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Do EK, Aarvig K, Panigrahi G, Hair EC. Past-Year Mental Illness Diagnosis and E-cigarette Use Status Among a College-Aged Sample: Findings From the National College Health Assessment (2017-2019). Am J Health Promot 2024; 38:468-477. [PMID: 38146733 DOI: 10.1177/08901171231224864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
PURPOSE To examine associations between past-year mental illness (MI) diagnoses and e-cigarette use status. DESIGN Data were obtained from the National College Health Assessment, a nationally recognized cross-sectional survey of university students. SETTING Participants were recruited from 2-year and 4-year public and private universities across the United States from 2017-2019. SUBJECTS The analytic sample included 277 291 university students. MEASURES Self-reported past-year MI diagnosis, binarily coded, served as the primary predictor. The outcome was e-cigarette use status (never, noncurrent, and current user). ANALYSIS Multinomial logistic regression models were used to estimate relative risk ratios (RRR) of e-cigarette use, as predicted by past-year MI diagnoses, age, race/ethnicity, sex and gender, sexual identity, geographic region, and other combustible tobacco, alcohol, and marijuana use. RESULTS Compared to those who had never received any MI diagnosis in the past year, those who did had a 16% higher relative risk (RRR = 1.16, 95% CI: 1.11, 1.20) of being a noncurrent e-cigarette user and a 33% higher relative risk (RRR = 1.33, 95% CI: 1.28, 1.38) of being a current e-cigarette user. Schizophrenia, substance use or addiction, bipolar disorder, and attention deficit and hyperactivity disorder (ADHD) diagnoses demonstrated the strongest associations with noncurrent and current e-cigarette use. CONCLUSION Results suggest the need to screen young adults for e-cigarette use and mental health indicators to facilitate early detection and timely intervention for at-risk university students.
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Affiliation(s)
- Elizabeth K Do
- Schroeder Institute, Truth Initiative, Washington, DC, USA
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | | | - Elizabeth C Hair
- Schroeder Institute, Truth Initiative, Washington, DC, USA
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- School of Global Public Health, New York University, New York, NY, USA
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2
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Kang W, Malvaso A. Understanding the longitudinal associations between e-cigarette use and general mental health, social dysfunction and anhedonia, depression and anxiety, and loss of confidence in a sample from the UK: A linear mixed effect examination. J Affect Disord 2024; 346:200-205. [PMID: 37956830 DOI: 10.1016/j.jad.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/04/2023] [Accepted: 11/07/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE Our objective was to the longitudinal associations between e-cigarette use and general mental health, social dysfunction & anhedonia, depression & anxiety, and loss of confidence in a sample from the UK. METHODS We analyzed data of 19,706 participants from Wave 9 (collected from 2017 to 2018) and Wave 10 (collected from 2018 to 2019) of the Understanding Society: the UK Household Longitudinal Study using a confirmatory factor analysis, linear mixed effect model, and one-sample t-tests. RESULTS We found that there is a significant time by e-cigarette use status interaction on mental health issues (b = 0.32, p < 0.001, 95 % C.I. [0.15, 0.49]), social dysfunction & anhedonia (b = 0.36, p < 0.001, 95 % C.I. [0.18, 0.54]), and loss of confidence (b = 0.24, p < 0.01, 95 % C.I. [0.06, 0.41]). Indeed, participants who became e-cigarette smokers at Wave 10 had worse mental health (t(107) = 2.64, p < 0.01, 95 % C.I. [0.07, 0.48], Cohen's d = 0.28), social dysfunction & anhedonia (t(107) = 3.16, p < 0.01, 95 % C.I. [0.12, 0.52], Cohen's d = 0.32), and loss of confidence (t(107) = 2.08, p < 0.05, 95 % C.I. [0.01, 0.37], Cohen's d = 0.19) comparing to one year ago. LIMITATION Limitations of this study included its self-report measures, unclassified e-cigarette type, limited generalizability to other populations, and lack of experimental manipulations. CONCLUSION We revealed longitudinal associations between e-cigarette initiation and adverse general and dimensions of mental health except for depression and anxiety, which have significant implications for public health, specifically in terms of e-cigarette product regulation and advertising.
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Affiliation(s)
- Weixi Kang
- Department of Brain Sciences, Imperial College London, London, United Kingdom.
| | - Antonio Malvaso
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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3
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Bautista M, Mogul AS, Fowler CD. Beyond the label: current evidence and future directions for the interrelationship between electronic cigarettes and mental health. Front Psychiatry 2023; 14:1134079. [PMID: 37645635 PMCID: PMC10460914 DOI: 10.3389/fpsyt.2023.1134079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
Electronic cigarette use has dramatically increased over the last decade. With this recent technological development and wide range of constituents in various products, putative adverse effects on the brain and body have been largely unexplored. Here, we review current evidence linking electronic nicotine cigarette use with potential health consequences and provide evidence supporting an association between drug use and depression in humans. We also examine the biological effects of individual constituents in electronic cigarette aerosols, which include labeled ingredients, such as propylene glycol, vegetable glycerin, nicotine, and flavorants, as well as unlabeled ingredients found in the aerosols, such as carbonyls and heavy metals. Lastly, we examine the effects of electronic cigarette use on endogenous metabolism via changes in cytochrome P450 enzymes, which can thereby impact therapeutic outcomes. While the current evidence offers insight into the potential effects of electronic cigarette use on biological processes, further studies are necessary to determine the long-term clinical relevance of aerosol inhalation.
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Affiliation(s)
| | | | - Christie D. Fowler
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, United States
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4
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Stevens ER, Sherman SE. A targeted approach to using e-cigarettes for harm reduction in adults. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2022; 48:128-132. [PMID: 35130449 DOI: 10.1080/00952990.2021.2007938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/12/2021] [Accepted: 11/14/2021] [Indexed: 06/14/2023]
Abstract
Smoking remains the leading preventable cause of death and disease in the US. While e-cigarettes (EC) are undeniably harmful when used by adolescents and nonsmokers, the perpetuation of the increasing negative perceptions of EC and widespread false belief that EC are equal or more harmful than combustible cigarettes (CC) represents a significant missed public health opportunity. EC have great potential to serve as a mechanism for smoking harm reduction among hard-to-treat populations of smokers who have failed to quit with currently available treatments. In this paper, we outline why we need to overcome the hostile EC research environment to explore the potential use of EC as a harm-reduction strategy in hard-to-treat populations.
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Affiliation(s)
- Elizabeth R Stevens
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Scott E Sherman
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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5
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Manning K, Garey L, Viana AG, Smit T, Zvolensky MJ. The moderating role of anxiety sensitivity in terms of fatigue severity and e-cigarette use expectancies. J Health Psychol 2021; 26:2676-2687. [PMID: 32498566 PMCID: PMC7916988 DOI: 10.1177/1359105320926534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Little is understood about individual difference factors related to e-cigarette expectancies about use. This study examined the interactive effects of fatigue severity and anxiety sensitivity in relation to e-cigarette expectancies among 525 e-cigarette users (51.0% female, Mage = 35.25 years, standard deviation = 10.10). Results indicated a significant interaction between fatigue severity and anxiety sensitivity in terms of positive expectancies (β = 0.57, p < 0.001, 95% confidence interval = (0.002, 0.01)), but not for negative expectancies (β = 0.25, p = 0.08, 95% confidence interval = (0, 0.005)) for e-cigarette use. These results support anxiety sensitivity as a moderator in the relation between fatigue severity and positive outcome expectancies for e-cigarette use.
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Affiliation(s)
| | | | | | | | - Michael J Zvolensky
- University of Houston, USA
- The University of Texas MD Anderson Cancer Center, USA
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6
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Masson CL, Le T, Hosakote S, Fokuo JK, Gubner NR, Shingle M, Guydish J. Correlates of e-cigarette use for smoking cessation among clients in residential substance use disorder treatment. Addict Behav 2021; 119:106947. [PMID: 33892312 DOI: 10.1016/j.addbeh.2021.106947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 03/07/2021] [Accepted: 04/05/2021] [Indexed: 11/28/2022]
Abstract
Little is known about e-cigarette use among persons in substance use disorder (SUD) treatment, or their use of e-cigarettes for smoking cessation. Prevalence of e-cigarette use and correlates of e-cigarette use for smoking cessation were examined among clients in SUD treatment. Participants (n = 332) were current cigarette smokers recruited from 20 residential SUD programs in California. We used multivariable logistic regression to identify correlates of using e-cigarettes for quitting smoking. Almost half (45.2%) of the sample had ever used e-cigarettes for smoking cessation, and 34% had used e-cigarettes in the past 30 days. Smokers who had used e-cigarettes for smoking cessation, compared to those who had not, were younger (adjusted odds ratio [AOR] = 0.94, 95% confidence interval [CI] = 0.91, 0.96), had more than a high school education (AOR = 1.69, 95% CI = 1.07, 2.68), sought treatment for both SUD and mental health disorder (AOR = 2.62, 95% CI = 1.38, 5.00), wanted help quitting smoking (AOR = 1.90, 95% CI = 1.03, 3.50) and perceived e-cigarettes as equally harmful (AOR = 3.03, 95% CI = 1.10, 8.33) or less harmful than tobacco cigarettes (AOR = 2.82, 95% CI = 1.02, 7.77). Black/African American and Hispanic/Latino participants were less likely to use e-cigarettes for smoking cessation than participants who identify as White. E-cigarettes were favorably perceived by clients in residential SUD treatment as a quit smoking aid. Treatment programs should consider how to advise clients with respect to the use of e-cigarettes for smoking cessation.
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Affiliation(s)
- Carmen L Masson
- University of California San Francisco, Department of Psychiatry and Behavioral Sciences, Zuckerberg San Francisco General Hospital, Building 20, Suite 2100, San Francisco, CA 94941, United States.
| | - Thao Le
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, United States.
| | - Sindhushree Hosakote
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, United States.
| | - J Konadu Fokuo
- University of California San Francisco, Department of Psychiatry and Behavioral Sciences, Zuckerberg San Francisco General Hospital, Building 20, Suite 2100, San Francisco, CA 94941, United States.
| | - Noah R Gubner
- Department of Psychiatry and Behavioral Sciences, University of Washington, School of Medicine, United States.
| | - Mallory Shingle
- University of California San Francisco, Department of Psychiatry and Behavioral Sciences, Zuckerberg San Francisco General Hospital, Building 20, Suite 2100, San Francisco, CA 94941, United States
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, United States.
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7
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Underner M, Perriot J, Brousse G, de Chazeron I, Schmitt A, Peiffer G, Afshari R, Ebrahimighavam S, Jaafari N. [Contribution of electronic cigarettes in smoking patients with psychotic disorders. A literature review]. L'ENCEPHALE 2021; 47:452-460. [PMID: 33863511 DOI: 10.1016/j.encep.2020.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/09/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This systematic literature review focused on patients suffering from schizophrenia (SZ), psychotic disorders or mental illness (MI) including SZ. It was interested in data on prevalence of electronic cigarette (EC) use, patient perceptions and expectations, as well as caregivers' attitudes towards the EC and its benefit in helping to stop or reduce smoking. METHOD The research was carried out on Medline for the period 2000-2020. Cross-sectional, case-control, prospective, randomized controlled studies and preliminary studies were included in this review. RESULTS EC is widely used by MI patients with current and lifetime use from 7.4% to 28.6%. More specifically, patients with SZ and schizoaffective disorders observe current and lifetime use from 7% to 36%, respectively. Many reasons are given by patients for its use including the possibility of using it in places where smoking is prohibited, its lower toxicity compared to cigarettes for oneself and those around, its lower cost, and the help provided to reduce consumption. CONCLUSION EC is used by smokers with MI; several studies confirm the possibility for these smokers to reduce tobacco consumption through EC and without disturbing their mental state. However, its value in helping to quit smoking remains uncertain.
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Affiliation(s)
- M Underner
- Unité de recherche clinique Pierre-Deniker, centre hospitalier Henri-Laborit, université de Poitiers, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France.
| | - J Perriot
- Dispensaire Émile-Roux, centre de tabacologie, 63100 Clermont-Ferrand, France
| | - G Brousse
- Service de psychiatrie-addictologie, CMP-B CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - I de Chazeron
- Service de psychiatrie-addictologie, CMP-B CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - A Schmitt
- Service de psychiatrie-addictologie, CMP-B CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - G Peiffer
- Service de pneumologie, CHR Metz-Thionville, 57038 Metz, France
| | - R Afshari
- Unité de recherche clinique Pierre-Deniker, centre hospitalier Henri-Laborit, université de Poitiers, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France; Prevention of social harms and substance use disorders center, Shiraz university of medical sciences, Shiraz, Iran
| | - S Ebrahimighavam
- Unité de recherche clinique Pierre-Deniker, centre hospitalier Henri-Laborit, université de Poitiers, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France; Département de psychologie de l'éducation, faculté de psychologie et de sciences de l'éducation, université Allameh Tabataba'i, Téhéran, Iran
| | - N Jaafari
- Unité de recherche clinique Pierre-Deniker, centre hospitalier Henri-Laborit, université de Poitiers, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France
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8
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Zvolensky MJ, Manning K, Garey L, Alfano CA, Mayorga NA, Peraza N. Emotion dysregulation, fatigue, and electronic cigarette expectancies. Cogn Behav Ther 2021; 50:138-153. [PMID: 33006499 PMCID: PMC7916989 DOI: 10.1080/16506073.2020.1819868] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
Emotion dysregulation and the experience of fatigue have both been linked to the maintenance of substance use. However, limited empirical data has evaluated individual differences in these constructs in terms of e-cigarette use expectancies. The present study examined a theoretically relevant model focused on whether the experience of more severe fatigue explains, in part, the relation between individual differences in emotion dysregulation and positive and negative e-cigarette expectancies among 525 adult e-cigarette users (50.9% female, Mage = 35.25 years, SD = 10.10). It was hypothesized that emotion dysregulation, via fatigue severity, would significantly predict greater positive and negative e-cigarette expectancies, which was examined in two separate mediation models. Fatigue severity significantly explained, in part, the relation between emotion dysregulation and positive (b = 0.02, CI [0.01, 0.02]) and negative expectancies of e-cigarette use (b = 0.02, 95% CI [0.02, 0.03]). The current findings suggest that the experience of fatigue helps explain the relation between emotion dysregulation and positive and negative e-cigarette expectancies among adult e-cigarette users. Future work is needed to explicate how reducing fatigue severity in the context of emotion dysregulation may change expectancies about e-cigarette expectancies.
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Affiliation(s)
- Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Psychology, HEALTH Institute, University of Houston, Houston, TX, USA
| | - Kara Manning
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, USA
| | | | - Nubia A. Mayorga
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Natalia Peraza
- Department of Psychology, University of Houston, Houston, TX, USA
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9
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Dixit D, Herbst E, Das S. E-Cigarette Use and Perceptions Among Veterans Receiving Outpatient Treatment in Veterans Affairs Substance Use and Mental Health Clinics. Mil Med 2021; 186:24-29. [PMID: 33005932 DOI: 10.1093/milmed/usaa292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/23/2020] [Accepted: 08/12/2020] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Introduction
Individuals with substance use disorders and/or mental health (MH) conditions have higher rates of cigarette smoking than the general population. Electronic nicotine delivery systems (ENDS) while gaining popularity pose health risks. Herein we investigate risk perceptions and attitudes toward e-cigarettes in military Veterans with MH conditions.
Materials and Methods
Participants included U.S. Veterans receiving services from Veterans Administration MH/substance use disorder clinics in the San Francisco Bay Area (N = 98; 95% male, 44% White, 34% Black/African American), who completed a survey on smoking and health. Results compare attitudes and perceptions regarding e-cigarette use between ever and never e-cigarette users. The study was reviewed by the Institutional Review Board at both the Veterans Administration and University.
Results
Most respondents reported being current/past cigarette smokers (91%) and over a third reported having ever used an e-cigarette (38%). Most believed that e-cigarettes are not safe, are potentially dangerous, are potentially addictive if they use every day and are tempting and appealing to youth. Fifty-one percent of ever-users agreed with a statement that e-cigarettes can help people quit smoking regular cigarettes completely, and there was a significant difference in this belief when comparing them with never-users (23% agreed); χ2 = 9.259, P = 0.010.
Conclusions
Proportion of e-cigarette use in this Veteran sample is greater than the general population. We observed high risk perception about e-cigarettes among all respondents and differences in perceived helpfulness of e-cigarettes for quitting in ever-users versus never-users in this sample. More consistent assessment of tobacco use among Veterans, with inclusion of ENDS use, would help inform prevention and treatment priorities, especially as information on health impacts of ENDS surfaces.
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Affiliation(s)
- Devika Dixit
- University of California, San Francisco Department of Psychiatry and Behavioral Sciences, San Francisco, CA 94143
- Morehouse School of Medicine, Atlanta, GA 30310
| | - Ellen Herbst
- University of California, San Francisco Department of Psychiatry and Behavioral Sciences, San Francisco, CA 94143
- Mental Health Service, San Francisco VA Medical Center, San Francisco, CA 94121
| | - Smita Das
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5717
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Pergadia ML, Newcomer JW, Gilbert DG. Depression and Nicotine Withdrawal Associations with Combustible and Electronic Cigarette Use. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249334. [PMID: 33327373 PMCID: PMC7764909 DOI: 10.3390/ijerph17249334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 11/16/2022]
Abstract
Depression is a risk factor for nicotine use and withdrawal. Population level epidemiologic studies that include users of either combustible or electronic cigarette (NICUSER) could inform interventions to reduce nicotine dependence in vulnerable populations. The current study examined the relationship between depression diagnosis (DEPDX), NICUSER, and lifetime rates of DSM-V nicotine withdrawal (NW) symptoms in a nationally representative sample of US adults (N = 979), who answered related questions in surveys administered through GfK’s KnowledgePanel. Over 42% of the sample reported lifetime ever combustible cigarette use, 15.6% electronic-cigarette use, and 45.9% either (NICUSER). Weighted logistic regression analyses (controlling for age and gender) found that DEPDX was associated with 2.3 times increased odds (ratio (OR); 95% Confidence Interval (CI): 1.5–3.5) of being a NICUSER. Regarding risks of NW symptoms among NICUSER, models that additionally controlled for frequency of nicotine use found that DEPDX was significantly associated with increased odds of concentration problems (OR = 2.4; 95% CI: 1.3–4.5) and depressed mood (OR = 2.2; 95% CI: 1.1–4.1) when quitting or cutting down on nicotine use. Results highlight the consistent comorbidity between depression, nicotine use, and symptomatic nicotine withdrawal in a population-based sample of combustible and electronic cigarette users.
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Affiliation(s)
- Michele L. Pergadia
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA;
- Correspondence: ; Tel.: +1-314-273-3057
| | - John W. Newcomer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA;
- Thriving Mind South Florida, Miami, FL 33126, USA
| | - David G. Gilbert
- Department of Psychology, Southern Illinois University, Carbondale, IL 62901, USA;
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11
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Laviolette SR. Molecular and neuronal mechanisms underlying the effects of adolescent nicotine exposure on anxiety and mood disorders. Neuropharmacology 2020; 184:108411. [PMID: 33245960 DOI: 10.1016/j.neuropharm.2020.108411] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/16/2020] [Accepted: 11/21/2020] [Indexed: 12/28/2022]
Abstract
Tobacco addiction is highly co-morbid with a variety of mental health conditions, including schizophrenia, mood and anxiety disorders. Nicotine, the primary psychoactive compound in tobacco-related products is known to functionally modulate brain circuits that are disturbed in these disorders. Nicotine can potently regulate the transmission of various neurochemicals, including dopamine (DA), γ-amino-butyric acid (GABA) and glutamate, within various mesocorticolimbic structures, such as the ventral tegmental area (VTA), nucleus accumbens (NAc) and prefrontal cortex (PFC), all of which show pathologies in these disorders. Many neuropsychiatric diseases have etiological origins during neurodevelopment, typically occurring during vulnerable periods of adolescent or pre-natal brain development. During these neurodevelopmental periods, exposure to extrinsic drug insults can induce enduring and long-term pathophysiological sequelae that ultimately increase the risk of developing chronic mental health disorders in later life. These vulnerability factors are of growing concern given rising rates of adolescent nicotine exposure via traditional tobacco use and the increasing use of alternative nicotine delivery formats such as vaping and e-cigarettes. A large body of clinical and pre-clinical evidence points to an important role for adolescent exposure to nicotine and increased vulnerability to developing mood and anxiety disorders in later life. This review will examine current clinical and pre-clinical evidence that pinpoints specific mechanisms within the mesocorticolimbic circuitry and molecular biomarkers linked to the association between adolescent nicotine exposure and increased risk of developing mood and anxiety-related disorders. This article is part of the special issue on 'Vulnerabilities to Substance Abuse'.
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Affiliation(s)
- Steven R Laviolette
- Addiction Research Group, Dept. of Anatomy & Cell Biology, Dept. of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, N6A 3K7, ON, Canada.
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12
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Becker TD, Arnold MK, Ro V, Martin L, Rice TR. Systematic Review of Electronic Cigarette Use (Vaping) and Mental Health Comorbidity Among Adolescents and Young Adults. Nicotine Tob Res 2020; 23:415-425. [DOI: 10.1093/ntr/ntaa171] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/03/2020] [Indexed: 12/12/2022]
Abstract
Abstract
Introduction
The prevalence of electronic cigarette (EC) use has risen dramatically among adolescents and young adults (AYA, ages 12–26) over the past decade. Despite extensive established relationships between combustible cigarette use and mental health problems, the mental health comorbidities of EC use remain unclear.
Aims and Methods
To provide a systematic review of existing literature on mental health comorbidities of EC use among AYA. Database searches using search terms related to EC, AYA, and mental health identified 1168 unique articles, 87 of which prompted full-text screening. Multiple authors extracted data, applied the Effective Public Health Practice Project Quality Assessment Tool to evaluate the evidence, and synthesized findings.
Results
Forty articles met eligibility criteria (n = 24 predominantly adolescent and 16 predominantly young adult). Analyses yielded three main categories of focus: internalizing disorders (including depression, anxiety, suicidality, eating disorders, post-traumatic stress disorder), externalizing disorders (attention-deficit/hyperactivity disorder and conduct disorder), and transdiagnostic concepts (impulsivity and perceived stress). Significant methodological limitations were noted.
Conclusions
Youth EC use is associated with greater mental health problems (compared with nonuse) across several domains, particularly among adolescents. Because many existing studies are cross-sectional, directionality remains uncertain. Well-designed longitudinal studies to investigate long-term mental health sequelae of EC use remain needed.
Implications
Forty recent studies demonstrate a variety of mental health comorbidities with AYA EC use, particularly among adolescents. Mental health comorbidities of EC use generally parallel those of combustible cigarette use, with a few exceptions. Future EC prevention and treatment strategies may be enhanced by addressing mental health.
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Affiliation(s)
- Timothy D Becker
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Melanie K Arnold
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Vicky Ro
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Lily Martin
- Levy Library, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Timothy R Rice
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
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13
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Spears CA, Jones DM, Weaver SR, Yang B, Pechacek TF, Eriksen MP. Use of and perceptions about electronic nicotine delivery systems (ENDS) among people with mental health conditions or serious psychological distress, 2018. Drug Alcohol Depend 2020; 212:108049. [PMID: 32442748 PMCID: PMC7867116 DOI: 10.1016/j.drugalcdep.2020.108049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND People with mental health conditions (MHC) experience health disparities related to combustible tobacco use, and recent studies suggest disproportionately high use of electronic nicotine delivery systems (ENDS, e.g., e-cigarettes) among adults with MHC. Continued surveillance of ENDS use by MHC status is needed, as well as in-depth examinations of why adults with versus without MHC are using ENDS. METHODS Using 2018 U.S. nationally representative data (N = 5878), this study examined associations between MHC and serious psychological distress (SPD) with ENDS use. Among current ENDS users (n = 544), associations between MHC and SPD with perceived benefits and reasons for using ENDS were also investigated. RESULTS Both MHC and SPD were associated with higher likelihood of having ever used ENDS, currently using ENDS, and currently using ENDS daily. There was an interaction between SPD and smoking status in predicting current ENDS use such that the association between SPD and higher current ENDS use was stronger among never smokers. Compared to those without MHC, participants with MHC indicated that using ENDS helped them feel more relaxed and that stress management was a more important reason for ENDS use. CONCLUSIONS U.S. adults with MHC (and particularly never smokers with SPD) report disproportionately high use of ENDS. Individuals with MHC may be particularly likely to use ENDS for relaxation and stress management.
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Affiliation(s)
- Claire Adams Spears
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, USA.
| | - Dina M Jones
- Center for the Study of Tobacco, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR, 72205, USA
| | - Scott R Weaver
- Department of Population Health Sciences, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, USA
| | - Bo Yang
- Department of Communication, University of Arizona, 1103 E. University Blvd., Tucson, AZ, 85721-0025, USA
| | - Terry F Pechacek
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, USA
| | - Michael P Eriksen
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, USA
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14
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Caponnetto P, Polosa R, Robson D, Bauld L. Tobacco smoking, related harm and motivation to quit smoking in people with schizophrenia spectrum disorders. Health Psychol Res 2020; 8:9042. [PMID: 32510003 PMCID: PMC7267811 DOI: 10.4081/hpr.2020.9042] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
This narrative review focuses on the topic of tobacco smoking amongst people with schizophrenia spectrum disorders. We searched PubMed, PsycInfo and Scopus databases for schizophrenia spectrum disorders and smoking and included articles about the epidemiology of tobacco smoking in people with schizophrenia spectrum disorders, examining the relationship between smoking and mental health. This narrative review describes that a higher prevalence, frequency and impact of both high nicotine dependence and its harmful effects in patients with schizophrenia spectrum disorders compared with those in the general population. Despite several existent theories, the reasons for high smoking rates, the high dependence on nicotine and severity of nicotine withdrawal symptoms are not fully understood. The main aim of this paper is to inform mental health personnel and particularly clinical and health psychologists about the impact and role of tobacco smoking for smokers with schizophrenia spectrum disorders.
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Affiliation(s)
| | | | | | - Linda Bauld
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- UK Centre for Tobacco & Alcohol Studies, Nottingham, UK
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15
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Zvolensky MJ, Mayorga NA, Garey L. Positive Expectancies for E-Cigarette Use and Anxiety Sensitivity Among Adults. Nicotine Tob Res 2020; 21:1355-1362. [PMID: 29800464 DOI: 10.1093/ntr/nty106] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/22/2018] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Although e-cigarette use is on the rise among youth and adults, there is little understanding of the individual difference factors at a cognitive level of analysis for e-cigarette beliefs and quit behavior. METHOD The present investigation sought to test a theoretically driven interactive model of positive expectancies for e-cigarettes and anxiety sensitivity (fear of the consequences of anxiety) among 551 adult e-cigarette users (50.6% female, Mage = 35.2 years, SD = 10.1). RESULTS Results indicated a significant interaction between positive expectancies for e-cigarette use and AS was significantly related to greater perceived benefits of e-cigarette use, greater perceived risk of e-cigarette use, and more serious attempts for trying to quit e-cigarettes. The significant interaction effect for each dependent variable was evident over and above the main effects as well as the covariates of sex, income, education, and concurrent combustible cigarette use. The form of this interaction indicated that e-cigarette users higher in AS who also maintained more positive outcome expectancies for e-cigarette use reported more perceived benefits as well as more perceived risk of e-cigarette use and engaged in more (failed) attempts to quit e-cigarettes. CONCLUSIONS Overall, the current data suggest that individual differences in AS and positive expectancies may represent two important factors to consider in e-cigarette beliefs and quit attempts. IMPLICATIONS This study provides the first empirical evidence of a transdiagnostic construct (anxiety sensitivity) in relation to e-cigarette use and how it interplays with positive expectancies for e-cigarette use beliefs and behavior. These novel data suggest that future clinical research may benefit by understanding the potential therapeutic role of anxiety sensitivity and expectancies for e-cigarette use behavior.
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX.,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX.,Health Institute, University of Houston, Houston, TX
| | - Nubia A Mayorga
- Department of Psychology, University of Houston, Houston, TX
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX
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16
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Pham T, Williams JVA, Bhattarai A, Dores AK, Isherwood LJ, Patten SB. Electronic cigarette use and mental health: A Canadian population-based study. J Affect Disord 2020; 260:646-652. [PMID: 31542558 DOI: 10.1016/j.jad.2019.09.026] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/29/2019] [Accepted: 09/03/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND To examine the association between electronic cigarette (e-cigarette) use and adverse mental health status. METHODS A cross-sectional analysis was conducted using data from the 2015 and 2016 Canadian Community Health Survey (n = 53,050). Sampling weights and associated bootstrap procedures were used to account for survey design effects. Multivariable logistic regression was employed to examine the association between e-cigarette use and the following mental health outcomes: depressive symptom ratings (using the Patient Health Questionnaire 9), self-reported professionally diagnosed mood and anxiety disorders, perceived mental health, suicidal thoughts/attempts, and binge drinking. RESULTS The overall prevalence of past 30-day e-cigarette use was 2.9% (95% CI: 2.6-3.1). 11.5% (95% CI: 10.4-12.7) of smokers reported also using e-cigarettes. Dual users had the highest prevalence of adverse mental health status. The association between e-cigarette use and mental health was found to be modified by smoking status and sex in most of the logistic models. E-cigarettes had less than multiplicative effects among smokers. Female e-cigarette users tended to have higher odds of adverse mental health than male users. Overall, in the multivariable modeling, e-cigarette use was consistently associated with poor mental health among non-smokers and women, a finding that persisted after adjustment for additional covariates. CONCLUSIONS These results indicate that e-cigarette use is associated with adverse mental health status, particularly among the non-smoking general population and women. LIMITATIONS The study relied on respondent self-report, and the cross-sectional nature of the study does not allow us to clarify the direction of this association.
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Affiliation(s)
- Tram Pham
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Jeanne V A Williams
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW Calgary, Alberta T2N 4Z6, Canada.
| | - Asmita Bhattarai
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW Calgary, Alberta T2N 4Z6, Canada.
| | - Ashley K Dores
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW Calgary, Alberta T2N 4Z6, Canada.
| | - Leah J Isherwood
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW Calgary, Alberta T2N 4Z6, Canada.
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW Calgary, Alberta T2N 4Z6, Canada; The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW Calgary, Alberta T2N 4Z6, Canada; The Department of Psychiatry, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW Calgary, Alberta T2N 4N1, Canada; Cuthbertson and Fischer Chair in Pediatric Mental Health, Canada.
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17
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Smith CA, McNeill A, Kock L, Ahmed Z, Shahab L. Mental health professionals' perceptions, judgements and decision-making practices regarding the use of electronic cigarettes as a tobacco harm reduction intervention in mental healthcare: A qualitative focus group study. Addict Behav Rep 2019; 10:100184. [PMID: 31193875 PMCID: PMC6545441 DOI: 10.1016/j.abrep.2019.100184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/24/2019] [Accepted: 04/24/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Smoking prevalence remains significantly higher among individuals with mental health conditions compared with the general population. Tobacco harm reduction (THR) in the form of replacing cigarettes for electronic cigarettes (ECs) is an alternative approach which may prove useful for these smokers who find it difficult to quit. Exploring how mental health professionals' (MHPs) perceive ECs, and how these influence decision making regarding their use in clinical settings is essential to determine the feasibility of incorporating ECs into the treatment pathway. METHODS We conducted six focus groups between March and August 2017. A total of 39 MHPs were recruited from mental healthcare services in England. Discussions were guided by a semi-structured guide, and responses were recorded, transcribed and coded using thematic framework analysis. RESULTS MHPs generally adopt a risk-averse approach when judging the safety and suitability of ECs. Risk-aversion was influenced by perceived obscurity surrounding ECs and THR, as well as high exposure to adverse and unreliable information regarding ECs, and perceived analogies between ECs and conventional cigarettes. Some MHPs adopt a pragmatic approach when making decisions based on THR and EC use in daily practice by considering the context of treatment and patient circumstances. However, this is often accompanied by a high degree of caution and misconceptions which limits the potential benefit this intervention could have in mental healthcare settings. CONCLUSION Improved dissemination of national guidance and scientific literature regarding THR and ECs is essential in mental healthcare to eliminate misconceptions and better inform MHPs evidence-based decision-making practices.
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Affiliation(s)
- Charlie Albert Smith
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Ann McNeill
- National Addiction Centre, King's College London, 4 Windsor Walk, London SE5 8BB, UK
- UK Centre for Tobacco and Alcohol Studies, UK
| | - Loren Kock
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Zoyah Ahmed
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
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18
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Garey L, Smit T, Mayorga NA, Peraza N, Nizio P, Otto MW, Zvolensky MJ. Differential Effects of Anxiety Sensitivity on E-Cigarettes Processes: The Importance of E-Cigarette Quit Attempt History. Am J Addict 2019; 28:390-397. [PMID: 31381212 DOI: 10.1111/ajad.12940] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/21/2019] [Accepted: 07/04/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Electronic cigarettes (e-cigarettes) are recognized as a prevalent form of substance use among adults in the United States. The rise in e-cigarette use has motivated research to identify subgroups of the population that may be particularly vulnerable to e-cigarette use and its associated harm. Individuals with elevated psychological vulnerability are one such group more at risk for being a lifetime or current e-cigarette user. Yet, little is known about how factors of psychological vulnerability relate to perceptions of e-cigarette use within the context of e-cigarette quit attempts. The current study evaluated the differential relations of anxiety sensitivity (AS), a core affective vulnerability factor, on several relevant e-cigarette processes across those with and without a previous attempt to quit using e-cigarettes. METHODS Our sample consisted of 547 current e-cigarette users (51% female, Mage = 35.38 years, SD = 10.1). RESULTS Results indicated that AS significantly related to greater perceived risks, benefits, and positive outcome expectancies of e-cigarette use among current e-cigarette users who reported at least one attempt to quit e-cigarettes but was unrelated among those who had never attempted to quit. DISCUSSION AND CONCLUSIONS Findings identify e-cigarette users who fail to quit as a potential vulnerable subgroup of users who experience more strongly held perceptions about e-cigarettes because of increased AS. SCIENTIFIC SIGNIFICANCE This work provides initial evidence for a conceptual model in which levels of AS and e-cigarette processes are strengthened by and differ across e-cigarette quit attempt history. (Am J Addict 2019;28:390-397).
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Affiliation(s)
- Lorra Garey
- Department of Psychology, University of Houston, Houston, Texas
| | - Tanya Smit
- Department of Psychology, University of Houston, Houston, Texas
| | | | - Natalia Peraza
- Department of Psychology, University of Houston, Houston, Texas
| | - Pamella Nizio
- Department of Psychology, University of Houston, Houston, Texas
| | - Michael W Otto
- Department of Psychology & Brain Sciences, Boston University, Boston, Massachusetts
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, Texas.,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
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19
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Bianco CL, Pratt SI, Ferron JC, Brunette MF. Electronic Cigarette Use During a Randomized Trial of Interventions for Smoking Cessation Among Medicaid Beneficiaries with Mental Illness. J Dual Diagn 2019; 15:184-191. [PMID: 31169077 DOI: 10.1080/15504263.2019.1620400] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: People with mental illness have high rates of cigarette smoking, but many wish to quit. Electronic cigarette (e-cigarette) use has become increasingly common, especially among smokers who wish to quit, but research on whether this facilitates quitting has been mixed, and little research has examined e-cigarette use among smokers with mental illness. This secondary analysis examined the associations between spontaneous e-cigarette use during cessation treatment and 6-month outcomes within a cessation trial among Medicaid beneficiaries with mental illness. Main outcomes were previously reported. Methods: Adult Medicaid beneficiaries receiving mental health services were recruited between 2012 and 2015. Eligible daily smokers were randomized, using equipoise stratification, to one of six cessation treatment conditions (combinations of prescriber visit for pharmacotherapy, behavioral interventions, and abstinence incentives; e-cigarette use was not a recommended intervention). Presence of any self-reported e-cigarette use, all tobacco product use, quit attempts, and biologically verified abstinence were assessed at 3, 6, 9, and 12 months. The 456 participants who completed the 6-month assessment were included in logistic regressions, adjusting for subject characteristics and treatment condition, examining associations between self-reported, spontaneous e-cigarette use and 6-month outcomes. We evaluated three outcomes: biologically verified abstinence at 6 months, quit attempts over the treatment period, and heavy smoking (≥20 cigarettes per day) at 6 months. Results: Any use of e-cigarettes was reported by 192 participants (42.1%) during the treatment period. Use of pharmacotherapy was not different between those who used e-cigarettes and those who did not use e-cigarettes. A total of 13.5% of participants (n = 61) had achieved biologically verified abstinence at the 6-month assessment. E-cigarettes were not significantly associated with biologically verified abstinence, use of cessation pharmacotherapy, self-reported quit attempts, or heavy smoking at the 6-month assessment. Conclusions: Spontaneous e-cigarette use during cessation treatment was common among smokers with mental illness and was not associated with positive or negative treatment outcomes. The high rate of naturalistic e-cigarette use in this group suggests that e-cigarettes are an appealing strategy to obtain nicotine during cessation treatment that could be harnessed as a smoking cessation tool or for harm reduction.
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Affiliation(s)
- Cynthia L Bianco
- Department of Psychiatry, Geisel School of Medicine, Dartmouth , Hanover , NH , USA.,Department of Psychiatry Research, Dartmouth-Hitchcock, Lebanon, NH, USA
| | - Sarah I Pratt
- Department of Psychiatry, Geisel School of Medicine, Dartmouth , Hanover , NH , USA.,Department of Psychiatry Research, Dartmouth-Hitchcock, Lebanon, NH, USA
| | - Joelle C Ferron
- Department of Psychiatry, Geisel School of Medicine, Dartmouth , Hanover , NH , USA.,Department of Psychiatry Research, Dartmouth-Hitchcock, Lebanon, NH, USA
| | - Mary F Brunette
- Department of Psychiatry, Geisel School of Medicine, Dartmouth , Hanover , NH , USA.,Department of Psychiatry Research, Dartmouth-Hitchcock, Lebanon, NH, USA
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20
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E-cigarette nicotine dose and flavor: Relationship with appeal, choice, and tobacco use amongst veterans with comorbid psychiatric disorders. Addict Behav 2019; 92:53-57. [PMID: 30583091 DOI: 10.1016/j.addbeh.2018.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 12/08/2018] [Accepted: 12/10/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Electronic cigarettes (EC) may aid some smokers in reducing combustible tobacco use. Smokers with psychiatric co-morbidities tend to have higher nicotine dependence and worse outcomes, so may particularly benefit from alternative cessation aids. EC characteristics, like nicotine level and flavor, may influence EC's appeal to smokers. Nicotine level may impact EC's efficacy in reducing combustible cigarette use. METHODS Non-treatment-seeking cigarette smokers with medical/psychiatric co-morbidities rated 'liking' of ECs varying in nicotine level (12 mg, 24 mg) and flavor (menthol, 'slim'-tobacco, 'burley'-tobacco), during an open-label Choice Procedure. Smokers (N = 43) chose ECs for a 4-week take-home-trial, and used EC and/or combustible cigarettes as they wished. Analyses examined ratings and choice by nicotine level and flavor, and the relationship between consistent take-home choice of 12 mg versus 24 mg baseline demographic/smoking characteristics, and outcomes (cigarettes/day, nicotine intake, motivation to quit smoking) during take-home-trial and one-month follow-up. RESULTS Smokers who chose menthol-flavor, tobacco-flavor and/or 24 mg nicotine e-liquids for the first take-home week rated these conditions as more 'liked' than alternative options, at baseline. Groups who chose 12 mg versus 24 mg throughout the take-home trial did not significantly differ on baseline characteristics, or smoking-related outcomes within the take-home trial, however, motivation to quit smoking increased more from baseline to one-month follow-up in choosers of higher nicotine (24 mg) ECs. CONCLUSIONS Associations between subjective ratings and subsequent choice support feasibility of open-label choice-procedures in EC trials. Access to 12 mg or 24 mg nicotine ECs was associated with reduced smoking, and 24 mg ECs with increased motivation to quit smoking in smokers with medical/psychiatric co-morbidities.
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21
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Hefner KR, Sollazzo A, Mullaney S, Coker KL, Sofuoglu M. E-cigarettes, alcohol use, and mental health: Use and perceptions of e-cigarettes among college students, by alcohol use and mental health status. Addict Behav 2019; 91:12-20. [PMID: 30396534 PMCID: PMC6358487 DOI: 10.1016/j.addbeh.2018.10.040] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 10/01/2018] [Accepted: 10/28/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Electronic cigarettes (e-cigarettes) are popular among college students, who display risky alcohol use patterns. However, little is known about patterns of co-use of e-cigarettes and alcohol. Further, relationships between e-cigarette use and mental illness among college students are unclear. METHODS College student participants (N = 631) at a northeastern U.S. university were invited via email to participate in a survey about e-cigarettes and alcohol use. Mental health was self-reported diagnosis of psychiatric (depression, bipolar disorder, schizophrenia, PTSD, anxiety disorder, personality disorder), and substance (alcohol and other drug) use disorders. Current use of e-cigarette, combustible cigarette, and other tobacco products were assessed via self-reported past 30-day use frequency. Alcohol consumption was assessed via number of self-reported standard alcoholic beverages consumed during a typical drinking episode. Participants also reported regarding co-use of alcohol, e-cigarettes and/or combustible cigarettes. Participants were categorized as non-drinkers, moderate drinkers or binge drinkers, and associations between e-cigarette use, drinking patterns and mental health diagnoses were examined. RESULTS E-cigarette use was associated with drinking alcohol χ2 = 18.62, p < .001, and binge drinking (vs. moderate drinking) χ2 = 12.20, p < .001. Students who had tried e-cigarettes reported drinking more alcohol per episode (χ2 = 15.94, p < .001). E-cigarette use was more prevalent among those with psychiatric and substance use disorders χ2 = 11.65, p < .001. CONCLUSIONS Drinking college students (especially binge drinkers) and those with mental illness may have heightened risks for e-cigarette use. More research is needed to elucidate relationships between risky alcohol and/or nicotine use and mental illness, and to guide appropriate prevention and intervention efforts for vulnerable college students.
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Affiliation(s)
- Kathryn R Hefner
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, United States; Veterans Health Administration Mental Illness Research, Education and Clinical Center (MIRECC), West Haven, CT, United States; Uniformed Services University of the Health Sciences, Department of Psychiatry, Center for the Study of Traumatic Stress, Bethesda, MD, United States.
| | - Antonietta Sollazzo
- University of New Haven, Department of Psychology, West Haven, CT, United States.
| | - Sean Mullaney
- University of New Haven, Department of Criminal Justice, West Haven, CT, United States.
| | - Kendell L Coker
- University of New Haven, Department of Psychology, West Haven, CT, United States; University of New Haven, Department of Criminal Justice, West Haven, CT, United States.
| | - Mehmet Sofuoglu
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, United States; Veterans Health Administration Mental Illness Research, Education and Clinical Center (MIRECC), West Haven, CT, United States.
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22
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Yang B, Spears CA, Popova L. Psychological distress and responses to comparative risk messages about electronic and combusted cigarettes. Addict Behav 2019; 91:141-148. [PMID: 30477820 DOI: 10.1016/j.addbeh.2018.11.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 11/16/2018] [Accepted: 11/16/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND People with mental illness suffer disproportionately high health burdens of smoking. Communicating to these smokers that electronic cigarettes (e-cigarettes) are a less harmful alternative to combusted cigarettes might help them reduce their health risks by encouraging complete switching to e-cigarettes. However, such messages might also cause unintended consequences (e.g., dual use of both combusted and e-cigarettes). Our study examined how smokers with vs. without serious psychological distress (SPD) responded to messages communicating reduced harm of e-cigarettes in relation to cigarettes. METHOD In an online experiment, 1400 U.S. adult smokers with and without SPD viewed 1 of 6 messages about reduced harm of e-cigarettes compared to cigarettes or a control message. Then participants reported e-cigarette- and cigarette-related beliefs, and behavioral intentions. RESULTS Message type (comparative risk messages vs. control) did not interact with SPD status to produce differential impacts on smokers with and without SPD. Regardless of being exposed to a comparative risk message or a control message, smokers with SPD reported greater perceived absolute risk of e-cigarettes and cigarettes, greater support for tobacco control, greater intentions to switch to e-cigarettes completely and seek help with quitting, and were less likely to report e-cigarettes were less harmful than cigarettes compared to smokers without SPD. DISCUSSION Smokers with SPD had greater intentions to switch to e-cigarettes completely and seek help quitting compared to smokers without SPD, which indicates that smokers with SPD may be optimistic about e-cigarettes to help them quit smoking.
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Affiliation(s)
- Bo Yang
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Claire Adams Spears
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA; Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Lucy Popova
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA; Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA.
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23
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Spears CA, Jones DM, Weaver SR, Yang B, Pechacek TF, Eriksen MP. Electronic nicotine delivery system (ENDS) use in relation to mental health conditions, past-month serious psychological distress and cigarette smoking status, 2017. Addiction 2019; 114:315-325. [PMID: 30291763 PMCID: PMC6314897 DOI: 10.1111/add.14464] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/29/2018] [Accepted: 09/28/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Adults with mental health conditions (MHC) exhibit disproportionately high smoking prevalence and experience profound tobacco-related disparities. US nationally representative surveys from 2012 to 2015 found relatively high usage of electronic nicotine delivery systems (ENDS; e.g. e-cigarettes) among adults with MHC. However, research has not examined these associations specifically among never smokers. Aims were to examine associations among MHC diagnosis, serious psychological distress (SPD) and ENDS use and to test whether associations varied by cigarette smoking status. DESIGN Cross-sectional US nationally representative survey. SETTING United States, 2017. PARTICIPANTS A total of 5762 adults (52.0% female; 64.8% non-Hispanic white, 11.4% non-Hispanic black, 15.9% Hispanic, 7.9% non-Hispanic other). MEASUREMENTS Outcomes were lifetime, current and current daily ENDS use. Predictors were lifetime MHC, past-month SPD and cigarette smoking status, and covariates were gender, age, race/ethnicity, education and annual household income. FINDINGS lifetime MHC and past-month SPD were each associated with higher likelihood of having ever used ENDS (P ≤ 0.001), currently using ENDS (P ≤ 0.001) and currently using ENDS daily (P < 0.05). There were interactions between MHC and smoking status in predicting ENDS use, such that MHC status predicted higher lifetime and current ENDS use specifically among never and current smokers. Never smokers with MHC had 2.62 higher odds [95% confidence interval, (CI) = 1.54, 4.45] of current ENDS use than those without MHC. Among never smokers, those with MHC indicated higher expectations that ENDS would improve relaxation and concentration (P < 0.05). CONCLUSIONS In 2017, US adults with versus without mental health conditions (MHC) were more likely to use electronic nicotine delivery systems (ENDS). In particular, both never and current smokers with MHC reported disproportionately high rates of current ENDS use.
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Affiliation(s)
- Claire Adams Spears
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA,Division of Health Promotion and Behavior, School of Public Health, Georgia State University, Atlanta, GA, USA,Correspondence: Claire Adams Spears, Ph.D., Assistant Professor, Health Promotion and Behavior, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA 30302-3995.
| | - Dina M. Jones
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Scott R. Weaver
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA,Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Bo Yang
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Terry F. Pechacek
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA,Division of Health Management and Policy, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Michael P. Eriksen
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA,Division of Health Management and Policy, School of Public Health, Georgia State University, Atlanta, GA, USA
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Smith PH, Chhipa M, Bystrik J, Roy J, Goodwin RD, McKee SA. Cigarette smoking among those with mental disorders in the US population: 2012-2013 update. Tob Control 2018; 29:29-35. [PMID: 30377242 DOI: 10.1136/tobaccocontrol-2018-054268] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 09/28/2018] [Accepted: 10/03/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Recent nationally representative estimates from the USA suggest the prevalence of cigarette smoking continues to be much higher among those with mental disorders compared with those without; however, prevalence estimates for current cigarette use by specific diagnoses are outdated. METHODS We analysed data from the National Epidemiologic Survey on Alcohol and Related Conditions III (2012-2013). We estimated the prevalence of lifetime and past-year smoking, lifetime and past-year daily smoking, and lifetime smoking cessation among ever smokers (ie, the quit ratio) among those with common mood, anxiety and substance use disorders in comparison to those without these disorders. RESULTS Across disorders, smoking prevalence was higher and the quit ratio was lower among those with common mental disorders compared with those without, with twofold to sixfold relativedifferences in the odds of the magnitude. CONCLUSIONS Despite tobacco control advances since 2000 and resulting declines in smoking prevalence, smoking remains extraordinarily more common among those with mood, anxiety and substance use disorders, with highest rates among those with bipolar and substance use disorders.
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Affiliation(s)
- Philip H Smith
- Department of Kinesiology and Health, Miami University, Oxford, Ohio, USA
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York City, New York, USA
| | - Mohammad Chhipa
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York City, New York, USA
| | - Josef Bystrik
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York City, New York, USA
| | - Jordan Roy
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York City, New York, USA
| | - Renee D Goodwin
- Department of Epidemiology and Biostatistics, School of Public Health, City University of New York, New York City, New York, USA
- Institute for Implementation Science in Population Health, City University of New York, New York City, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York, USA
| | - Sherry A McKee
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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25
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Chang YC, Lee YH, Liu CT, Shelley M. Patterns of e-cigarette use and self-reported health outcomes among smokers and non-smokers in the United States: A preliminary assessment. JOURNAL OF SUBSTANCE USE 2018. [DOI: 10.1080/14659891.2018.1510053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Yen-Chang Chang
- Center for General Education, National Tsing Hua University, Hsinchu City, Taiwan (Republic of China)
| | - Yen-Han Lee
- Department of Applied Health Sciences, Indiana University School of Public Health, Bloomington, Indiana, USA
| | - Ching-Ti Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Mack Shelley
- Department of Political Science, Department of Statistics, Iowa State University College of Liberal Arts and Sciences, Ames, Iowa, USA
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26
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Camenga DR, Tindle HA. Weighing the Risks and Benefits of Electronic Cigarette Use in High-Risk Populations. Med Clin North Am 2018; 102:765-779. [PMID: 29933828 DOI: 10.1016/j.mcna.2018.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This article reviews the current evidence on electronic cigarette (e-cigarette) safety and efficacy for smoking cessation, with a focus on smokers with cardiovascular disease, pulmonary disease, or serious mental illness. In the United States, adult smokers use e-cigarettes primarily to quit or reduce cigarette smoking. An understanding of the potential risks and benefits of e-cigarette use may help clinicians counsel smokers about the potential impact of e-cigarettes on health.
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Affiliation(s)
- Deepa R Camenga
- Yale School of Medicine, 464 Congress Avenue Suite 260, New Haven, CT 06519, USA.
| | - Hilary A Tindle
- Vanderbilt University Medical Center, 2525 West End, Suite 370, Nashville, TN 37203, USA
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27
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Valentine GW, Hefner K, Jatlow PI, Rosenheck RA, Gueorguieva R, Sofuoglu M. Impact of E-cigarettes on Smoking and Related Outcomes in Veteran Smokers With Psychiatric Comorbidity. J Dual Diagn 2018; 14:2-13. [PMID: 29083287 PMCID: PMC7131866 DOI: 10.1080/15504263.2017.1384877] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Compared to the general U.S. population, smokers with comorbid psychiatric and/or substance use disorders have lower quit rates after evidence-based treatments and disproportionately high smoking-related deaths. Improved modalities for reducing tobacco-related harm in this subpopulation are needed. Because electronic cigarettes (e-cigarettes) can now deliver physiologically relevant levels of nicotine to consumers, they represent an additional nicotine delivery system that could be used in cessation interventions. While current data suggest that the use of e-cigarettes by smokers promotes a reduction in combustible cigarette use, smoking quit rates through use of e-cigarettes appears to be low. The goal of this study was to examine impact of e-cigarette use on combustible tobacco use as well as on the readiness to quit smoking and changes in nicotine dependence in a multimorbid population. METHODS We conducted a 4-week, open-label study in 43 military veteran smokers who had no immediate intention to stop smoking and were currently receiving psychiatric services from the Department of Veterans Affairs health care system. Participants were provided with a study e-cigarette they could use ad libitum along with other tobacco products and were encouraged to attend weekly laboratory visits and a one-month follow-up visit. Main outcome measures were number of cigarettes smoked per day (CPD), the frequency of e-cigarette use, the amount of money spent on combustible cigarettes (U.S. dollars/week), alveolar carbon monoxide (CO) levels, and urine cotinine levels. RESULTS Mean e-cigarette use was 5.7 days per week and only 9% of participants used the e-cigarette for fewer than 4 days per week. Significant reductions in breath CO (9.3 ppm to 7.3 ppm, p < .02) and CPD (from 16.6 to 5.7, p < .001) were observed across study weeks, and no serious adverse events were reported. Three participants (10% of completers) reported smoking cessation that was corroborated biochemically. At one-month follow-up, motivation to quit smoking remained significantly higher and the level of nicotine dependence was significantly lower than at baseline. CONCLUSIONS E-cigarettes are acceptable to smokers with psychiatric comorbidities, as indicated by sustained and frequent e-cigarette use by 90% of participants, and may promote reduction and/or cessation of combustible cigarette use. E-cigarettes appear to be a viable harm reduction modality in smokers with psychiatric comorbidities.
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Affiliation(s)
- Gerald W Valentine
- a Department of Psychiatry , Yale School of Medicine , New Haven , Connecticut , USA.,b Veterans Health Administration Mental Illness Research, Education and Clinical Center (MIRECC) , West Haven , Connecticut , USA
| | - Kathryn Hefner
- a Department of Psychiatry , Yale School of Medicine , New Haven , Connecticut , USA.,b Veterans Health Administration Mental Illness Research, Education and Clinical Center (MIRECC) , West Haven , Connecticut , USA
| | - Peter I Jatlow
- a Department of Psychiatry , Yale School of Medicine , New Haven , Connecticut , USA.,c Department of Laboratory Medicine , Yale School of Medicine , New Haven , Connecticut , USA
| | - Robert A Rosenheck
- a Department of Psychiatry , Yale School of Medicine , New Haven , Connecticut , USA.,b Veterans Health Administration Mental Illness Research, Education and Clinical Center (MIRECC) , West Haven , Connecticut , USA
| | - Ralitza Gueorguieva
- d Department of Biostatistics , Yale School of Public Health , New Haven , Connecticut , USA
| | - Mehmet Sofuoglu
- a Department of Psychiatry , Yale School of Medicine , New Haven , Connecticut , USA.,b Veterans Health Administration Mental Illness Research, Education and Clinical Center (MIRECC) , West Haven , Connecticut , USA
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