BACKGROUND: Singapore, a high-income city-state in Southeast Asia, pre-emptively banned the sale, import, and marketing of e-cigarette and vaping products in 2010, and tightened the ban in 2017 to also include purchase, use and possession. Despite the strict ban, vaping has become more prevalent in Singapore since the COVID-19 pandemic. More countries seek to regulate vaping but, as in Singapore, lack tailored services or guidelines for vaping cessation. Clinicians may therefore face challenges in identifying or treating vaping cases due to stigma or patients’ reluctance to disclose their vaping. Few studies have explored how clinicians identify or manage vaping cases in a context where vaping is heavily regulated or stigmatized.
METHODS: We conducted semi-structured interviews with 12 Singaporean clinical practitioners from pharmacy, psychology, respiratory medicine, smoking cessation or youth welfare settings, all of whom had encountered vaping cases in their practice. Interview questions explored how they manage vaping cases. We analysed data using inductive thematic methods.
RESULTS: According to clinicians, patients were reluctant to disclose their vaping for fear of being reported to authorities and some clinicians were unsure of their duty to report, making it challenging to identify vaping cases. Variability in usage patterns and inaccurate e-liquid labelling posed difficulties in estimating nicotine dependence, leaving practitioners to use trial and error methods or to adapt from smoking cessation guidelines when calculating nicotine replacement therapy or medication dosage. Tailored quit support for people who vape was lacking, especially in the form of subsidised nicotine replacement therapy.
CONCLUSIONS: Even in contexts where vaping is heavily regulated, given the rising incidence of vaping globally it is important to record patients’ vaping history as part of routine practice and to provide services to help people quit vaping without facing stigma or legal repercussions because of their vaping.