support, interventions offered, training and confidence, and perceived barriers to providing support. Results Awareness was universal for cigars, pipes, and shisha; high for chewing tobacco (87.5%), heated tobacco (77.1%), and cigarillos (71.9%); and lower for dry snuff (56.3%), bidis (33.3%), and moist snuff/dip (26.0%). Client demand for cessation support was low: 20.8% of participants reported requests at least monthly for cigars and ≤ 13.5% for other products. Support was mainly behavioral and NRT-based, with few offering other pharmacotherapies (<25%). Most participants who offered support used the same approach as for cigarettes (>90% across products), with few having received product-specific training (2.1-19.8% of all participants). The main barriers included perceived lack of demand (46.9%), training (44.8%), and knowledge (43.8%); open-ended responses also emphasized that commissioning constraints excluded non-cigarette products. Conclusions Healthcare professionals in England report limited demand for cessation support for non-cigarette tobacco products, which may partly reflect service reach and commissioning constraints rather than lack of need. Few report receiving product-specific training; most apply standard cigarette cessation approaches or are not commissioned to provide support.