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Asharani PV, Seet V, Devi F, Wang P, Roystonn K, Subramaniam M. Electronic nicotine delivery systems: prevalence and perception of risk/harm in individuals with mental illness. Singapore Med J 2024; 65:51-56. [PMID: 35851648 PMCID: PMC10863740 DOI: 10.11622/smedj.2022091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 08/09/2021] [Indexed: 11/18/2022]
Affiliation(s)
- PV Asharani
- Research Division, Institute of Mental Health, Singapore
| | - Vanessa Seet
- Research Division, Institute of Mental Health, Singapore
| | - Fiona Devi
- Research Division, Institute of Mental Health, Singapore
| | - Peizhi Wang
- Research Division, Institute of Mental Health, Singapore
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Rajalu BM, Jayarajan D, Muliyala KP, Sharma P, Gandhi S, Chand PK. Development of a Personalized Tobacco Cessation Intervention Package (PTCIP) for Persons with Schizophrenia in India. Indian J Psychol Med 2023; 45:132-138. [PMID: 36925498 PMCID: PMC10011849 DOI: 10.1177/02537176221105581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Among persons with schizophrenia (PwS), tobacco use is higher in comparison to the general population, contributing to greater morbidity and mortality. Pharmacological interventions combined with psychosocial interventions are effective in tobacco cessation. While the effectiveness of extant psychosocial interventions-when used in isolation-seems limited, developing better combinations of interventions could help treatment providers deliver tobacco cessation services to PwS at different stages of motivation to quit. We aimed to develop a personalized tobacco cessation intervention package (PTCIP) for PwS. Methods The stage-based intervention package was developed through a systematic review of interventions for tobacco cessation, the authors' clinical experience, and expert validation. The components of the intervention package, developed for PwS visiting the outpatient psychiatric department, were retained, removed, or added based on the content validity ratio (CVR). Results The final components included brief advice, principles of motivational interviewing, psychoeducation, decisional balance matrix, positive reinforcement, offering various treatment options, personalized feedback using a smoking-risk calculator, and prediction of cardiovascular risk using the WHO package of essential noncommunicable disease (PEN). The delivery of the intervention package was refined based on pilot testing in eight participants. Conclusion The tailored package was designed to be delivered by a mental health professional as a single comprehensive 40 min to 45 min face-to-face session, integrated with routine follow-up visits, followed by two telephonic conversations in the second and third week of the initial session. The package needs to be tested in a randomized controlled trial for its effectiveness.
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Affiliation(s)
- Banu Manickam Rajalu
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Deepak Jayarajan
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Krishna Prasad Muliyala
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Priyamvada Sharma
- Dept. of Clinical Pharmacology and Neurotoxicology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Sailaxmi Gandhi
- Dept. of Nursing, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Prabhat Kumar Chand
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Hartmann-Boyce J, Lindson N, Butler AR, McRobbie H, Bullen C, Begh R, Theodoulou A, Notley C, Rigotti NA, Turner T, Fanshawe TR, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev 2022; 11:CD010216. [PMID: 36384212 PMCID: PMC9668543 DOI: 10.1002/14651858.cd010216.pub7] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Electronic cigarettes (ECs) are handheld electronic vaping devices which produce an aerosol by heating an e-liquid. Some people who smoke use ECs to stop or reduce smoking, although some organizations, advocacy groups and policymakers have discouraged this, citing lack of evidence of efficacy and safety. People who smoke, healthcare providers and regulators want to know if ECs can help people quit smoking, and if they are safe to use for this purpose. This is a review update conducted as part of a living systematic review. OBJECTIVES To examine the effectiveness, tolerability, and safety of using electronic cigarettes (ECs) to help people who smoke tobacco achieve long-term smoking abstinence. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO to 1 July 2022, and reference-checked and contacted study authors. SELECTION CRITERIA: We included randomized controlled trials (RCTs) and randomized cross-over trials, in which people who smoke were randomized to an EC or control condition. We also included uncontrolled intervention studies in which all participants received an EC intervention. Studies had to report abstinence from cigarettes at six months or longer or data on safety markers at one week or longer, or both. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods for screening and data extraction. Our primary outcome measures were abstinence from smoking after at least six months follow-up, adverse events (AEs), and serious adverse events (SAEs). Secondary outcomes included the proportion of people still using study product (EC or pharmacotherapy) at six or more months after randomization or starting EC use, changes in carbon monoxide (CO), blood pressure (BP), heart rate, arterial oxygen saturation, lung function, and levels of carcinogens or toxicants, or both. We used a fixed-effect Mantel-Haenszel model to calculate risk ratios (RRs) with a 95% confidence interval (CI) for dichotomous outcomes. For continuous outcomes, we calculated mean differences. Where appropriate, we pooled data in meta-analyses. MAIN RESULTS We included 78 completed studies, representing 22,052 participants, of which 40 were RCTs. Seventeen of the 78 included studies were new to this review update. Of the included studies, we rated ten (all but one contributing to our main comparisons) at low risk of bias overall, 50 at high risk overall (including all non-randomized studies), and the remainder at unclear risk. There was high certainty that quit rates were higher in people randomized to nicotine EC than in those randomized to nicotine replacement therapy (NRT) (RR 1.63, 95% CI 1.30 to 2.04; I2 = 10%; 6 studies, 2378 participants). In absolute terms, this might translate to an additional four quitters per 100 (95% CI 2 to 6). There was moderate-certainty evidence (limited by imprecision) that the rate of occurrence of AEs was similar between groups (RR 1.02, 95% CI 0.88 to 1.19; I2 = 0%; 4 studies, 1702 participants). SAEs were rare, but there was insufficient evidence to determine whether rates differed between groups due to very serious imprecision (RR 1.12, 95% CI 0.82 to 1.52; I2 = 34%; 5 studies, 2411 participants). There was moderate-certainty evidence, limited by imprecision, that quit rates were higher in people randomized to nicotine EC than to non-nicotine EC (RR 1.94, 95% CI 1.21 to 3.13; I2 = 0%; 5 studies, 1447 participants). In absolute terms, this might lead to an additional seven quitters per 100 (95% CI 2 to 16). There was moderate-certainty evidence of no difference in the rate of AEs between these groups (RR 1.01, 95% CI 0.91 to 1.11; I2 = 0%; 5 studies, 1840 participants). There was insufficient evidence to determine whether rates of SAEs differed between groups, due to very serious imprecision (RR 1.00, 95% CI 0.56 to 1.79; I2 = 0%; 8 studies, 1272 participants). Compared to behavioural support only/no support, quit rates were higher for participants randomized to nicotine EC (RR 2.66, 95% CI 1.52 to 4.65; I2 = 0%; 7 studies, 3126 participants). In absolute terms, this represents an additional two quitters per 100 (95% CI 1 to 3). However, this finding was of very low certainty, due to issues with imprecision and risk of bias. There was some evidence that (non-serious) AEs were more common in people randomized to nicotine EC (RR 1.22, 95% CI 1.12 to 1.32; I2 = 41%, low certainty; 4 studies, 765 participants) and, again, insufficient evidence to determine whether rates of SAEs differed between groups (RR 1.03, 95% CI 0.54 to 1.97; I2 = 38%; 9 studies, 1993 participants). Data from non-randomized studies were consistent with RCT data. The most commonly reported AEs were throat/mouth irritation, headache, cough, and nausea, which tended to dissipate with continued EC use. Very few studies reported data on other outcomes or comparisons, hence evidence for these is limited, with CIs often encompassing clinically significant harm and benefit. AUTHORS' CONCLUSIONS There is high-certainty evidence that ECs with nicotine increase quit rates compared to NRT and moderate-certainty evidence that they increase quit rates compared to ECs without nicotine. Evidence comparing nicotine EC with usual care/no treatment also suggests benefit, but is less certain. More studies are needed to confirm the effect size. Confidence intervals were for the most part wide for data on AEs, SAEs and other safety markers, with no difference in AEs between nicotine and non-nicotine ECs nor between nicotine ECs and NRT. Overall incidence of SAEs was low across all study arms. We did not detect evidence of serious harm from nicotine EC, but longest follow-up was two years and the number of studies was small. The main limitation of the evidence base remains imprecision due to the small number of RCTs, often with low event rates, but further RCTs are underway. To ensure the review continues to provide up-to-date information to decision-makers, this review is a living systematic review. We run searches monthly, with the review updated when relevant new evidence becomes available. Please refer to the Cochrane Database of Systematic Reviews for the review's current status.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ailsa R Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Chris Bullen
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Rachna Begh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Tari Turner
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Pratt SI, Ferron JC, Brunette MF, Santos M, Sargent J, Xie H. E-Cigarette Provision to Promote Switching in Cigarette Smokers With Serious Mental Illness-A Randomized Trial. Nicotine Tob Res 2022; 24:1405-1412. [PMID: 35363874 PMCID: PMC9356685 DOI: 10.1093/ntr/ntac082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 03/16/2022] [Accepted: 03/28/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND High cigarette smoking prevalence and low quit rates in people with serious mental illness (SMI) contribute to disparate rates of chronic disease and premature death. This prospective trial tested the impact of switching to a potentially lower-harm nicotine-containing product on smoking in this population. AIMS AND METHODS A total of 240 cigarette smokers with SMI who tried but were currently unwilling to quit were randomly assigned to receive disposable e-cigarettes for 8 weeks or not, with assessments at baseline, 2, 4, 6, 8, 13, and 26 weeks. Generalized linear mixed models examined the effects of e-cigarette provision on e-cigarette appeal, cigarettes per day (CPD), breath carbon monoxide (CO), nicotine dependence, and side effects. Clinical Trial registration: NCT03050853. RESULTS Self-reported smoking was similar between groups at baseline (mean = 18.7 CPD). By week 2, 79% of the e-cigarette group were using e-cigarettes daily. During weeks 2-8, CPD and CO decreased in the e-cigarette versus assessment-only group (eg, 7.5 CPD [95% CI = 5.9, 9.2] vs. 18.1 CPD [CI = 16.4, 19.8] and 16.4 ppm [CI = 13.4, 19.5] vs. 25.4 ppm [CI = 22.4, 28.9], respectively, at week 2). Additionally, 19%-22% in the e-cigarette group reported smoking no cigarettes in weeks 2-8 compared to 0% in the assessment-only group. By 13 and 26 weeks, group differences in CPD, but not CO, remained significant. Nicotine dependence did not increase and side effects were minor. CONCLUSIONS Providing e-cigarettes for 8 weeks to smokers with SMI resulted in substantial reductions in CPD and CO. Enhancing and maintaining switching from cigarettes to e-cigarettes warrant further study. IMPLICATIONS This was the first prospective study to compare e-cigarette provision with assessments only to evaluate the appeal and impact of e-cigarettes on smoking behavior, carbon monoxide exposure, and nicotine dependence among smokers with SMI who had tried but were unable to quit and were not currently interested in cessation treatment. The finding that e-cigarette provision led to significant reductions in smoking and carbon monoxide without increasing nicotine dependence has implications for reducing harm not only among the millions of smokers with SMI who struggle to quit, but also for other vulnerable smokers who cannot achieve cessation.
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Affiliation(s)
- Sarah I Pratt
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Concord, NH, USA
- C. Everett Koop Institute, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Joelle C Ferron
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Concord, NH, USA
| | - Mary F Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Concord, NH, USA
- C. Everett Koop Institute, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Meghan Santos
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Concord, NH, USA
| | - James Sargent
- C. Everett Koop Institute, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Haiyi Xie
- Department of Biomedical Data Sciences, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Churchill V, Duong HT, Massey ZB, Popova L. Serious Psychological Distress Is Associated with Higher Intentions to Quit among Smokers during the COVID-19 Pandemic. J Psychoactive Drugs 2021; 54:199-206. [PMID: 34930099 DOI: 10.1080/02791072.2021.2013583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
COVID-19 has increased the rates of serious psychological distress (SPD) among the general population. However, the SPD among smokers during the pandemic remains understudied. In a parent study, 1,004 U.S. adult smokers with and without SPD were randomized to view messages about COVID-19 risk, smoking risk, combined COVID-19 and smoking risk, or control. Outcomes were smoking quit intentions and COVID-19 protective behavior intentions. We analyzed the prevalence of SPD among current smokers; the associations between SPD, personal characteristics, and smoking and COVID-19 protective behavioral intentions; and whether SPD moderated the effect of messages about risks of smoking and COVID-19.Thirty-six percent of smokers met the criteria for SPD. Odds of having SPD were higher for older, everyday smokers, who had COVID-19, had poor health and conservative ideology. Smokers with SPD were significantly more likely to report intentions to quit smoking and seek counseling than smokers without SPD, controlling for demographics, readiness to quit, and message condition. SPD was not significantly related to COVID-19 protective intentions. The interactions between SPD and messages were nonsignificant. During the pandemic, smokers with SPD may be motivated to quit smoking, which provides an opportunity for targeted interventions to increase quit attempts.
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Affiliation(s)
| | - Hue Trong Duong
- Department of Communication, Georgia State University, Atlanta, GA, USA
| | | | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, GA, USA
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Hartmann-Boyce J, McRobbie H, Butler AR, Lindson N, Bullen C, Begh R, Theodoulou A, Notley C, Rigotti NA, Turner T, Fanshawe TR, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev 2021; 9:CD010216. [PMID: 34519354 PMCID: PMC8438601 DOI: 10.1002/14651858.cd010216.pub6] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Electronic cigarettes (ECs) are handheld electronic vaping devices which produce an aerosol formed by heating an e-liquid. Some people who smoke use ECs to stop or reduce smoking, but some organizations, advocacy groups and policymakers have discouraged this, citing lack of evidence of efficacy and safety. People who smoke, healthcare providers and regulators want to know if ECs can help people quit and if they are safe to use for this purpose. This is an update conducted as part of a living systematic review. OBJECTIVES To examine the effectiveness, tolerability, and safety of using electronic cigarettes (ECs) to help people who smoke tobacco achieve long-term smoking abstinence. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO to 1 May 2021, and reference-checked and contacted study authors. We screened abstracts from the Society for Research on Nicotine and Tobacco (SRNT) 2021 Annual Meeting. SELECTION CRITERIA: We included randomized controlled trials (RCTs) and randomized cross-over trials, in which people who smoke were randomized to an EC or control condition. We also included uncontrolled intervention studies in which all participants received an EC intervention. Studies had to report abstinence from cigarettes at six months or longer or data on safety markers at one week or longer, or both. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods for screening and data extraction. Our primary outcome measures were abstinence from smoking after at least six months follow-up, adverse events (AEs), and serious adverse events (SAEs). Secondary outcomes included the proportion of people still using study product (EC or pharmacotherapy) at six or more months after randomization or starting EC use, changes in carbon monoxide (CO), blood pressure (BP), heart rate, arterial oxygen saturation, lung function, and levels of carcinogens or toxicants or both. We used a fixed-effect Mantel-Haenszel model to calculate risk ratios (RRs) with a 95% confidence interval (CI) for dichotomous outcomes. For continuous outcomes, we calculated mean differences. Where appropriate, we pooled data in meta-analyses. MAIN RESULTS We included 61 completed studies, representing 16,759 participants, of which 34 were RCTs. Five of the 61 included studies were new to this review update. Of the included studies, we rated seven (all contributing to our main comparisons) at low risk of bias overall, 42 at high risk overall (including all non-randomized studies), and the remainder at unclear risk. There was moderate-certainty evidence, limited by imprecision, that quit rates were higher in people randomized to nicotine EC than in those randomized to nicotine replacement therapy (NRT) (risk ratio (RR) 1.53, 95% confidence interval (CI) 1.21 to 1.93; I2 = 0%; 4 studies, 1924 participants). In absolute terms, this might translate to an additional three quitters per 100 (95% CI 1 to 6). There was low-certainty evidence (limited by very serious imprecision) that the rate of occurrence of AEs was similar (RR 0.98, 95% CI 0.80 to 1.19; I2 = 0%; 2 studies, 485 participants). SAEs were rare, but there was insufficient evidence to determine whether rates differed between groups due to very serious imprecision (RR 1.30, 95% CI 0.89 to 1.90: I2 = 0; 4 studies, 1424 participants). There was moderate-certainty evidence, again limited by imprecision, that quit rates were higher in people randomized to nicotine EC than to non-nicotine EC (RR 1.94, 95% CI 1.21 to 3.13; I2 = 0%; 5 studies, 1447 participants). In absolute terms, this might lead to an additional seven quitters per 100 (95% CI 2 to 16). There was moderate-certainty evidence of no difference in the rate of AEs between these groups (RR 1.01, 95% CI 0.91 to 1.11; I2 = 0%; 3 studies, 601 participants). There was insufficient evidence to determine whether rates of SAEs differed between groups, due to very serious imprecision (RR 1.06, 95% CI 0.47 to 2.38; I2 = 0; 5 studies, 792 participants). Compared to behavioural support only/no support, quit rates were higher for participants randomized to nicotine EC (RR 2.61, 95% CI 1.44 to 4.74; I2 = 0%; 6 studies, 2886 participants). In absolute terms this represents an additional six quitters per 100 (95% CI 2 to 15). However, this finding was of very low certainty, due to issues with imprecision and risk of bias. There was some evidence that non-serious AEs were more common in people randomized to nicotine EC (RR 1.22, 95% CI 1.12 to 1.32; I2 = 41%, low certainty; 4 studies, 765 participants), and again, insufficient evidence to determine whether rates of SAEs differed between groups (RR 1.51, 95% CI 0.70 to 3.24; I2 = 0%; 7 studies, 1303 participants). Data from non-randomized studies were consistent with RCT data. The most commonly reported AEs were throat/mouth irritation, headache, cough, and nausea, which tended to dissipate with continued use. Very few studies reported data on other outcomes or comparisons, hence evidence for these is limited, with CIs often encompassing clinically significant harm and benefit. AUTHORS' CONCLUSIONS There is moderate-certainty evidence that ECs with nicotine increase quit rates compared to NRT and compared to ECs without nicotine. Evidence comparing nicotine EC with usual care/no treatment also suggests benefit, but is less certain. More studies are needed to confirm the effect size. Confidence intervals were for the most part wide for data on AEs, SAEs and other safety markers, with no difference in AEs between nicotine and non-nicotine ECs. Overall incidence of SAEs was low across all study arms. We did not detect evidence of harm from nicotine EC, but longest follow-up was two years and the number of studies was small. The main limitation of the evidence base remains imprecision due to the small number of RCTs, often with low event rates, but further RCTs are underway. To ensure the review continues to provide up-to-date information to decision-makers, this review is now a living systematic review. We run searches monthly, with the review updated when relevant new evidence becomes available. Please refer to the Cochrane Database of Systematic Reviews for the review's current status.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Ailsa R Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Chris Bullen
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Rachna Begh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Tari Turner
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Hartmann-Boyce J, McRobbie H, Lindson N, Bullen C, Begh R, Theodoulou A, Notley C, Rigotti NA, Turner T, Butler AR, Fanshawe TR, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev 2021; 4:CD010216. [PMID: 33913154 PMCID: PMC8092424 DOI: 10.1002/14651858.cd010216.pub5] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Electronic cigarettes (ECs) are handheld electronic vaping devices which produce an aerosol formed by heating an e-liquid. Some people who smoke use ECs to stop or reduce smoking, but some organizations, advocacy groups and policymakers have discouraged this, citing lack of evidence of efficacy and safety. People who smoke, healthcare providers and regulators want to know if ECs can help people quit and if they are safe to use for this purpose. This is an update of a review first published in 2014. OBJECTIVES To examine the effectiveness, tolerability, and safety of using electronic cigarettes (ECs) to help people who smoke achieve long-term smoking abstinence. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO to 1 February 2021, together with reference-checking and contact with study authors. SELECTION CRITERIA We included randomized controlled trials (RCTs) and randomized cross-over trials in which people who smoke were randomized to an EC or control condition. We also included uncontrolled intervention studies in which all participants received an EC intervention. To be included, studies had to report abstinence from cigarettes at six months or longer and/or data on adverse events (AEs) or other markers of safety at one week or longer. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods for screening and data extraction. Our primary outcome measures were abstinence from smoking after at least six months follow-up, adverse events (AEs), and serious adverse events (SAEs). Secondary outcomes included changes in carbon monoxide, blood pressure, heart rate, blood oxygen saturation, lung function, and levels of known carcinogens/toxicants. We used a fixed-effect Mantel-Haenszel model to calculate the risk ratio (RR) with a 95% confidence interval (CI) for dichotomous outcomes. For continuous outcomes, we calculated mean differences. Where appropriate, we pooled data from these studies in meta-analyses. MAIN RESULTS We included 56 completed studies, representing 12,804 participants, of which 29 were RCTs. Six of the 56 included studies were new to this review update. Of the included studies, we rated five (all contributing to our main comparisons) at low risk of bias overall, 41 at high risk overall (including the 25 non-randomized studies), and the remainder at unclear risk. There was moderate-certainty evidence, limited by imprecision, that quit rates were higher in people randomized to nicotine EC than in those randomized to nicotine replacement therapy (NRT) (risk ratio (RR) 1.69, 95% confidence interval (CI) 1.25 to 2.27; I2 = 0%; 3 studies, 1498 participants). In absolute terms, this might translate to an additional four successful quitters per 100 (95% CI 2 to 8). There was low-certainty evidence (limited by very serious imprecision) that the rate of occurrence of AEs was similar) (RR 0.98, 95% CI 0.80 to 1.19; I2 = 0%; 2 studies, 485 participants). SAEs occurred rarely, with no evidence that their frequency differed between nicotine EC and NRT, but very serious imprecision led to low certainty in this finding (RR 1.37, 95% CI 0.77 to 2.41: I2 = n/a; 2 studies, 727 participants). There was moderate-certainty evidence, again limited by imprecision, that quit rates were higher in people randomized to nicotine EC than to non-nicotine EC (RR 1.70, 95% CI 1.03 to 2.81; I2 = 0%; 4 studies, 1057 participants). In absolute terms, this might again lead to an additional four successful quitters per 100 (95% CI 0 to 11). These trials mainly used older EC with relatively low nicotine delivery. There was moderate-certainty evidence of no difference in the rate of AEs between these groups (RR 1.01, 95% CI 0.91 to 1.11; I2 = 0%; 3 studies, 601 participants). There was insufficient evidence to determine whether rates of SAEs differed between groups, due to very serious imprecision (RR 0.60, 95% CI 0.15 to 2.44; I2 = n/a; 4 studies, 494 participants). Compared to behavioral support only/no support, quit rates were higher for participants randomized to nicotine EC (RR 2.70, 95% CI 1.39 to 5.26; I2 = 0%; 5 studies, 2561 participants). In absolute terms this represents an increase of seven per 100 (95% CI 2 to 17). However, this finding was of very low certainty, due to issues with imprecision and risk of bias. There was no evidence that the rate of SAEs differed, but some evidence that non-serious AEs were more common in people randomized to nicotine EC (AEs: RR 1.22, 95% CI 1.12 to 1.32; I2 = 41%, low certainty; 4 studies, 765 participants; SAEs: RR 1.17, 95% CI 0.33 to 4.09; I2 = 5%; 6 studies, 1011 participants, very low certainty). Data from non-randomized studies were consistent with RCT data. The most commonly reported AEs were throat/mouth irritation, headache, cough, and nausea, which tended to dissipate with continued use. Very few studies reported data on other outcomes or comparisons and hence evidence for these is limited, with confidence intervals often encompassing clinically significant harm and benefit. AUTHORS' CONCLUSIONS There is moderate-certainty evidence that ECs with nicotine increase quit rates compared to ECs without nicotine and compared to NRT. Evidence comparing nicotine EC with usual care/no treatment also suggests benefit, but is less certain. More studies are needed to confirm the size of effect, particularly when using modern EC products. Confidence intervals were for the most part wide for data on AEs, SAEs and other safety markers, though evidence indicated no difference in AEs between nicotine and non-nicotine ECs. Overall incidence of SAEs was low across all study arms. We did not detect any clear evidence of harm from nicotine EC, but longest follow-up was two years and the overall number of studies was small. The evidence is limited mainly by imprecision due to the small number of RCTs, often with low event rates. Further RCTs are underway. To ensure the review continues to provide up-to-date information, this review is now a living systematic review. We run searches monthly, with the review updated when relevant new evidence becomes available. Please refer to the Cochrane Database of Systematic Reviews for the review's current status.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Chris Bullen
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Rachna Begh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Tari Turner
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Ailsa R Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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8
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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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9
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Wang RJ, Bhadriraju S, Glantz SA. E-Cigarette Use and Adult Cigarette Smoking Cessation: A Meta-Analysis. Am J Public Health 2021; 111:230-246. [PMID: 33351653 PMCID: PMC7811087 DOI: 10.2105/ajph.2020.305999] [Citation(s) in RCA: 184] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 01/01/2023]
Abstract
Objectives. To determine the association between e-cigarette use and smoking cessation.Methods. We searched PubMed, Web of Science Core Collection, and EMBASE and computed the association of e-cigarette use with quitting cigarettes using random effects meta-analyses.Results. We identified 64 papers (55 observational studies and 9 randomized clinical trials [RCTs]). In observational studies of all adult smokers (odds ratio [OR] = 0.947; 95% confidence interval [CI] = 0.772, 1.160) and smokers motivated to quit smoking (OR = 0.851; 95% CI = 0.684, 1.057), e-cigarette consumer product use was not associated with quitting. Daily e-cigarette use was associated with more quitting (OR = 1.529; 95% CI = 1.158, 2.019) and less-than-daily use was associated with less quitting (OR = 0.514; 95% CI = 0.402, 0.665). The RCTs that compared quitting among smokers who were provided e-cigarettes to smokers with conventional therapy found e-cigarette use was associated with more quitting (relative risk = 1.555; 95% CI = 1.173, 2.061).Conclusions. As consumer products, in observational studies, e-cigarettes were not associated with increased smoking cessation in the adult population. In RCTs, provision of free e-cigarettes as a therapeutic intervention was associated with increased smoking cessation.Public Health Implications. E-cigarettes should not be approved as consumer products but may warrant consideration as a prescription therapy.
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Affiliation(s)
- Richard J Wang
- Richard J. Wang and Sudhamayi Bhadriraju were initially postdoctoral fellows in the Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California San Francisco; Richard J. Wang subsequently joined the faculty as an assistant professor of medicine, and Sudhamayi Bhadriraju joined the pulmonary medicine staff at the Kaiser Permanente Medical Center, Redwood City, CA. Stanton A. Glantz was professor of medicine and director of the Center for Tobacco Control Research and Education at the University of California San Francisco
| | - Sudhamayi Bhadriraju
- Richard J. Wang and Sudhamayi Bhadriraju were initially postdoctoral fellows in the Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California San Francisco; Richard J. Wang subsequently joined the faculty as an assistant professor of medicine, and Sudhamayi Bhadriraju joined the pulmonary medicine staff at the Kaiser Permanente Medical Center, Redwood City, CA. Stanton A. Glantz was professor of medicine and director of the Center for Tobacco Control Research and Education at the University of California San Francisco
| | - Stanton A Glantz
- Richard J. Wang and Sudhamayi Bhadriraju were initially postdoctoral fellows in the Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California San Francisco; Richard J. Wang subsequently joined the faculty as an assistant professor of medicine, and Sudhamayi Bhadriraju joined the pulmonary medicine staff at the Kaiser Permanente Medical Center, Redwood City, CA. Stanton A. Glantz was professor of medicine and director of the Center for Tobacco Control Research and Education at the University of California San Francisco
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10
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Kanniah G, Kumar S, Prasad S. E-cigarettes and vaping - a panacea or a bane to smoking in current times? Australas Psychiatry 2021; 29:7-9. [PMID: 32838540 DOI: 10.1177/1039856220950095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Use of electronic cigarettes has increased across the world in the last decade with heavy investment from the tobacco industry targeting younger population through well-designed marketing campaigns portraying e-cigarettes as harmless, less addictive and effective in smoking cessation while delivering higher nicotine concentration. The safety profile of e-cigarettes is reviewed in this paper. CONCLUSIONS The safety of e-cigarettes and the chemicals they contain have not been evaluated rigorously. Emerging data suggest e-cigarette use could do severe harm. People with serious mental illness, already the highest nicotine consumers, could be exploited by the tobacco industry.
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Affiliation(s)
- Guna Kanniah
- Mental Health and Addictions Services, Waikato Hospital, New Zealand
| | - Shailesh Kumar
- Midland Regional Forensic Psychiatric Service, New Zealand.,University of Auckland, New Zealand
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11
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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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12
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Hartmann-Boyce J, McRobbie H, Lindson N, Bullen C, Begh R, Theodoulou A, Notley C, Rigotti NA, Turner T, Butler AR, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev 2020; 10:CD010216. [PMID: 33052602 PMCID: PMC8094228 DOI: 10.1002/14651858.cd010216.pub4] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Electronic cigarettes (ECs) are handheld electronic vaping devices which produce an aerosol formed by heating an e-liquid. People who smoke report using ECs to stop or reduce smoking, but some organisations, advocacy groups and policymakers have discouraged this, citing lack of evidence of efficacy and safety. People who smoke, healthcare providers and regulators want to know if ECs can help people quit and if they are safe to use for this purpose. This review is an update of a review first published in 2014. OBJECTIVES To evaluate the effect and safety of using electronic cigarettes (ECs) to help people who smoke achieve long-term smoking abstinence. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO for relevant records to January 2020, together with reference-checking and contact with study authors. SELECTION CRITERIA We included randomized controlled trials (RCTs) and randomized cross-over trials in which people who smoke were randomized to an EC or control condition. We also included uncontrolled intervention studies in which all participants received an EC intervention. To be included, studies had to report abstinence from cigarettes at six months or longer and/or data on adverse events (AEs) or other markers of safety at one week or longer. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods for screening and data extraction. Our primary outcome measures were abstinence from smoking after at least six months follow-up, AEs, and serious adverse events (SAEs). Secondary outcomes included changes in carbon monoxide, blood pressure, heart rate, blood oxygen saturation, lung function, and levels of known carcinogens/toxicants. We used a fixed-effect Mantel-Haenszel model to calculate the risk ratio (RR) with a 95% confidence interval (CI) for dichotomous outcomes. For continuous outcomes, we calculated mean differences. Where appropriate, we pooled data from these studies in meta-analyses. MAIN RESULTS We include 50 completed studies, representing 12,430 participants, of which 26 are RCTs. Thirty-five of the 50 included studies are new to this review update. Of the included studies, we rated four (all which contribute to our main comparisons) at low risk of bias overall, 37 at high risk overall (including the 24 non-randomized studies), and the remainder at unclear risk. There was moderate-certainty evidence, limited by imprecision, that quit rates were higher in people randomized to nicotine EC than in those randomized to nicotine replacement therapy (NRT) (risk ratio (RR) 1.69, 95% confidence interval (CI) 1.25 to 2.27; I2 = 0%; 3 studies, 1498 participants). In absolute terms, this might translate to an additional four successful quitters per 100 (95% CI 2 to 8). There was low-certainty evidence (limited by very serious imprecision) of no difference in the rate of adverse events (AEs) (RR 0.98, 95% CI 0.80 to 1.19; I2 = 0%; 2 studies, 485 participants). SAEs occurred rarely, with no evidence that their frequency differed between nicotine EC and NRT, but very serious imprecision led to low certainty in this finding (RR 1.37, 95% CI 0.77 to 2.41: I2 = n/a; 2 studies, 727 participants). There was moderate-certainty evidence, again limited by imprecision, that quit rates were higher in people randomized to nicotine EC than to non-nicotine EC (RR 1.71, 95% CI 1.00 to 2.92; I2 = 0%; 3 studies, 802 participants). In absolute terms, this might again lead to an additional four successful quitters per 100 (95% CI 0 to 12). These trials used EC with relatively low nicotine delivery. There was low-certainty evidence, limited by very serious imprecision, that there was no difference in the rate of AEs between these groups (RR 1.00, 95% CI 0.73 to 1.36; I2 = 0%; 2 studies, 346 participants). There was insufficient evidence to determine whether rates of SAEs differed between groups, due to very serious imprecision (RR 0.25, 95% CI 0.03 to 2.19; I2 = n/a; 4 studies, 494 participants). Compared to behavioural support only/no support, quit rates were higher for participants randomized to nicotine EC (RR 2.50, 95% CI 1.24 to 5.04; I2 = 0%; 4 studies, 2312 participants). In absolute terms this represents an increase of six per 100 (95% CI 1 to 14). However, this finding was very low-certainty, due to issues with imprecision and risk of bias. There was no evidence that the rate of SAEs varied, but some evidence that non-serious AEs were more common in people randomized to nicotine EC (AEs: RR 1.17, 95% CI 1.04 to 1.31; I2 = 28%; 3 studies, 516 participants; SAEs: RR 1.33, 95% CI 0.25 to 6.96; I2 = 17%; 5 studies, 842 participants). Data from non-randomized studies were consistent with RCT data. The most commonly reported AEs were throat/mouth irritation, headache, cough, and nausea, which tended to dissipate over time with continued use. Very few studies reported data on other outcomes or comparisons and hence evidence for these is limited, with confidence intervals often encompassing clinically significant harm and benefit. AUTHORS' CONCLUSIONS There is moderate-certainty evidence that ECs with nicotine increase quit rates compared to ECs without nicotine and compared to NRT. Evidence comparing nicotine EC with usual care/no treatment also suggests benefit, but is less certain. More studies are needed to confirm the degree of effect, particularly when using modern EC products. Confidence intervals were wide for data on AEs, SAEs and other safety markers. Overall incidence of SAEs was low across all study arms. We did not detect any clear evidence of harm from nicotine EC, but longest follow-up was two years and the overall number of studies was small. The main limitation of the evidence base remains imprecision due to the small number of RCTs, often with low event rates. Further RCTs are underway. To ensure the review continues to provide up-to-date information for decision-makers, this review is now a living systematic review. We will run searches monthly from December 2020, with the review updated as relevant new evidence becomes available. Please refer to the Cochrane Database of Systematic Reviews for the review's current status.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Chris Bullen
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Rachna Begh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Tari Turner
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Ailsa R Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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13
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McDonald CF, Jones S, Beckert L, Bonevski B, Buchanan T, Bozier J, Carson‐Chahhoud KV, Chapman DG, Dobler CC, Foster JM, Hamor P, Hodge S, Holmes PW, Larcombe AN, Marshall HM, McCallum GB, Miller A, Pattemore P, Roseby R, See HV, Stone E, Thompson BR, Ween MP, Peters MJ. Electronic cigarettes: A position statement from the Thoracic Society of Australia and New Zealand. Respirology 2020; 25:1082-1089. [PMID: 32713105 PMCID: PMC7540297 DOI: 10.1111/resp.13904] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/08/2020] [Accepted: 06/11/2020] [Indexed: 02/06/2023]
Abstract
The TSANZ develops position statements where insufficient data exist to write formal clinical guidelines. In 2018, the TSANZ addressed the question of potential benefits and health impacts of electronic cigarettes (EC). The working party included groups focused on health impacts, smoking cessation, youth issues and priority populations. The 2018 report on the Public Health Consequences of E-Cigarettes from the United States NASEM was accepted as reflective of evidence to mid-2017. A search for papers subsequently published in peer-reviewed journals was conducted in August 2018. A small number of robust and important papers published until March 2019 were also identified and included. Groups identified studies that extended, modified or contradicted the NASEM report. A total of 3793 papers were identified and reviewed, with summaries and draft position statements developed and presented to TSANZ membership in April 2019. After feedback from members and external reviewers, a collection of position statements was finalized in December 2019. EC have adverse lung effects and harmful effects of long-term use are unknown. EC are unsuitable consumer products for recreational use, part-substitution for smoking or long-term exclusive use by former smokers. Smokers who require support to quit smoking should be directed towards approved medication in conjunction with behavioural support as having the strongest evidence for efficacy and safety. No specific EC product can be recommended as effective and safe for smoking cessation. Smoking cessation claims in relation to EC should be assessed by established regulators.
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14
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Payne TJ, Hart JL, Giachello AL, Walker KL, Wang W, Groom A, Sims M, Sears CG, Lee AS, Tompkins LK, Kesh A, Robb K, Robertson RM. Tobacco perceptions and practices: User groups and demographic characteristics, Mississippi, USA. POPULATION MEDICINE 2020; 2. [PMID: 33521651 DOI: 10.18332/popmed/127236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Despite decreases in the overall US smoking rate, tobacco use remains more common in some areas and by some groups. Deeper understanding of group differences is needed in order to tailor public health campaigns to the interests, perceptions and experiences of targeted audiences. Although some differences have been identified across African American and Caucasian smokers in the United States, additional insight is needed regarding factors that differentiate these groups. This study examined tobacco-related perceptions and practices, with an emphasis on identifying differences across African American and Caucasian smokers. Toward this goal, we examined key demographic variables of race and age, and tobacco use characteristics. METHODS The sample consisted of 284 people from the Jackson, Mississippi area who participated in focus groups and completed surveys addressing a variety of tobacco-related topics, including knowledge and perceptions of products as well as use and health information seeking behavior. The selection criteria and recruitment approach ensured a balance across race (black, white), age (18-34, >35 years), sex, and cigarette smoking status (current, former, never). Statistical analyses were performed using SAS (v.9.4). RESULTS Differences were observed across demographic subgroups regarding type and pattern of tobacco products used (e.g. mentholated, markers of nicotine dependence, hookah). Differences in preferred sources of health information based on age as well as perceptions of risk as a function of age, smoking status and race were also noted. Exposure to secondhand smoke and perceptions of its risks, quitting efforts and cessation methods differed by race. CONCLUSIONS Study findings suggest key differences across important subgroups. Knowledge of such differences has the potential to improve strategic public health messaging, allowing health campaigns to more effectively prevent tobacco product uptake as well as promote interest in quitting tobacco.
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Affiliation(s)
- Thomas J Payne
- Department of Otolaryngology-Head and Neck Surgery, University of Mississippi Medical Center, Jackson, United States.,American Heart Association Tobacco Center for Regulatory Science, Dallas, United States
| | - Joy L Hart
- American Heart Association Tobacco Center for Regulatory Science, Dallas, United States.,Department of Communication, University of Louisville, Louisville, United States
| | - Aida L Giachello
- American Heart Association Tobacco Center for Regulatory Science, Dallas, United States.,Department of Preventative Medicine, Northwestern University, Chicago, United States
| | - Kandi L Walker
- American Heart Association Tobacco Center for Regulatory Science, Dallas, United States.,Department of Communication, University of Louisville, Louisville, United States
| | - Wei Wang
- U.S. Food and Drug Administration, Silver Spring, United States
| | - Allison Groom
- American Heart Association Tobacco Center for Regulatory Science, Dallas, United States.,Customer and Marketing Research, American Heart Association, Dallas, United States
| | - Mario Sims
- American Heart Association Tobacco Center for Regulatory Science, Dallas, United States.,Department of Medicine, University of Mississippi Medical Center, Jackson, United States
| | - Clara G Sears
- American Heart Association Tobacco Center for Regulatory Science, Dallas, United States.,Department of Communication, University of Louisville, Louisville, United States
| | - Alexander S Lee
- American Heart Association Tobacco Center for Regulatory Science, Dallas, United States.,Department of Communication, University of Louisville, Louisville, United States
| | - Lindsay K Tompkins
- American Heart Association Tobacco Center for Regulatory Science, Dallas, United States.,Department of Communication, University of Louisville, Louisville, United States
| | - Anshula Kesh
- American Heart Association Tobacco Center for Regulatory Science, Dallas, United States.,Office of Science Operations, American Heart Association, Dallas, United States
| | - Karen Robb
- American Heart Association Tobacco Center for Regulatory Science, Dallas, United States.,Customer and Marketing Research, American Heart Association, Dallas, United States
| | - Rose M Robertson
- American Heart Association Tobacco Center for Regulatory Science, Dallas, United States.,Science and Medicine Office, American Heart Association, Dallas, United States
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15
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Peckham E, Mishu M, Fairhurst C, Robson D, Bradshaw T, Arundel C, Bailey D, Heron P, Ker S, Gilbody S. E-cigarette use and associated factors among smokers with severe mental illness. Addict Behav 2020; 108:106456. [PMID: 32388396 DOI: 10.1016/j.addbeh.2020.106456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/08/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Smoking is more prevalent among people with severe mental illness (SMI) than the general population. E-cigarettes could provide an effective means of helping people to quit smoking. The aim of this paper is to explore the use of e-cigarettes and factors related to their use in people smokers with SMI. METHODS This is a cross sectional study including adult smokers with a documented diagnosis of SMI (ICD-10) recruited to the SCIMITAR + trial (2015-2016) from primary and secondary care. At baseline, participants were asked for demographic information and about their use of e-cigarettes. Data was were analysed to explore factors associated with e-cigarette use. After testing bivariate associations, logistic regressions were conducted. RESULTS Among 526 participants, 58.7% were male, mean age 46 years (SD 12.1), the majority (70.3%) had tried an e-cigarette. Among those who had ever tried an e-cigarette, over half (54.6%) reported the reason was to quit smoking, while 13.9% reported that the reason was to reduce smoking. Having an educational qualification of GCSE or higher (odds ratio 2.17, 95% CI 1.22 to 3.86, p = 0.008) and having made a quit attempt in the past six months (OR 1.66, 95% CI 1.04 to 2.63, p = 0.032) was associated with ever having tried an e-cigarette. CONCLUSIONS Ever use of an e-cigarette was associated with education levels and recent quit attempts. Future trials could explore the effectiveness of e-cigarettes as a cessation aid in this participant group.
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Affiliation(s)
- Emily Peckham
- Department of Health Sciences, University of York, Heslington YO10 5DD, UK.
| | - Masuma Mishu
- Department of Health Sciences, University of York, Heslington YO10 5DD, UK
| | - Caroline Fairhurst
- Department of Health Sciences, University of York, Heslington YO10 5DD, UK
| | - Deborah Robson
- Institute of Psychiatry, Psychology and Neuroscience, King'S College London, Denmark Hill, London, UK
| | - Tim Bradshaw
- School of Health Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Catherine Arundel
- Department of Health Sciences, University of York, Heslington YO10 5DD, UK
| | - Della Bailey
- Department of Health Sciences, University of York, Heslington YO10 5DD, UK
| | - Paul Heron
- Department of Health Sciences, University of York, Heslington YO10 5DD, UK
| | - Suzy Ker
- Tees, Esk and Wear Valleys NHS Foundation Trust, Huntington, York YO32 9XW, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, Heslington YO10 5DD, UK
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16
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Narcisse MR, Dobbs P, Long CR, Purvis RS, Kimminau KS, McElfish PA. Electronic cigarette use and psychological distress in the Native Hawaiian and Pacific Islander adults compared with other racial/ethnic groups: Data from the National Health Interview Survey, 2014. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:225-236. [PMID: 31535719 PMCID: PMC9284937 DOI: 10.1002/jcop.22248] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 08/22/2019] [Accepted: 08/30/2019] [Indexed: 06/10/2023]
Abstract
Document the prevalence of electronic cigarette (E-cigarette) use among the native Hawaiian and other Pacific Islander (NHPI) adults compared with other racial/ethnic groups, and examine associations between psychological distress and E-cigarette use. 2014 National Health Interview Survey (NHIS) and 2014 NHPI-NHIS were combined for comparisons. Data were analyzed using descriptive statistics, Rao-Scott χ2 test, and multivariable logistic regression. E-cigarette use among NHPI (5.6%) was significantly higher than among Blacks (2.1%), Hispanics (2.2%), and Asians (1.7%; p < .001). NHPI with Kessler 6 (K6) score of 11-24 had greater odds of using E-cigarettes (odds ratio [OR]: 3.90; 95% confidence intervals [CI]: 1.81-8.42) as compared to those with a K6 score of 0. Associations between having a K6 score of 11-24 and using E-cigarettes were also found for Whites (OR: 3.49; CI: 2.44-4.99), Asians (OR: 5.29; CI: 1.29-21.70), and Hispanics (OR: 6.14; CI: 2.72-13.83). E-cigarette use was higher among NHPI relative to other racial/ethnic groups. NHPI with K6 score of 11-24 had greater odds of using E-cigarettes as compared to those with a K6 score of 0. Policies and strategies to reduce E-cigarette use among NHPI should give careful consideration to the associations between E-cigarette use and psychological distress in the NHPI population.
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Affiliation(s)
- Marie-Rachelle Narcisse
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR 72703
| | - Page Dobbs
- College of Arts and Sciences, Department of Health and Exercise Science, The University of Oklahoma, 1401 Asp Ave., Room 118 Norman, OK 73019
| | - Christopher R. Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR 72703
| | - Rachel S. Purvis
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR 72703
| | - Kim S. Kimminau
- Department of Family Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 North College Avenue, Fayetteville, AR 72703
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Bold KW, Krishnan-Sarin S, Stoney CM. E-cigarette use as a potential cardiovascular disease risk behavior. ACTA ACUST UNITED AC 2019; 73:955-967. [PMID: 30394775 DOI: 10.1037/amp0000231] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Electronic cigarette (e-cigarette) use is rapidly increasing among youth and adults despite limited information regarding the long-term risks or benefits. The potential impact of e-cigarette use on public health is complex. E-cigarettes are sometimes considered as smoking cessation aids and, to the extent that they are successful in this regard, could have a net population benefit for adult smokers. However, limited knowledge exists about the long-term health effects of e-cigarette use, and research has suggested these novel tobacco products may lead to initiation and continued use among vulnerable populations, including youth. The current review aimed to summarize trends and available scientific information about e-cigarette use, focusing on the potential cardiovascular health risks and benefits, characteristics associated with e-cigarette use, and critical areas for future investigation to inform the research and clinical work of psychologists. Psychologists have a leadership role in mitigating health risks from smoking behavior, and there is a need for rigorous research assessing the impact of e-cigarette use on population health. In addition, psychologists are uniquely qualified to understand the underlying processes regarding decision-making and behaviors around e-cigarette use. Collectively, the research of psychologists in this area can have a substantial impact on patient education, policies, and the development of prevention and intervention programs to promote public health. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- Krysten W Bold
- Department of Psychiatry, Yale University School of Medicine
| | | | - Catherine M Stoney
- Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health
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Patil S, Arakeri G, Patil S, Ali Baeshen H, Raj T, Sarode SC, Sarode GS, Awan KH, Gomez R, Brennan PA. Are electronic nicotine delivery systems (ENDs) helping cigarette smokers quit?-Current evidence. J Oral Pathol Med 2019; 49:181-189. [PMID: 31642553 DOI: 10.1111/jop.12966] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Electronic cigarettes (e-cigarettes) and other electronic vaping devices are commonly used as a method to help tobacco smoking cessation. However, the data on their safety and efficacy are currently scarce. The aim of this review was to explore the role of e-cigarettes in tobacco cessation among tobacco users. TYPES OF STUDIES REVIEWED PubMed, EMBASE, Scopus, Web of Science, and grey literature from January 1990 were searched up to and including September 2018. Two independent reviewers performed the study selection according to eligibility criteria. RESULTS A total of 13 studies that met the eligibility criteria were included. The majority of studies were done in the USA, and all studies were longitudinal cohort studies. The odds of increased smoking cessation in association with e-cigarette use ranged from onefold to sixfolds. No significant increase in smoking cessation was found among e-cigarette users compared with non-e-cigarette users. Pattern of e-cigarette had positive influence on smoking cessation among users. CONCLUSIONS AND PRACTICAL IMPLICATIONS E-cigarette use was not significantly associated with increased smoking cessation among cigarette smokers. We also found that pattern of e-cigarette may have significant effect on smoking cessation capability of e-cigarettes. Well-designed randomized controlled clinical trials are needed to assess the clinical efficacy of e-cigarettes in comparison with approved smoking cessation therapies.
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Affiliation(s)
- Shankargouda Patil
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Gururaj Arakeri
- Department of Oral and Maxillofacial surgery, Navodaya Dental College and Hospital, Raichur, karnataka, India
| | - Shekar Patil
- Department of Medical Oncology, HCG Cancer Hospital, Bangalore, karnataka, India
| | - Hosam Ali Baeshen
- Department of Orthodontics, College of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Thirumal Raj
- Department of Oral Pathology and Microbiology, Sri Venkateswara Dental College and Hospital, Chennai, India
| | - Sachin C Sarode
- Department of Oral Pathology and Microbiology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Gargi S Sarode
- Department of Oral Pathology and Microbiology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Kamran H Awan
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT, USA
| | - Ricardo Gomez
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas, Gerais, Brazil
| | - Peter A Brennan
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
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Martner SG, Dallery J. Technology-based contingency management and e-cigarettes during the initial weeks of a smoking quit attempt. J Appl Behav Anal 2019; 52:928-943. [PMID: 31578724 DOI: 10.1002/jaba.641] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/16/2019] [Indexed: 12/18/2022]
Abstract
Contingency management (CM) interventions are among the most effective behavioral interventions for smoking. This study assessed the effects of CM and electronic cigarettes (ECs) on smoking reductions and abstinence for durations of 30-36 days. Twelve participants were exposed to Baseline, EC alone, and EC + CM conditions. An internet-based platform was used to monitor smoking via breath carbon monoxide (CO) and deliver CM for smoking abstinence (CO ≤4 ppm). A Bluetooth-enabled EC monitored daily EC puffs. Abstinence rates were equivalent between EC (34.4%) and EC + CM (30.4%) conditions. Both conditions promoted smoking reductions. We observed an inverse correlation between smoking and EC puffs (r = -.62, p < .05). Results suggest the use of electronic cigarettes can promote smoking reductions and abstinence, and CM did not improve these outcomes. Larger magnitude consequences or tailoring EC characteristics (e.g., flavor) may have improved outcomes. Technology-based methods to collect intensive, longitudinal measures of smoking and electronic cigarette use may be useful to characterize their environmental determinants.
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Examining e-cigarette purchases and cessation in a consumer panel of smokers. J Smok Cessat 2019; 14:32-41. [PMID: 31435438 DOI: 10.1017/jsc.2018.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives Examine correlates of initiation of e-cigarette use among smokers and determine the impact of e-cigarette use on cessation among smokers in a national U.S. consumer panel. Methods This study used the Nielsen Homescan Panel data from 2011 to 2013, augmented with state-specific measures of tobacco control activities, to examine 1) correlates of single and repeat e-cigarette purchasing among panelists currently purchasing cigarettes; and 2) correlates of "cessation". Participating panelists scanned all retail purchases, and Nielsen recorded over 3 million product types. The key explanatory variable for cessation was e-cigarette purchase. Parallel analysis was conducted for conventional nicotine replacement therapy (NRT) purchase. Cessation was defined as no purchases for at least 6 months and no subsequent purchases until the end of 2013. Analysis was conducted in 2015. E-cigarettes tracked by Nielsen during this period were cig-a-like products resembling tobacco cigarettes in appearance. Results Single e-cigarette purchase was associated with whether the panelist resided in a single person male household and bought a higher volume of cigarettes. Repeat purchase was associated with higher state cigarette taxes, less stringent state public smoke-free policies, lower cigarette prices, and more frequent cigarette purchasing. Cessation was associated with repeat e-cigarette purchasing, repeat NRT purchasing, younger age, lower monthly cigarette volume, less frequent purchasing of cigarettes, less recent cigarette purchase at baseline, and single e-cigarette purchase before baseline. Conclusions Both individual and policy variables were associated with e-cigarette use. Repeat e-cigarette purchase was associated with cigarette purchase discontinuation, as were various smoking intensity measures.
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Abstract
AbstractIntroductionThe use of electronic cigarettes (e-cigarettes) in smokers with mental health conditions (MHC) is not well understood.AimsThis study aims to compare e-cigarette users and non-users among veteran smokers with MHC to characterize differences in smoking behavior, motivation to quit, psychological distress, primary psychiatric diagnosis, and other factors.MethodsBaseline survey data were used from a randomized smoking cessation trial enrolling smokers with MHC from four Veterans Health Administration hospitals. Participants were categorized as current, former (having ever tried an e-cigarette), or never e-cigarette users. Pearson's χ2 and ANOVA Type-3 F-tests were used to test the bivariate associations between e-cigarette use and variables measured.ResultsAmong 1,836 participants, mean age was 58 years (STD ± 12.5), 87% were male, 15% were current e-cigarette users (n = 275), and 27% were former users (n = 503). Sixty-five percent of e-cigarette users reported ‘wanting to quit smoking’ as a primary reason. Mean readiness to quit smoking (1–10) was 7.2, 6.8, and 6.4 for current, former, and never e-cigarette users, respectively (P = 0.0002). Sixty-three percent of current and former users and 55% of never-users reported some mental distress on Kessler-6 scale (P = 0.0003, OR = 1.4, 95% CI 1.1–1.7). A primary psychiatric diagnosis of alcohol or substance use disorder was recorded for 50% of current or former users and 60% of never-users (P = 0.0003, OR = 0.69, 95% CI 0.56–0.84).ConclusionsE-cigarette users were more ready to quit and most often reported using e-cigarettes to assist with quitting. E-cigarette users had more psychological distress and were less likely to have substance use disorders as their primary psychiatric diagnosis.
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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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Manning K, Garey L, Mayorga NA, Shepherd JM, Zvolensky MJ. The relation between fatigue severity and anxious arousal, negative affect, and emotion dysregulation among adult e-cigarette users. FATIGUE: BIOMEDICINE, HEALTH & BEHAVIOR 2019. [DOI: 10.1080/21641846.2019.1626059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- 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
| | | | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Behavioral Sciences, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
- HEALTH Institute, University of Houston, Houston, TX, USA
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Gentry S, Forouhi N, Notley C. Are Electronic Cigarettes an Effective Aid to Smoking Cessation or Reduction Among Vulnerable Groups? A Systematic Review of Quantitative and Qualitative Evidence. Nicotine Tob Res 2019; 21:602-616. [PMID: 29608714 PMCID: PMC6697178 DOI: 10.1093/ntr/nty054] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 03/27/2018] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Smoking prevalence remains high in some vulnerable groups, including those who misuse substances, have a mental illness, are homeless, or are involved with the criminal justice system. E-cigarette use is increasing and may support smoking cessation/reduction. METHODS Systematic review of quantitative and qualitative data on the effectiveness of e-cigarettes for smoking cessation/reduction among vulnerable groups. Databases searched were MEDLINE, EMBASE, PsychINFO, CINAHL, ASSIA, ProQuest Dissertations and Theses, and Open Grey. Narrative synthesis of quantitative data and thematic synthesis of qualitative data. RESULTS 2628 records and 46 full texts were screened; 9 studies were identified for inclusion. Due to low quality of evidence, it is uncertain whether e-cigarettes are effective for smoking cessation in vulnerable populations. A moderate quality study suggested that e-cigarettes were as effective as nicotine replacement therapy. Four studies suggested significant smoking reduction; however, three were uncontrolled and had sample sizes below 30. A prospective cohort study found no differences between e-cigarette users and nonusers. No significant adverse events and minimal side effects were identified. Qualitative thematic synthesis revealed barriers and facilitators associated with each component of the COM-B (capability, opportunity, motivation, and behavior) model, including practical barriers; perceptions of effectiveness for cessation/reduction; design features contributing to automatic and reflective motivation; smoking bans facilitating practical opportunity; and social connectedness increasing social opportunity. CONCLUSION Further research is needed to identify the most appropriate device types for practicality and safety, level of support required in e-cigarette interventions, and to compare e-cigarettes with current best practice smoking cessation support among vulnerable groups. IMPLICATIONS Smoking prevalence among people with mental illness, substance misuse, homelessness, or criminal justice system involvement remains high. E-cigarettes could support cessation. This systematic review found limited quantitative evidence assessing effectiveness. No serious adverse events were identified. Qualitative thematic synthesis revealed barriers and facilitators mapping to each component of the COM-B (capability, opportunity, motivation, and behavior) model, including practical barriers; perceived effectiveness; design features contributing to automatic and reflective motivation; smoking bans facilitating practical opportunity; and social connectedness increasing social opportunity. Further research should consider appropriate devices for practicality and safety, concurrent support, and comparison with best practice smoking cessation support.
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Affiliation(s)
- Sarah Gentry
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ
- Department of Public Health & Primary Care, Institute of Public Health, Forvie Site, Cambridge Biomedical Campus, Cambridge, CB2 0SR
| | - Nita Forouhi
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ
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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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Bianco CL. Rates of electronic cigarette use among adults with a chronic mental illness. Addict Behav 2019; 89:1-4. [PMID: 30237110 DOI: 10.1016/j.addbeh.2018.08.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/06/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Electronic cigarette (e-cig) use has increased dramatically over the past decade, rates of e-cig use among those with a chronic mental illness has largely been unexplored. Exploring this relationship for adults with a mental illness is necessary when examining the health needs of this population. METHODS Data from the 2016 National Health Interview Survey (NHIS) was used to explore associations between e-cig use and chronic mental illness. E-cig use was explored in two different contexts, having tried an e-cig at least once and current e-cig use. Chronic mental illness was categorized as depression, anxiety, emotional disorder, or ADD, bipolar, schizophrenia, other disorder. RESULTS Rates of ever trying an e-cig and current e-cig use were higher among those with a chronic mental illness. Complex logistic regressions suggested having a chronic mental illness significantly increases the likelihood of both trying an e-cig and being an e-cig user. CONCLUSIONS Increased likelihood of e-cig use in chronic mental illness supports previous findings. This may be due to perceptions that e-cigs are less harmful and they provide ways of socially connecting with others. IMPLICATIONS Current knowledge surrounding e-cig use in this population is lacking. The 2016 NHIS allows for a nationally representative prediction of e-cig use in this population. This data is relevant in monitoring potential harm caused by e-cigs, in addition it may be helpful when assessing the value of e-cigs as a smoking cessation tool for those with a mental illness.
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Bals R, Boyd J, Esposito S, Foronjy R, Hiemstra PS, Jiménez-Ruiz CA, Katsaounou P, Lindberg A, Metz C, Schober W, Spira A, Blasi F. Electronic cigarettes: a task force report from the European Respiratory Society. Eur Respir J 2019; 53:13993003.01151-2018. [PMID: 30464018 DOI: 10.1183/13993003.01151-2018] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/09/2018] [Indexed: 01/10/2023]
Abstract
There is a marked increase in the development and use of electronic nicotine delivery systems or electronic cigarettes (ECIGs). This statement covers electronic cigarettes (ECIGs), defined as "electrical devices that generate an aerosol from a liquid" and thus excludes devices that contain tobacco. Database searches identified published articles that were used to summarise the current knowledge on the epidemiology of ECIG use; their ingredients and accompanied health effects; second-hand exposure; use of ECIGs for smoking cessation; behavioural aspects of ECIGs and social impact; in vitro and animal studies; and user perspectives.ECIG aerosol contains potentially toxic chemicals. As compared to conventional cigarettes, these are fewer and generally in lower concentrations. Second-hand exposures to ECIG chemicals may represent a potential risk, especially to vulnerable populations. There is not enough scientific evidence to support ECIGs as an aid to smoking cessation due to a lack of controlled trials, including those that compare ECIGs with licenced stop-smoking treatments. So far, there are conflicting data that use of ECIGs results in a renormalisation of smoking behaviour or for the gateway hypothesis. Experiments in cell cultures and animal studies show that ECIGs can have multiple negative effects. The long-term effects of ECIG use are unknown, and there is therefore no evidence that ECIGs are safer than tobacco in the long term. Based on current knowledge, negative health effects cannot be ruled out.
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Affiliation(s)
- Robert Bals
- Dept of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, Germany
| | | | - Susanna Esposito
- Pediatric Clinic, Dept of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Robert Foronjy
- Pulmonary and Critical Care Medicine, SUNY Downstate Medical Center, New York, NY, USA
| | - Pieter S Hiemstra
- Dept of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Paraskevi Katsaounou
- 1st ICU Evangelismos Hospital, National Kapodistrian University of Athens, Athens, Greece
| | - Anne Lindberg
- Dept of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Carlos Metz
- Dept of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, Germany
| | - Wolfgang Schober
- Bavarian Health and Food Safety Authority, Dept of Chemical Safety and Toxicology, Munich, Germany
| | - Avrum Spira
- Boston University School of Medicine, Boston, MA, USA
| | - Francesco Blasi
- Dept of Pathophysiology and Transplantation, Università degli Studi di Milano, Internal Medicine Department, Respiratory Unit and Regional Adult Cystic Fibrosis Center, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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Zvolensky MJ, Garey L, Mayorga NA, Rogers AH, Orr MF, Ditre JW, Peraza N. Current pain severity and electronic cigarettes: an initial empirical investigation. J Behav Med 2018; 42:461-468. [DOI: 10.1007/s10865-018-9995-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/19/2018] [Indexed: 12/15/2022]
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Zvolensky MJ, Mayorga NA, Garey L. Worry, anxiety sensitivity, and electronic cigarettes among adults. Psychiatry Res 2018; 269:321-327. [PMID: 30173037 PMCID: PMC10034964 DOI: 10.1016/j.psychres.2018.08.087] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 12/27/2022]
Abstract
Although electronic cigarette (e-cigarette) use is now a common substance use behavior, there is little understanding of the individual difference factors related to e-cigarette use beliefs and dependence. The present investigation sought to test a theoretically-driven model of anxiety sensitivity as an explanatory element in a worry-e-cigarette beliefs and dependence model. Participants included 558 adult e-cigarette users (51.4% female; 35.2 years, SD = 10.1) who were nationally recruited via an online survey system. Participants completed a single survey that assessed their mood and e-cigarette behavior and beliefs. Results supported a statistically significant indirect pathway for worry in relation to perceived benefits of e-cigarettes, e-cigarette positive outcome expectancies, and e-cigarette dependence via anxiety sensitivity; effect sizes were small. The indirect effects were evident when accounting for several theoretically relevant covariates (sex, income, education, concurrent cigarette use, and neuroticism). This study provides the first empirical evidence of the role of anxiety sensitivity in the relation between worry and e-cigarette use beliefs and behavior, which may represent a novel intervention target.
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX 77204, USA; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Health Institute, University of Houston, Houston, TX, USA.
| | - Nubia A Mayorga
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX 77204, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX 77204, USA
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Benmarhnia T, Pierce JP, Leas E, White MM, Strong DR, Noble ML, Trinidad DR. Can E-Cigarettes and Pharmaceutical Aids Increase Smoking Cessation and Reduce Cigarette Consumption? Findings From a Nationally Representative Cohort of American Smokers. Am J Epidemiol 2018; 187:2397-2404. [PMID: 29955810 PMCID: PMC6211241 DOI: 10.1093/aje/kwy129] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 06/12/2018] [Accepted: 06/21/2018] [Indexed: 12/18/2022] Open
Abstract
Many smokers believe that electronic nicotine delivery systems (ENDS) and pharmaceutical cessation aids can help them quit smoking or reduce cigarette consumption, but the evidence for e-cigarettes to aid quitting is limited. Examining 3,093 quit attempters in the nationally representative US Population Assessment of Tobacco and Health (PATH) Study, using data from 2013-2015, we evaluated the influence of ENDS and pharmaceutical cessation aids on persistent abstinence (≥30 days) from cigarettes and reduced cigarette consumption, using propensity score matching to balance comparison groups on potential confounders and multiple imputation to handle missing data. At PATH Wave 2, 25.2% of quit attempters reported using ENDS to quit during the previous year, making it the most popular cessation aid in 2014-2015. More quit attempters were persistently cigarette abstinent than were persistently tobacco abstinent (15.5% (standard error, 0.8) vs. 9.6% (standard error, 0.6)). Using ENDS to quit cigarettes increased the probability of persistent cigarette abstinence at Wave 2 (risk difference (RD) = 6%, 95% confidence interval (CI): 2, 10), but using approved pharmaceutical aids did not (for varenicline, RD = 2%, 95% CI: -6, 13; for bupropion, RD = 4%, 95% CI: -6, 17; for nicotine replacement therapy, RD = -3%, 95% CI: -8, 2). Among quit attempters who relapsed, ENDS did not reduce the average daily cigarette consumption (cigarettes per day, -0.18, 95% CI: -1.87, 1.51).
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Affiliation(s)
- Tarik Benmarhnia
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
- Division of Epidemiology, Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
| | - John P Pierce
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
- Division of Health Policy, Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
| | - Eric Leas
- Stanford Prevention Research Center, Stanford University, Palo Alto, California
| | - Martha M White
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - David R Strong
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
- Division of Behavioral Medicine, Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
| | - Madison L Noble
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Dennis R Trinidad
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
- Division of Health Policy, Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
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Kim B, Yoo S, Cho SI. Association between stages of change for smoking cessation and electronic cigarette use among adult smokers: A nationwide cross-sectional study in Korea. PLoS One 2018; 13:e0204244. [PMID: 30235294 PMCID: PMC6147483 DOI: 10.1371/journal.pone.0204244] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 09/04/2018] [Indexed: 11/22/2022] Open
Abstract
This study aimed to investigate whether smokers who are ready to quit are more likely to use electronic cigarette (e-cigarette) than those who are not. The association between the ever and current use of e-cigarettes with the stages of change (SOC) model was examined, which reflects the readiness to quit smoking. Current smokers were categorized based on the SOC (precontemplation, contemplation, and preparation). We investigated the associations between quit attempts, intention to quit, and stage of change with e-cigarette use in the general population and different age groups. We used data from the Korea Community Health Survey that was conducted nationwide in 2014, and 45,378 current smokers were included in the study. Adult smokers were more likely to use e-cigarettes simultaneously in the preparation and contemplation stages than in the precontemplation stage (adjusted odds ratio [AOR] of preparation stage: 2.88 and 95% confidence interval [CI]: 2.26–3.66; AOR of contemplation stage: 1.93 and 95% CI: 1.67–2.24). Ever use of e-cigarette was significantly associated with the contemplation stage in smokers younger than 50 years, while current e-cigarette use was greater in the contemplation stage than in the precontemplation stage at all ages. Both ever and current use of e-cigarettes were significantly related with the preparation stage among all age groups except 50–59 years. Because the use of e-cigarette among smokers may continually increase, public health guidance must be provided to different types of dual users. Previous studies on the association between e-cigarette use and the cognitive and behavioral aspects of smokers have conflicting results. This study highlights whether the use of e-cigarettes can be used as an indicator for the readiness to quit smoking. Thus, counselors can encourage smoking cessation and provide tailored interventions.
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Affiliation(s)
- Boram Kim
- Bureau of Public Health Policy, Office for Healthcare Policy, Ministry of Health and Welfare, Sejong-si, Korea
| | - Seunghyun Yoo
- Department of Public Health Science, Graduate School of Public Health, and Institute of Health and Environment, Seoul National University, Seoul, Korea
- * E-mail:
| | - Sung-il Cho
- Department of Public Health Science, Graduate School of Public Health, and Institute of Health and Environment, Seoul National University, Seoul, Korea
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Main and Interactive Effects of e-Cigarette Use Health Literacy and Anxiety Sensitivity in Terms of e-Cigarette Perceptions and Dependence. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9953-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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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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Spears CA, Jones DM, Weaver SR, Pechacek TF, Eriksen MP. Motives and perceptions regarding electronic nicotine delivery systems (ENDS) use among adults with mental health conditions. Addict Behav 2018; 80:102-109. [PMID: 29407679 PMCID: PMC5857232 DOI: 10.1016/j.addbeh.2018.01.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 01/10/2018] [Accepted: 01/12/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Smoking rates are disproportionately high among adults with mental health conditions (MHC), and recent research suggests that among former smokers, those with MHC are more likely to use electronic nicotine delivery systems (ENDS). This study investigated reasons for ENDS use and related risk perceptions among individuals with versus without MHC. METHODS Among adult current ENDS users (n=550), associations between self-reported MHC diagnoses and motives for ENDS use and ENDS risk perceptions were examined, stratified by smoking status. RESULTS There were no significant associations between MHC status and ENDS motives or perceptions in the overall sample. However, current smokers with MHC indicated thinking more about how ENDS might improve their health, and former smokers with MHC reported thinking less about how ENDS might harm their health, compared to their counterparts without MHC. Former smokers with MHC rated several reasons for ENDS use (e.g., less harmful than regular cigarettes; to quit smoking; appealing flavors) as more important than did those without MHC. CONCLUSIONS Current and former smokers with MHC may be especially optimistic about health benefits of ENDS. However, they might also be prone to health risks of continued ENDS use or concurrent use with traditional cigarettes. It will be important for public health messaging to provide this population with accurate information about benefits and risks of ENDS.
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Affiliation(s)
- Claire Adams Spears
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, United States; Division of Health Promotion and Behavior, School of Public Health, Georgia State University, Atlanta, GA, United States.
| | - Dina M Jones
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, United States.
| | - Scott R Weaver
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, United States; Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, GA, United States.
| | - Terry F Pechacek
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, United States; Division of Health Management and Policy, School of Public Health, Georgia State University, Atlanta, GA, United States.
| | - Michael P Eriksen
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, United States; Division of Health Management and Policy, School of Public Health, Georgia State University, Atlanta, GA, United States.
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Abstract
Since e-cigarettes appeared in the mid-2000s, some practitioners, researchers, and policy makers have embraced them as a safer alternative to conventional cigarettes and an effective way to stop smoking. While e-cigarettes deliver lower levels of carcinogens than do conventional cigarettes, they still expose users to high levels of ultrafine particles and other toxins that may substantially increase cardiovascular and noncancer lung disease risks, which account for more than half of all smoking-caused deaths, at rates similar to conventional cigarettes. Moreover, rather than stimulating smokers to switch from conventional cigarettes to less dangerous e-cigarettes or quitting altogether, e-cigarettes are reducing smoking cessation rates and expanding the nicotine market by attracting youth.
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Affiliation(s)
- Stanton A Glantz
- Center for Tobacco Control Research and Education and Department of Medicine, University of California, San Francisco, California 94143, USA;
| | - David W Bareham
- Lincolnshire Community Health Services NHS Trust, Louth, LN11 0EU, United Kingdom;
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Soneji SS, Sung HY, Primack BA, Pierce JP, Sargent JD. Quantifying population-level health benefits and harms of e-cigarette use in the United States. PLoS One 2018; 13:e0193328. [PMID: 29538396 PMCID: PMC5851558 DOI: 10.1371/journal.pone.0193328] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 02/08/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Electronic cigarettes (e-cigarettes) may help cigarette smokers quit smoking, yet they may also facilitate cigarette smoking for never-smokers. We quantify the balance of health benefits and harms associated with e-cigarette use at the population level. METHODS AND FINDINGS Monte Carlo stochastic simulation model. Model parameters were drawn from census counts, national health and tobacco use surveys, and published literature. We calculate the expected years of life gained or lost from the impact of e-cigarette use on smoking cessation among current smokers and transition to long-term cigarette smoking among never smokers for the 2014 US population cohort. RESULTS The model estimated that 2,070 additional current cigarette smoking adults aged 25-69 (95% CI: -42,900 to 46,200) would quit smoking in 2015 and remain continually abstinent from smoking for ≥7 years through the use of e-cigarettes in 2014. The model also estimated 168,000 additional never-cigarette smoking adolescents aged 12-17 and young adults aged 18-29 (95% CI: 114,000 to 229,000), would initiate cigarette smoking in 2015 and eventually become daily cigarette smokers at age 35-39 through the use of e-cigarettes in 2014. Overall, the model estimated that e-cigarette use in 2014 would lead to 1,510,000 years of life lost (95% CI: 920,000 to 2,160,000), assuming an optimistic 95% relative harm reduction of e-cigarette use compared to cigarette smoking. As the relative harm reduction decreased, the model estimated a greater number of years of life lost. For example, the model estimated-1,550,000 years of life lost (95% CI: -2,200,000 to -980,000) assuming an approximately 75% relative harm reduction and -1,600,000 years of life lost (95% CI: -2,290,000 to -1,030,000) assuming an approximately 50% relative harm reduction. CONCLUSIONS Based on the existing scientific evidence related to e-cigarettes and optimistic assumptions about the relative harm of e-cigarette use compared to cigarette smoking, e-cigarette use currently represents more population-level harm than benefit. Effective national, state, and local efforts are needed to reduce e-cigarette use among youth and young adults if e-cigarettes are to confer a net population-level benefit in the future.
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Affiliation(s)
- Samir S. Soneji
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States of America
- Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States of America
| | - Hai-Yen Sung
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, San Francisco, CA, United States of America
| | - Brian A. Primack
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - John P. Pierce
- Moores Cancer Center, University of California, San Diego, San Diego, CA, United States of America
- Department of Family Medicine & Public Health, University of California, San Diego, San Diego, CA, United States of America
| | - James D. Sargent
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States of America
- Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States of America
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Villanti AC, Feirman SP, Niaura RS, Pearson JL, Glasser AM, Collins LK, Abrams DB. How do we determine the impact of e-cigarettes on cigarette smoking cessation or reduction? Review and recommendations for answering the research question with scientific rigor. Addiction 2018; 113:391-404. [PMID: 28975720 PMCID: PMC6947656 DOI: 10.1111/add.14020] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/19/2016] [Accepted: 08/21/2017] [Indexed: 12/22/2022]
Abstract
AIMS To propose a hierarchy of methodological criteria to consider when determining whether a study provides sufficient information to answer the question of whether e-cigarettes can facilitate cigarette smoking cessation or reduction. DESIGN A PubMed search to 1 February 2017 was conducted of all studies related to e-cigarettes and smoking cessation or reduction. SETTINGS Australia, Europe, Iran, Korea, New Zealand and the United States. PARTICIPANTS AND STUDIES 91 articles. MEASUREMENTS Coders organized studies according to six proposed methodological criteria: (1) examines outcome of interest (cigarette abstinence or reduction), (2) assesses e-cigarette use for cessation as exposure of interest, (3) employs appropriate control/comparison groups, (4) ensures that measurement of exposure precedes the outcome, (5) evaluates dose and duration of the exposure and (6) evaluates the type and quality of the e-cigarette used. FINDINGS Twenty-four papers did not examine the outcomes of interest. Forty did not assess the specific reason for e-cigarette use as an exposure of interest. Twenty papers did not employ prospective study designs with appropriate comparison groups. The few observational studies meeting some of the criteria (duration, type, use for cessation) triangulated with findings from three randomized trials to suggest that e-cigarettes can help adult smokers quit or reduce cigarette smoking. CONCLUSIONS Only a small proportion of studies seeking to address the effect of e-cigarettes on smoking cessation or reduction meet a set of proposed quality standards. Those that do are consistent with randomized controlled trial evidence in suggesting that e-cigarettes can help with smoking cessation or reduction.
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Affiliation(s)
- Andrea C. Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Shari P. Feirman
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA
| | - Raymond S. Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer L. Pearson
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Allison M. Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA
| | - Lauren K. Collins
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA
| | - David B. Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
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Das S, Prochaska JJ. Innovative approaches to support smoking cessation for individuals with mental illness and co-occurring substance use disorders. Expert Rev Respir Med 2017; 11:841-850. [PMID: 28756728 PMCID: PMC5790168 DOI: 10.1080/17476348.2017.1361823] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 07/27/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Tobacco remains the leading preventable cause of death in the US, accounting for over 520,000 deaths annually. While the smoking prevalence has declined over the past 50 years, those with mental illness and addictive disorders continue to smoke at high levels and with significant tobacco-related health problems. Areas covered: This review highlights the epidemiology, contributing factors, and evidence-base for intervening upon tobacco use in those with mental illness and addictive disorders. Historically underprioritized, a growing body of literature supports treating tobacco within mental health and addiction treatment settings. Critically, treating tobacco use appears to support, and not harm, mental health recovery and sobriety. This review also summarizes novel, emerging approaches to mitigate the harms of cigarette smoking. Expert commentary: People with mental illness and addictive disorders have a high prevalence of tobacco use with serious health harms. Treating tobacco use is essential. Evidence-based strategies include individual treatments that are stage-matched to readiness to quit and combine cessation medications with behavioral therapies, supported by smoke-free policies in treatment settings and residential environments. Emerging approaches, with a focus on harm reduction, are electronic nicotine delivery systems and tobacco regulatory efforts to reduce the nicotine content in cigarettes, thereby reducing their addiction potential.
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Affiliation(s)
- Smita Das
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Judith J. Prochaska
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
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Abstract
As research, has progressed through ages, we have been able to uncover the true nature of nicotine addiction. Humankind is now aware of the various ailments that it brings with it. As the slogan for a smokeless world for a better world has been raised, a new practice called "vaping" has come to the forefront. The use of electronic cigarettes (EC) has been on the rise recently. Claims have been made over its role for nicotine deaddiction as well as reducing harmful use for chronic nicotine abusers. In the current review, we searched the PubMed database for available literatures on this practice. We conclude that though EC has the potential to work wonders in smoking cessation, the unforeseen adverse effects needs to be evaluated first before its large-scale introduction in market through solid evidence-based research.
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Affiliation(s)
- Subrata Naskar
- Department of Neuropsychiatry, Institute of Neurosciences, Kolkata, West Bengal, India
| | - Praveen Kumar Jakati
- Department of Neuropsychiatry, Institute of Neurosciences, Kolkata, West Bengal, India
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Chen LS, Baker T, Brownson RC, Carney RM, Jorenby D, Hartz S, Smock N, Johnson M, Ziedonis D, Bierut LJ. Smoking Cessation and Electronic Cigarettes in Community Mental Health Centers: Patient and Provider Perspectives. Community Ment Health J 2017; 53:695-702. [PMID: 27900650 PMCID: PMC5449258 DOI: 10.1007/s10597-016-0065-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 11/22/2016] [Indexed: 01/15/2023]
Abstract
Little is known about patients' electronic cigarette use, interest in and use of smoking cessation treatments, and providers' attitude towards such treatment. We assessed patients (N = 231) and providers (45 psychiatrists, 97 case workers) in four Community Mental Health Centers. Interestingly, 50% of smokers reported interest in using electronic cigarettes to quit smoking, and 22% reported current use. While 82% of smokers reported wanting to quit or reduce smoking, 91% of psychiatrists and 84% of case workers reported that patients were not interested in quitting as the lead barrier, limiting the provision of cessation interventions. Providers' assumption of low patient interest in treatment may account for the low rate of smoking cessation treatment. In contrast, patients report interest and active use of electronic cigarettes to quit smoking. This study highlights the need for interventions targeting different phases of smoking cessation in these patients suffering disproportionately from tobacco dependence.
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Affiliation(s)
- Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave., Box 8134, St. Louis, MO, 63110, USA.
- BJC Behavioral Health, BJC Healthcare, St. Louis, MO, USA.
| | - Timothy Baker
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Robert M Carney
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave., Box 8134, St. Louis, MO, 63110, USA
| | - Douglas Jorenby
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Sarah Hartz
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave., Box 8134, St. Louis, MO, 63110, USA
| | - Nina Smock
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave., Box 8134, St. Louis, MO, 63110, USA
| | - Mark Johnson
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave., Box 8134, St. Louis, MO, 63110, USA
- BJC Behavioral Health, BJC Healthcare, St. Louis, MO, USA
| | - Douglas Ziedonis
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave., Box 8134, St. Louis, MO, 63110, USA
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De Genna NM, Ylioja T, Schulze AE, Manta C, Douaihy AB, Davis EM. Electronic Cigarette Use Among Counseled Tobacco Users Hospitalized in 2015. J Addict Med 2017; 11:449-453. [PMID: 28753139 DOI: 10.1097/adm.0000000000000344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Few studies have examined the prevalence of electronic cigarette use among the inpatient population regardless of the patients' cessation goals. The objectives of this study were to examine the prevalence of electronic cigarette use among counseled tobacco users admitted to 2 academic hospitals. METHODS Cross-sectional data of hospitalized adult tobacco users who were admitted between January 1, 2015 and December 31, 2015 and who received bedside tobacco cessation counseling from a tobacco treatment service counselor were examined. Demographic and smoking history items were compared as a function of electronic cigarette use using chi-square and independent t tests. Logistic regression was used to test independent associations with electronic cigarette use. RESULTS Of 2194 hospitalized tobacco users counseled, 22% had used an electronic cigarette. Most of these patients used electronic cigarettes to quit or reduce use of combustible cigarettes. Adjusted odds of electronic cigarette use were higher for females (adjusted odds ratio [AOR] 0.60 for male patients, 95% confidence interval [CI] 0.47-0.76), younger patients (AOR 0.98 for older patients, 95% CI 0.97-0.99), and individuals who initiated tobacco use earlier in life (AOR 0.97 for later smoking initiation, 95% CI 0.95-0.99). CONCLUSIONS Screening hospitalized cigarette smokers for electronic cigarette use offers an opportunity to counsel all patients on evidence-based quit aids. Young, female patients are most likely to use electronic cigarettes and may benefit most from directed discussions about electronic cigarette use and Federal Drug Administration-approved cessation methods during smoking cessation counseling.
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Affiliation(s)
- Natacha M De Genna
- Departments of Psychiatry and Epidemiology, University of Pittsburgh School of Medicine and Graduate School of Public Health (NMDG); University of Pittsburgh School of Social Work (TY); University of Pittsburgh Medical Center (AES, CM); Departments of Psychiatry and Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center (ABD); Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA (EMD)
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Breland A, Soule E, Lopez A, Ramôa C, El-Hellani A, Eissenberg T. Electronic cigarettes: what are they and what do they do? Ann N Y Acad Sci 2017; 1394:5-30. [PMID: 26774031 PMCID: PMC4947026 DOI: 10.1111/nyas.12977] [Citation(s) in RCA: 230] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Electronic cigarettes (ECIGs) use electricity to power a heating element that aerosolizes a liquid containing solvents, flavorants, and the dependence-producing drug nicotine for user inhalation. ECIGs have evolved rapidly in the past 8 years, and the changes in product design and liquid constituents affect the resulting toxicant yield in the aerosol and delivery to the user. This rapid evolution has been accompanied by dramatic increases in ECIG use prevalence in many countries among adults and, especially, adolescents in the United States. The increased prevalence of ECIGs that deliver nicotine and other toxicants to users' lungs drives a rapidly growing research effort. This review highlights the most recent information regarding the design of ECIGs and their liquid and aerosol constituents, the epidemiology of ECIG use among adolescents and adults (including correlates of ECIG use), and preclinical and clinical research regarding ECIG effects. The current literature suggests a strong rationale for an empirical regulatory approach toward ECIGs that balances any potential ECIG-mediated decreases in health risks for smokers who use them as substitutes for tobacco cigarettes against any increased risks for nonsmokers who may be attracted to them.
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Affiliation(s)
| | - Eric Soule
- Virginia Commonwealth University, Richmond, Virgina
| | - Alexa Lopez
- Virginia Commonwealth University, Richmond, Virgina
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Brunette MF, Feiron JC, Aschbrenner K, Colctti D, Devitt T, Greene MA, Harrington A, MoHugo GC, Pratt S, Robinson D, Williams J, Xie H. Characteristics and Predictors of Intention to use Cessation Treatment among Smokers with Schizophrenia: Young Adults Compared to Older Adults. JOURNAL OF SUBSTANCE ABUSE AND ALCOHOLISM 2017; 5:1055. [PMID: 29881770 PMCID: PMC5988490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Over half of young adults with schizophrenia smoke. Quitting before age 30 could prevent some of the disparate morbidity and mortality due to smoking-related diseases. However, little research has addressed smoking in this group nor evaluated strategies to help young adults with schizophrenia quit smoking. METHODS We compared demographic and smoking-related characteristics of young adults and those over 30 years of age among 184 smokers with schizophrenia. With a series of regression models, we assessed whether age, gender, smoking characteristics, social norms, attitudes, and perceived behavioral control predicted intention to quit smoking and to use cessation treatments. RESULTS Young adults had smoked for fewer years, had lower nicotine dependence, and had lower breath carbon monoxide levels than those over 30, yet awareness of the harms of smoking and readiness to quit were similar between groups. Attitudes about smoking, attitudes about cessation treatment, social norms for cessation treatment, and perceived behavioral control for cessation treatment significantly predicted intention to use cessation treatment. Age was not a predictor of intention to quit, nor to use cessation treatment. CONCLUSIONS Young adults with schizophrenia are amenable to smoking cessation intervention. Increasing awareness of the safety, efficacy and access to cessation treatments among smokers with schizophrenia and also among those in their social network may improve use of effective cessation treatment. These strategies may enhance the standard educational approach (increasing awareness of harms). Research is needed to evaluate such intervention strategies in smokers with schizophrenia of all ages.
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Affiliation(s)
- Mary F. Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, USA
| | - Joelle C. Feiron
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, USA
| | - Kelly Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, USA
| | | | | | - Mary Ann Greene
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, USA
| | - Amy Harrington
- Department of Psychiatry, University of Massachusetts, USA
| | - Gregory C. MoHugo
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, USA
| | - Samh Pratt
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, USA
| | | | - Jill Williams
- Rutgcrs University-Robert Wood Johnson Medical School, USA
| | - Haiyi Xie
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, USA
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Park SH, Lee L, Shearston JA, Weitzman M. Patterns of electronic cigarette use and level of psychological distress. PLoS One 2017; 12:e0173625. [PMID: 28278239 PMCID: PMC5344459 DOI: 10.1371/journal.pone.0173625] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/22/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Psychological distress has been correlated with higher levels of nicotine dependence. To date, the possible association between individuals' levels of psychological distress and e-cigarette use has not been investigated, despite the dramatic growth of e-cigarette use in the US. We examined this possible association using a nationally representative sample of US adults. METHODS A total of 36,697 adults from the 2014 National Health Interview Survey (NHIS) were included. The Kessler 6 scale was used to measure psychological distress. Multivariate logistic regression analysis was conducted to assess the association between level of psychological distress and e-cigarette use. RESULTS Both e-cigarette and cigarette use varied according to level of psychological distress as well as multiple socio-demographic characteristics. In a multivariate model, psychological distress was significantly associated with the following groups: (a) exclusive e-cigarette ever-use (aOR = 3.7; 95% CI = 1.6, 8.6), (b) current dual use of e-cigarettes and cigarettes (aOR = 4.6; 95% CI = 3.1, 6.7), (c) former cigarette use and ever use of e-cigarette (aOR = 3.2; 95% CI = 2.2, 4.8) and (d) current use of cigarettes only (aOR = 2.1; 95% CI = 1.7, 2.6). CONCLUSION These are the first data to demonstrate that, as is true for cigarettes, e-cigarette use is associated with increased levels of psychological distress. Further large-scale, longitudinal studies are needed to determine the direction of this relationship and to evaluate the long-term positive and negative consequences of such use.
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Affiliation(s)
- Su Hyun Park
- Department of Pediatrics, New York University School of Medicine, New York, New York, United States of America
- Department of Population Health, New York University School of Medicine, New York, New York, United States of America
| | - Lily Lee
- Department of Pediatrics, New York University School of Medicine, New York, New York, United States of America
- Brooklyn College, New York, New York, United States of America
| | - Jenni A. Shearston
- Department of Population Health, New York University School of Medicine, New York, New York, United States of America
- College of Global Public Health, New York University, New York, New York, United States of America
- New York University/ Abu Dhabi Public Health Research Center, Abu Dhabi, United Arab Emirates
| | - Michael Weitzman
- Department of Pediatrics, New York University School of Medicine, New York, New York, United States of America
- Brooklyn College, New York, New York, United States of America
- New York University/ Abu Dhabi Public Health Research Center, Abu Dhabi, United Arab Emirates
- Department of Environmental Medicine, New York University, New York, New York, United States of America
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El Dib R, Suzumura EA, Akl EA, Gomaa H, Agarwal A, Chang Y, Prasad M, Ashoorion V, Heels-Ansdell D, Maziak W, Guyatt G. Electronic nicotine delivery systems and/or electronic non-nicotine delivery systems for tobacco smoking cessation or reduction: a systematic review and meta-analysis. BMJ Open 2017; 7:e012680. [PMID: 28235965 PMCID: PMC5337697 DOI: 10.1136/bmjopen-2016-012680] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE A systematic review and meta-analysis to investigate the impact of electronic nicotine delivery systems (ENDS) and/or electronic non-nicotine delivery systems (ENNDS) versus no smoking cessation aid, or alternative smoking cessation aids, in cigarette smokers on long-term tobacco use. DATA SOURCES Searches of MEDLINE, EMBASE, PsycInfo, CINAHL, CENTRAL and Web of Science up to December 2015. STUDY SELECTION Randomised controlled trials (RCTs) and prospective cohort studies. DATA EXTRACTION Three pairs of reviewers independently screened potentially eligible articles, extracted data from included studies on populations, interventions and outcomes and assessed their risk of bias. We used the Grading of Recommendations Assessment, Development and Evaluation approach to rate overall certainty of the evidence by outcome. DATA SYNTHESIS Three randomised trials including 1007 participants and nine cohorts including 13 115 participants proved eligible. Results provided by only two RCTs suggest a possible increase in tobacco smoking cessation with ENDS in comparison with ENNDS (RR 2.03, 95% CI 0.94 to 4.38; p=0.07; I2=0%, risk difference (RD) 64/1000 over 6 to 12 months, low-certainty evidence). Results from cohort studies suggested a possible reduction in quit rates with use of ENDS compared with no use of ENDS (OR 0.74, 95% CI 0.55 to 1.00; p=0.051; I2=56%, very low certainty). CONCLUSIONS There is very limited evidence regarding the impact of ENDS or ENNDS on tobacco smoking cessation, reduction or adverse effects: data from RCTs are of low certainty and observational studies of very low certainty. The limitations of the cohort studies led us to a rating of very low-certainty evidence from which no credible inferences can be drawn. Lack of usefulness with regard to address the question of e-cigarettes' efficacy on smoking reduction and cessation was largely due to poor reporting. This review underlines the need to conduct well-designed trials measuring biochemically validated outcomes and adverse effects.
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Affiliation(s)
- Regina El Dib
- Department of Anaesthesiology, Botucatu Medical School, UNESP—Univ Estadual Paulista, São Paulo, Brazil
- McMaster Institute of Urology, McMaster University, Hamilton, Ontario, Canada
- Institute of Science and Technology, Department of Biosciences and Oral Diagnosis, Unesp—Univ Estadual Paulista, São José dos Campos, Brazil
| | - Erica A Suzumura
- Research Institute—Hospital do Coração (HCor), São Paulo, Brazil
| | - Elie A Akl
- Department of Internal Medicine, Clinical Research Institute (CRI), Center for Systematic Reviews in Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Huda Gomaa
- Department of Pharmacy, Tanta Chest Hospital, Tanta, Egypt
| | - Arnav Agarwal
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yaping Chang
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Manya Prasad
- Department of Community Medicine, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Vahid Ashoorion
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Isfahan Medical Education Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Diane Heels-Ansdell
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Gordon Guyatt
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Hefner K, Valentine G, Sofuoglu M. Electronic cigarettes and mental illness: Reviewing the evidence for help and harm among those with psychiatric and substance use disorders. Am J Addict 2017; 26:306-315. [DOI: 10.1111/ajad.12504] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 12/22/2016] [Accepted: 01/14/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- Kathryn Hefner
- Veterans Health Administration Mental Illness Research; Education and Clinical Center (MIRECC); West Haven Connecticut
- Department of Psychiatry; Yale University School of Medicine; New Haven Connecticut
| | - Gerald Valentine
- Veterans Health Administration Mental Illness Research; Education and Clinical Center (MIRECC); West Haven Connecticut
- Department of Psychiatry; Yale University School of Medicine; New Haven Connecticut
| | - Mehmet Sofuoglu
- Veterans Health Administration Mental Illness Research; Education and Clinical Center (MIRECC); West Haven Connecticut
- Department of Psychiatry; Yale University School of Medicine; New Haven Connecticut
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Glasser AM, Collins L, Pearson JL, Abudayyeh H, Niaura RS, Abrams DB, Villanti AC. Overview of Electronic Nicotine Delivery Systems: A Systematic Review. Am J Prev Med 2017; 52:e33-e66. [PMID: 27914771 PMCID: PMC5253272 DOI: 10.1016/j.amepre.2016.10.036] [Citation(s) in RCA: 320] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/07/2016] [Accepted: 10/26/2016] [Indexed: 12/20/2022]
Abstract
CONTEXT Rapid developments in e-cigarettes, or electronic nicotine delivery systems (ENDS), and the evolution of the overall tobacco product marketplace warrant frequent evaluation of the published literature. The purpose of this article is to report updated findings from a comprehensive review of the published scientific literature on ENDS. EVIDENCE ACQUISITION The authors conducted a systematic review of published empirical research literature on ENDS through May 31, 2016, using a detailed search strategy in the PubMed electronic database, expert review, and additional targeted searches. Included studies presented empirical findings and were coded to at least one of nine topics: (1) Product Features; (2) Health Effects; (3) Consumer Perceptions; (4) Patterns of Use; (5) Potential to Induce Dependence; (6) Smoking Cessation; (7) Marketing and Communication; (8) Sales; and (9) Policies; reviews and commentaries were excluded. Data from included studies were extracted by multiple coders (October 2015 to August 2016) into a standardized form and synthesized qualitatively by topic. EVIDENCE SYNTHESIS There were 687 articles included in this systematic review. The majority of studies assessed patterns of ENDS use and consumer perceptions of ENDS, followed by studies examining health effects of vaping and product features. CONCLUSIONS Studies indicate that ENDS are increasing in use, particularly among current smokers, pose substantially less harm to smokers than cigarettes, are being used to reduce/quit smoking, and are widely available. More longitudinal studies and controlled trials are needed to evaluate the impact of ENDS on population-level tobacco use and determine the health effects of longer-term vaping.
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Affiliation(s)
- Allison M Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia.
| | - Lauren Collins
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Jennifer L Pearson
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Haneen Abudayyeh
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Raymond S Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - David B Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Abstract
OBJECTIVES Very few studies have evaluated perceptions of electronic nicotine delivery systems (ENDS) among smokers with mental illness. This study assessed expectancies about the effects of smoking combustible cigarettes or using ENDS among current smokers with and without severe psychological distress (SPD). METHODS We used a crowdsourcing system to survey 268 smokers on their expectancies for the effects of combustible cigarettes and ENDS. Positive expectancies assessed included negative affect reduction, stimulation, positive social effects and weight control, and negative expectancies included negative physical effects, negative psychosocial effects and future health concerns. RESULTS Smokers with SPD had higher positive expectancies for weight control and social effects of both products compared to those without such distress, and higher expectancies for stimulation from combustible cigarettes compared to ENDS. All participants had significantly lower negative expectancies for ENDS compared to combustible cigarettes, with no significant differences between the groups. CONCLUSIONS Smokers with SPD may be more vulnerable toward ENDS use, as they are for combustible cigarette use, due to greater positive expectancies of the products. Challenging positive expectancies may increase the efficacy of tobacco control efforts in this vulnerable population.
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Sharma R, Wigginton B, Meurk C, Ford P, Gartner CE. Motivations and Limitations Associated with Vaping among People with Mental Illness: A Qualitative Analysis of Reddit Discussions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 14:ijerph14010007. [PMID: 28025516 PMCID: PMC5295258 DOI: 10.3390/ijerph14010007] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 11/27/2016] [Accepted: 12/19/2016] [Indexed: 02/06/2023]
Abstract
This study aims to understand the nature and significance of online lay discussions about e-cigarettes and mental illness. We systematically searched the website Reddit.com using keywords related to e-cigarettes and mental illness. We coded relevant posts into themes under the framework of motivations for and limitations of vaping for people with mental illness. The thematic analysis included 3263 comments from 133 discussion threads. Six themes were classified as motivations to vape for people with mental illness: Self-medication; Quitting smoking; Freedom and control; Hobby; Social connectedness; and Motivation from caregivers and online communities. The limitations of vaping included: Unsatisfactory substitute for cigarettes and psychiatric medicines; Drug interactions; Nicotine addiction; Risks of e-liquid; Practical difficulties and Cost. People with mental illness; and their carers; use online discussion boards like Reddit to discuss the benefits and limitations of e-cigarettes for people with mental illness. Both positive and negative views exist. Media platforms like Reddit may shape the opinions of stakeholders and generate lay expertise about contentious health topics such as e-cigarettes. These findings have implications for policy and practice concerning assisting smokers with mental illness to reduce their health risk through switching to e-cigarettes.
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Affiliation(s)
- Ratika Sharma
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia.
| | - Britta Wigginton
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia.
| | - Carla Meurk
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia.
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Locked Bag 500, Archerfield, QLD 4018, Australia.
| | - Pauline Ford
- School of Dentistry, The University of Queensland, Herston, QLD 4006, Australia.
| | - Coral E Gartner
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia.
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