The NHS should consider working with reputable vape shops to help smokers quit, according to new research.
E-cigarettes are now the most popular method of quitting smoking, and most are bought in specialist vape shops.
New research from the University of East Anglia (UEA), funded by Cancer Research UK, found that vape shops provide behavioural support which could help smokers quit the habit and remain smoke free.
And the study also suggests that health professionals could benefit from understanding the role that vape shops play in reducing smoking.
There are now more than 2,000 vape shops in Britain, and they are by far the most popular places that the country's estimated 2.9 million vapers buy their e-cigarettes.
The industry is estimated to be worth more than £600 million annually in the UK alone.
Smoke free zones
Researchers looked at how vape shops help smokers quit and remain smoke free.
They interviewed 40 people who switched to e-cigarettes to attempt to quit smoking.They also worked with six shops in various locations so they could watch interactions between staff and customers.
Lead researcher Dr Emma Ward, of UEA's Norwich Medical School, said: "Previous evidence suggests that 90 per cent of attempts to quit smoking eventually end in relapse.
"Smokers are addicted to nicotine, but there are also lots of complex psycho-social behaviours associated with smoking.
"Nicotine replacement therapy doesn't always address the behavioural and social aspects of smoking, but switching to e-cigarettes can be a really effective way to stop.
"At present there are no e-cigarettes licenced for medicinal use and vape shops are often the 'frontline' for cessation support.
"We found that vape shops provided effective behavioural support to help quitters stay smoke free.
"Shop assistants were really keen to understand customers' smoking preferences and give tailored advice about the most appropriate products. And they were an ongoing point of contact for practical help.
"An unsatisfying vaping set-up, device malfunction, or a lack of access to vape supplies can trigger a smoking relapse.
"But support from vape shops can help sustain smoking abstinence. We found that shop assistants trouble shoot with customers if they had relapsed and try and find a solution, such as fixing their device or upping their nicotine strength."
Social vapersThe research team also studied the vape shop environment and found that they offer a chance to socialise and reinforce vaping as an 'identity'.Dr Ward said: "Because they are now commonplace on the high street, they're really accessible.
"Many of the shops market themselves as places for socialising and relaxing with a 'café' feel interior."
She said the findings show that the sort of informal atmosphere can appeal to those who enjoyed the social aspect of smoking.
But Dr Ward said vape shops were seen as largely "masculine" territories.
She added: "Some of the women we spoke to said they didn't feel confident in vape shops, and said that their male partner or a colleague would visit the shops on their behalf.
"We also saw that men would come in to buy products or ask for advice on behalf of absent female partners."
The study concludes that health professionals could capitalise on the success of vape shops by working in partnership to ensure the best results for patients.
Study principal investigator Dr Caitlin Notley, a Society for the Study of Addiction Research Fellow at UEA's Norwich Medical School, said: "Vape shops could be very valuable allies to the NHS in the fight against smoking.
"The Public Health England evidence update released on Tuesday states that 'there is compelling evidence that e-cigarettes be made available to NHS patients'.
"Although not all ex-smokers in our study wanted a medical route to quitting smoking by vaping, for some people trying an e-cigarette on prescription may be a good introduction.
"Particularly for those who cannot afford to purchase a start-up kit initially, having a prescription could be very important.
"However, our study shows that it is just as important to offer ongoing support and give advice on which vape set-up to choose, and how best to use e-cigarettes, particularly to help people stay quit in the long term. Vape shops are well placed to provide this type of support."
She added: "Health professionals should consider engaging with the local vaping community to avoid referring clients to shops offering poor customer service or inappropriate sales driven advice.
"Likewise smoking cessation training for shops could be beneficial.
"Most of the shops were interested in working more closely with health professionals.
"And nearly all of the participating vapers wanted the NHS to promote e-cigarette use including more information for GPs and even e-cigarettes available on prescription.
"Interestingly though, around a third of vapers we spoke to planned to eventually stop using e-cigarettes, which could be in conflict with the vape shops' commercial interests."
The study recommends that future research should evaluate joint working between Stop Smoking Services and vape shops to help smokers stub out the habit for good.