Electronic-cigarette use by individuals in treatment for substance abuse: A survey of 24 treatment centers in the United States

Prevalence and reasons for using electronic cigarettes (e-cigarettes) was examined among patients enrolled in 24 substance abuse treatment centers in the United States (N = 1113). Prevalence of e-cigarette use was assessed for the full sample. Bivariate analyses and multivariate logistic regression were used to identify characteristics associated with e-cigarette use among current cigarette smokers (the majority of e-cigarette users). Overall 55.5% of the sample reported lifetime use of e-cigarettes, and 30.5% reported using e-cigarettes in the past 30 days (current users). The main reasons for using e-cigarettes were (a) at times/places when smoking was prohibited (53.5%), and (b) as a way to quit/reduce cigarette smoking (50.3%). Daily vs non-daily e-cigarette users were more likely to use e-cigarettes both as a way to reduce health risks, and as a way to quit/reduce cigarette smoking. A majority of e-cigarette users (87.1%) reported dual use of e-cigarettes and tobacco cigarettes during the past month. Among current cigarette smokers, those that also used e-cigarettes smoked more cigarettes per day, were more likely to have made a past year cigarette quit attempt, and to have tried nicotine replacement therapy compared to cigarette only smokers. There was a high rate of dual e-cigarette and cigarette use by persons enrolled in addiction treatment. E-cigarette users may be heavier cigarette smokers trying to quit or reduce their cigarette smoking. However, e-cigarettes were also used at times when individuals could not smoke cigarettes. Substance abuse treatment centers developing tobacco policies need to consider these potentially conflicting reasons for using e-cigarettes.     

Reductions in biomarkers of exposure (BoE) to harmful or potentially harmful constituents (HPHCs) following partial or complete substitution of cigarettes with electronic cigarettes in adult smokers

Changes in fifteen urine, blood and exhaled breath BoEs of HPHCs representing classes of compounds reported by FDA to be significant contributors to smoking-associated disease risks were measured in 105 clinical-confined subjects following randomization and a five-day forced-switch from usual brand conventional combustible cigarettes to: (i) exclusive commercial e-cigarette use; (ii) dual-use of commercial e-cigarettes and the subject’s usual cigarette brand; or (iii) discontinued use of all tobacco or nicotine products. Levels of urinary biomarkers in subjects that completely substituted their usual cigarette with e-cigarettes were significantly lower (29–95%) after 5 days. Percent reductions in eight of nine urinary BoEs were indistinguishable to smokers who had quit smoking, except for nicotine equivalents, which declined by 25–40%. Dual users who halved self-reported daily cigarette consumption with e-cigarettes exhibited reductions (7–38%) in eight of nine urinary biomarkers, but had increase (1–20%) in nicotine equivalents. Reductions were broadly proportional to the reduced numbers of cigarettes smoked. Dual user urinary nicotine equivalents were slightly higher, but not statistically significant. After 5 days, blood nicotine biomarker levels were lower in the cessation (75–96%) and exclusive use groups (11–83%); with dual users experiencing no significant reductions. All subjects experienced significant decreases in exhaled CO. Decreases in the cessation and exclusive groups ranged from 88–89% and 27–32% in dual users. Exhaled NO increased in the cessation and exclusive groups (46–63% respectively), whereas the dual users experienced minimal changes. Overall, smokers who completely or partially substituted conventional cigarettes with e-cigarettes over five days, experienced reductions in HPHCs.     

What Factors are Associated with Electronic Cigarette,Shisha-Tobacco and Conventional Cigarette Use? Findings from a Cross-Sectional Survey of Australian Adolescents?

Background: Adolescents' use of electronic cigarettes and shisha-tobacco increased in several countries during the 2000s, including in the United States, United Kingdom and Canada. Few studies have examined the factors associated with exclusive e-cigarette or shisha-tobacco use and whether adolescents using these substances exclusively differ from those using traditional cigarettes. Objectives: To examine the socio-demographic and behavioural correlates of exclusive e-cigarette and exclusive shisha-tobacco use to those found for users of tobacco cigarettes and multiple nicotine products in Australian adolescents. Methods: Cross-sectional survey of smoking behaviours of a random sample of 4,576 students in the Australian state of Victoria aged 12–17 conducted between June 2014 and December 2014. Results: Overall, 14% of students had used an e-cigarette with 3% using e-cigarettes exclusively. 13% had used shisha-tobacco, with 2% using shisha-tobacco exclusively. Most students (65%) using e-cigarette and shisha-tobacco (67%) had also used tobacco cigarettes. After adjusting for demographic factors, students using e-cigarettes only were more likely to have never used cannabis or drink alcohol in the past year compared to tobacco cigarette users. Compared to tobacco cigarette users, students using only shisha-tobacco were younger, less likely to use cannabis or alcohol or have friends or parents who smoke. Conclusions: Most Australian adolescents who use alternative nicotine and tobacco-related products do so in conjunction with tobacco cigarettes. Students using e-cigarettes or shisha-tobacco exclusively were less likely to use other substances. Australian longitudinal studies are needed to determine whether this group of students are on a pathway to traditional tobacco use.     

Associations of risk factors of e-cigarette and cigarette use and susceptibility to use among baseline PATH study youth participants (2013–2014)

IntroductionImproved understanding of the distribution of traditional risk factors of cigarette smoking among youth who have ever used or are susceptible to e-cigarettes and cigarettes will inform future longitudinal studies examining transitions in use.MethodsMultiple logistic regression analysis was conducted using data from youth (ages 12–17 years) who had ever heard of e-cigarettes at baseline of the PATH Study (n = 12,460) to compare the distribution of risk factors for cigarette smoking among seven mutually exclusive groups based on ever cigarette/e-cigarette use and susceptibility status.ResultsCompared to committed never users, youth susceptible to e-cigarettes, cigarettes, or both had increasing odds of risk factors for cigarette smoking, with those susceptible to both products at highest risk, followed by cigarettes and e-cigarettes. Compared to e-cigarette only users, dual users had higher odds of nearly all risk factors (aOR range = 1.6–6.8) and cigarette only smokers had higher odds of other (non-e-cigarette) tobacco use (aOR range = 1.5–2.3), marijuana use (aOR = 1.9, 95%CI = 1.4–2.5), a high GAIN substance use score (aOR = 1.9, 95%CI = 1.1–3.4), low academic achievement (aOR range = 1.6–3.4), and exposure to smoking (aOR range = 1.8–2.1). No differences were observed for externalizing factors (depression, anxiety, etc.), sensation seeking, or household use of non-cigarette tobacco.ConclusionsAmong ever cigarette and e-cigarette users, dual users had higher odds of reporting traditional risk factors for smoking, followed by single product cigarette smokers and e-cigarette users. Understanding how e-cigarette and cigarette users differ may inform youth tobacco use prevention efforts and advise future studies assessing probability of progression of cigarette and e-cigarette use.     

E-cigarette use,dual use of e-cigarettes and tobacco cigarettes,and frequency of cannabis use among high school students

BackgroundThe proliferation of electronic vaping products raises many concerns, including whether these products will lead to risky behaviors among adolescents. Evidence suggests that e-cigarettes may be used to vaporize cannabis (marijuana). The current study examined associations between e-cigarette use, dual use of e-cigarettes and tobacco cigarettes, and frequency of cannabis use.MethodsData on high school students (grades 9–12) were from the 2014–2015 Canadian Student Tobacco, Alcohol and Drugs Survey (n = 23,429 respondents). Multinomial logistic regression analyses were used to examine frequency of cannabis use among those who reported using only e-cigarettes, only tobacco cigarettes, both products, and nonusers.ResultsApproximately 15% of respondents reported using cannabis at least once in the past month. Likelihood of using cannabis was significantly higher for e-cigarette only and cigarette- only users. Users of both products had increased odds for a higher frequency of cannabis use. These results indicated a sequential risk gradient in the use of cannabis for dual use, cigarette only, e-cigarette only, and non-use groups, respectively.ConclusionsYouth who reported use of e-cigarettes, tobacco cigarettes, and both products showed a heightened risk of using cannabis more frequently.     

Cognitive risk factors of electronic and combustible cigarette use in adolescents

IntroductionCognitive susceptibility to cigarette smoking has been demonstrated to predict future cigarette initiation in adolescents. Examining this construct prior to tobacco product initiation may provide useful information on the differential risk of individuals initiating cigarette vs. e-cigarette products. Additionally, examining how susceptibility and tobacco product use relate to perceived harm cognitions will increase understanding of risk predisposition among adolescents.MethodData were taken from a longitudinal study of middle school students (n = 1023; age = 12.1, 52.2% female, 72.1% white) in the Northeastern U.S. Likelihood of e-cigarette and cigarette ever-use in high school was examined as a function of a validated index of cigarette smoking susceptibility among tobacco naïve students in middle school. Prospective associations between cognitive susceptibility to smoking and subsequent perceived harm of e-cigarettes (assessed in high school), and cross-sectional associations between concurrent tobacco product ever-use status and perceived harm of e–cigarettes were examined.ResultsAdolescents classified as susceptible to cigarette smoking in middle school were more likely to initiate use of cigarettes (OR = 2.53) and e-cigarettes (OR = 1.95) as compared to adolescents classified as non-susceptible; cigarette smoking susceptibility did not differentially predict use of one product over the other. Adolescents endorsing e-cigarette use, reported significantly less perceived harm associated with e-cigarettes vs. cigarettes, while those who endorsed cigarette only or dual use did not.ConclusionOur data indicate that cognitive susceptibility to cigarette smoking may index a broad risk factor for using either cigarettes or e-cigarettes in the future, and is prospectively associated with perceived harm of e-cigarette use. Overall, those who used any tobacco product perceived e-cigarettes as less harmful when compared to abstainers. Individual facets of perceived harm (addiction potential and harm vs. cigarettes) differ between cigarette only users and e-cigarette users and may help to explain the choice to use one product vs. the other.ImplicationsThis is the first study to examine prospective associations between cognitive susceptibility to cigarette smoking, predating tobacco use, and subsequent likelihood of cigarette vs. e-cigarette initiation. This study demonstrates that initiation of either product is elevated among youth who are susceptible to smoking; thus susceptibility to smoking may serve as a useful marker of vulnerability to tobacco product use. Furthermore, this study provides novel information on the relationship between tobacco product onset and specific harm perceptions associated with e-cigarettes versus cigarettes among adolescents.     

Exclusive versus dual use of tobacco and electronic cigarettes among adolescents in Poland, 2010–2016

Globally, electronic cigarette (e-cigarette) use among adolescents has increased, along with concerns about potential health implications from exclusive and concurrent tobacco and e-cigarette use (i.e., “dual use”). This study used data from a cross-sectional survey administered to 5708 students aged 15–19 in secondary and technical schools throughout two regions of Poland. Data from 2010–2011 (n = 1760); 2013–2014 (n = 1970) and 2015–2016 (n = 1978) were analyzed to assess changes in use of cigarettes and e-cigarettes from 2010–2016, and correlates of exclusive and dual use, daily use, and intensity of product use from 2013–2016. In this sample, e-cigarette trial and past 30-day exclusive e-cigarette use significantly increased over time (2010–2011: 2%; 2013–2014: 8%; 2015–2016: 11% (p < .05)). Dual use increased from 2010–2011 (4%) to 2013–2014 only (23%, p < .05); and remained stable from 2013–2014 to 2015–2016 (24%, p = .60). Most dual users reported using cigarettes before trying e-cigarettes (82% in 2013–2014, 76% in 2015–2016). Analyses comparing dual users to exclusive users showed significant differences in frequency and intensity of product use, similar findings were observed within dual users. Following the introduction of e-cigarettes, both total tobacco use and total cigarette use increased. Among youth in Poland, e-cigarettes do not seem to replace conventional cigarettes, but instead contribute to a more diverse array of available products from which youth can experiment.     

Acute electronic cigarette use: nicotine delivery and subjective effects in regular users

Rationale

Electronic cigarettes are becoming increasingly popular among smokers worldwide. Commonly reported reasons for use include the following: to quit smoking, to avoid relapse, to reduce urge to smoke, or as a perceived lower-risk alternative to smoking. Few studies, however, have explored whether electronic cigarettes (e-cigarettes) deliver measurable levels of nicotine to the blood.

Objective

This study aims to explore in experienced users the effect of using an 18-mg/ml nicotine first-generation e-cigarette on blood nicotine, tobacco withdrawal symptoms, and urge to smoke.

Methods

Fourteen regular e-cigarette users (three females), who are abstinent from smoking and e-cigarette use for 12 h, each completed a 2.5 h testing session. Blood was sampled, and questionnaires were completed (tobacco-related withdrawal symptoms, urge to smoke, positive and negative subjective effects) at four stages: baseline, 10 puffs, 60 min of ad lib use and a 60-min rest period.

Results

Complete sets of blood were obtained from seven participants. Plasma nicotine concentration rose significantly from a mean of 0.74 ng/ml at baseline to 6.77 ng/ml 10 min after 10 puffs, reaching a mean maximum of 13.91 ng/ml by the end of the ad lib puffing period. Tobacco-related withdrawal symptoms and urge to smoke were significantly reduced; direct positive effects were strongly endorsed, and there was very low reporting of adverse effects.

Conclusions

These findings demonstrate reliable blood nicotine delivery after the acute use of this brand/model of e-cigarette in a sample of regular users. Future studies might usefully quantify nicotine delivery in relation to inhalation technique and the relationship with successful smoking cessation/harm reduction.     

Urinary cotinine levels of electronic cigarette (e-cigarette) users

The popularity of electronic cigarettes (e-cigarettes) is rapidly increasing in many countries. These devices are designed to imitate regular cigarettes, delivering nicotine via inhalation without combusting tobacco but currently, there is a lack of scientific evidence on the presence or absence of nicotine exposure. Such research relies on evidence from e-cigarette users urine samples. In this study, we aimed to determine the levels and compare the amount of nicotine to which e-cigarette users, cigarette smokers and passive smokers are exposed. Therefore, urine samples were collected from e-cigarette users, cigarette smokers, passive smokers, and healthy nonsmokers. The urinary cotinine levels of the subjects were determined using gas chromatography–mass spectrometry. The mean (±SD) urinary cotinine levels were determined as 1755?±?1848?ng/g creatinine for 32 e-cigarette users, 1720?±?1335?ng/g creatinine for 33 cigarette smokers and 81.42?±?97.90?ng/g creatinine for 33 passive smokers. A significant difference has been found between cotinine levels of e-cigarette users and passive smokers (p?<?0.05). There were no statistically significant differences between e-cigarette users and cigarette smokers (p?>?0.05). This is a seminal study to demonstrate the e-cigarette users are exposed to nicotine as much as cigarette smokers.     

Electronic cigarettes and narghile users in Brazil: Do they differ from cigarettes smokers?

BackgroundCigarette smoking prevalence is declining, however, other tobacco products have emerged recently, such as electronic cigarettes (e-cigarettes) and narghile (hookah/shisha/waterpipe). Narghile sales are not prohibited in Brazil, but e-cigarettes are. Accurate estimates of such products are key for proper monitoring and control.ObjectiveTo describe the prevalence of e-cigarettes and narghile use and to investigate whether sociodemographic characteristics of individuals who are using these products differ from those who are using manufactured cigarettes.MethodsUsing a nationally representative sample survey of Brazilians aged 12–65 years in 2015, we estimated the prevalence rates of each tobacco products within the last 12-months, stratified by macro-region, municipality size, sex-at-birth, sexual orientation, color/race, age-group, and monthly income. Multivariable logistic models were fitted to understand determinants of each tobacco product use, considering the complex sample design.ResultsE-cigarette, narghile, and cigarette prevalence rates were estimated at 0.43%, 1.65% and 15.35%, respectively, corresponding to around 0.6million e-cigarette users, 2.5 million narghile users and 23.5 million cigarette users. Non-heterosexual individuals were a most-at-risk group for both e-cigarette/narghile and cigarette use. Despite similarities, e-cigarette/narghile users were younger and had higher socioeconomic status than cigarette users. Additional analyses showed that recent cigarette use seems to be more associated with e-cigarette/narghile use among youth than among adults.ConclusionsOur findings may provide valuable information about e-cigarette/narghile use in Brazil. Prevention strategies targeted to youth to both narghile and e-cigarettes use should be implemented together, which might be one strategy to prevent the emergency of a new generation of smokers in Brazil.     

E-cigarette- specific symptoms of nicotine dependence among Texas adolescents

IntroductionThe potential of e-cigarettes to elicit symptoms of nicotine dependence has not been adequately studied, particularly in adolescent populations. The present study examined the prevalence of e-cigarette-specific symptoms of nicotine dependence (“symptoms of e-cigarette dependence”) and the associations between these symptoms, e-cigarette usage group, and e-cigarette cessation-related items among Texas adolescents.MethodsThis study involved a cross-sectional analysis of adolescents from Wave 4 of the Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS) (n = 2891/N = 461,069). Chi-Square analyses examined differences in the prevalence of symptoms of dependence by e-cigarette usage group (exclusive versus dual users of e-cigarettes and combustible tobacco products) and demographic characteristics. Weighted multivariable logistic regression analyses examined the associations between symptoms of e-cigarette dependence, e-cigarette usage group, and e-cigarette cessation items.ResultsExclusive e-cigarette users experienced symptoms of e-cigarette dependence, although the prevalence of most of the symptoms was higher for dual users. Adolescents who reported more symptoms of dependence were less likely to report both wanting to quit e-cigarettes and a past-year quit attempt for e-cigarettes (adjusted odds ratio “AOR” = 0.61 (95% CI = 0.41, 0.92) and AOR = 0.52 (95% CI = 0.30, 0.92), respectively).ConclusionsThis study is the first to demonstrate that adolescent e-cigarette users are experiencing symptoms of dependence specific to e-cigarettes. In addition, symptoms of dependence may be barriers to e-cigarette cessation. Future research is needed to determine if characteristics of e-cigarette use (e.g. frequency and intensity) are associated with dependence.     

What is the nicotine delivery profile of electronic cigarettes?

ABSTRACT

Introduction: Electronic cigarettes (e-cigarettes) are a rapidly evolving class of tobacco products intended to deliver nicotine to users. There are many types of e-cigarettes available and the most popular type today in the United States are ‘pod’ based devices that use high nicotine concentration liquids. Understanding the nicotine delivery capabilities of e-cigarettes is imperative for understanding their addictive potential and safety profile, informing regulation, and revealing their potential use as smoking cessation aids.

Areas covered: This review discusses nicotine content of e-cigarettes, effectiveness of nicotine aerosolization by devices, delivery of nicotine to users, and user and device characteristics that impact each of these.

Expert opinion: Modern e-cigarettes have the potential to deliver equal or more nicotine compared to a tobacco cigarette. Future research needs to identify the nicotine delivery profiles likely to benefit public health and the means to regulate them appropriately while also identifying those that are likely to cause harm. Public health benefit accrues if e-cigarettes help smokers quit combustible cigarettes completely. Harm is possible if inadequate nicotine delivery undermines cessation attempts, e-cigarettes facilitate continued combustible cigarette use, long-term e-cigarette use is associated with substantial morbidity/mortality, and/or e-cigarettes increase the initiation of combustible cigarette use among never smokers.     

Comparison of the effects of e-cigarette vapor and cigarette smoke on indoor air quality

Context: Electronic cigarettes (e-cigarettes) have earned considerable attention recently as an alternative to smoking tobacco, but uncertainties about their impact on health and indoor air quality have resulted in proposals for bans on indoor e-cigarette use.

Objective: To assess potential health impacts relating to the use of e-cigarettes, a series of studies were conducted using e-cigarettes and standard tobacco cigarettes.

Methods and materials: Four different high nicotine e-liquids were vaporized in two sets of experiments by generic 2-piece e-cigarettes to collect emissions and assess indoor air concentrations of common tobacco smoke by products. Tobacco cigarette smoke tests were conducted for comparison.

Results: Comparisons of pollutant concentrations were made between e-cigarette vapor and tobacco smoke samples. Pollutants included VOCs, carbonyls, PAHs, nicotine, TSNAs, and glycols. From these results, risk analyses were conducted based on dilution into a 40 m³ room and standard toxicological data. Non-cancer risk analysis revealed “No Significant Risk” of harm to human health for vapor samples from e-liquids (A-D). In contrast, for tobacco smoke most findings markedly exceeded risk limits indicating a condition of “Significant Risk” of harm to human health. With regard to cancer risk analysis, no vapor sample from e-liquids A-D exceeded the risk limit for either children or adults. The tobacco smoke sample approached the risk limits for adult exposure.

Conclusions: For all byproducts measured, electronic cigarettes produce very small exposures relative to tobacco cigarettes. The study indicates no apparent risk to human health from e-cigarette emissions based on the compounds analyzed.     

Dual use of electronic cigarettes and classic cigarettes: a systematic review

Purpose: Dual use is an emerging phenomenon and while there is no consensus on its definition, in most evidence based literature it is commonly referred to as those who use both e-cigarettes and classic cigarettes whereas those who smoke only e-cigarettes are referred to as single users. The risks and benefits of e-cigarette dual usage should be considered on an individual level as well as on a population level. Almost two thirds of adult tobacco users in the US report using more than one tobacco product. Yet, our understanding about dual use is limited by a fragmented evidence-base. Synthesizing this literature is critical for the purpose of developing a profile for ‘dual users’, understanding the influences of dual use on classic cigarette, classic cigarette smoking behavior, evaluating health outcomes from dual use, and dual users perceptions and experiences. 

Materials and methods: The objective of this review is to summarize the literature focused on dual use of the e-cigarette and classic cigarette. PubMed and PsycINFO were searched. Concepts that made up the investigation were: electronic cigarette and dual use. The publication date was limited to 2009–2017. 

Results: We identified 718 original studies from the electronic search of the databases (407 studies from PUBMED, and 311 from PsycINFO) and 3 from a dedicated mailing list. The reviewers screened the title and abstract of each citation to determine their eligibility and considered 76 articles. 

Conclusions: Dual users make use of e-cigarettes for smoking reduction, smoking cessation, reduction of health risks and they perceive e-cigarettes to be safer and less addictive than tobacco cigarettes. Dual users are more likely to use tobacco cigarettes in hedonistic situations, when there is no restriction of use, or when stressed and/or anxious. Situations such as these might be the most difficult circumstances to dissuade dual users from classic smoking.     

Associations between frequency of cigarette and alternative tobacco product use and depressive symptoms: A longitudinal study of young adults

The association between cigarette use and depression has been documented in many studies. Fewer studies have examined other tobacco products such as electronic cigarettes (e-cigarettes) and hookah that are used by young adults. This study examined whether increased frequency of use of these products was associated with depressive symptoms in a cohort of n = 5236 Texas college students followed from 2014 to 2017. To analyze the longitudinal data, a hierarchical model was used. Model results showed that increased frequency of single product use of cigarettes, refillable e-cigarettes and hookah was associated with depressive symptoms. Refillable and disposable e-cigarettes were examined separately and results did not provide evidence of a different association for each type of e-cigarette when cigarettes were not also used. Dual use of cigarettes with another product was also examined. Dual use was associated with higher depressive symptoms for most product combinations. However, infrequent dual use of disposable e-cigarettes and cigarettes may not be associated with depressive symptoms. Suggestions for further research are included.     

Impact of E-cigarettes on Smoking and Related Outcomes in Veteran Smokers With Psychiatric Comorbidity

Objective: Compared to the general U.S. population, smokers with comorbid psychiatric and/or substance use disorders have lower quit rates after evidence-based treatments and disproportionately high smoking-related deaths. Improved modalities for reducing tobacco-related harm in this subpopulation are needed. Because electronic cigarettes (e-cigarettes) can now deliver physiologically relevant levels of nicotine to consumers, they represent an additional nicotine delivery system that could be used in cessation interventions. While current data suggest that the use of e-cigarettes by smokers promotes a reduction in combustible cigarette use, smoking quit rates through use of e-cigarettes appears to be low. The goal of this study was to examine impact of e-cigarette use on combustible tobacco use as well as on the readiness to quit smoking and changes in nicotine dependence in a multimorbid population. Methods: We conducted a 4-week, open-label study in 43 military veteran smokers who had no immediate intention to stop smoking and were currently receiving psychiatric services from the Department of Veterans Affairs health care system. Participants were provided with a study e-cigarette they could use ad libitum along with other tobacco products and were encouraged to attend weekly laboratory visits and a one-month follow-up visit. Main outcome measures were number of cigarettes smoked per day (CPD), the frequency of e-cigarette use, the amount of money spent on combustible cigarettes (U.S. dollars/week), alveolar carbon monoxide (CO) levels, and urine cotinine levels. Results: Mean e-cigarette use was 5.7 days per week and only 9% of participants used the e-cigarette for fewer than 4 days per week. Significant reductions in breath CO (9.3 ppm to 7.3 ppm, p < .02) and CPD (from 16.6 to 5.7, p < .001) were observed across study weeks, and no serious adverse events were reported. Three participants (10% of completers) reported smoking cessation that was corroborated biochemically. At one-month follow-up, motivation to quit smoking remained significantly higher and the level of nicotine dependence was significantly lower than at baseline. Conclusions: E-cigarettes are acceptable to smokers with psychiatric comorbidities, as indicated by sustained and frequent e-cigarette use by 90% of participants, and may promote reduction and/or cessation of combustible cigarette use. E-cigarettes appear to be a viable harm reduction modality in smokers with psychiatric comorbidities.     

Perceived risk and benefits of e-cigarette use among college students

Recent data demonstrates that the use of e-cigarettes is growing, especially among college students and young adults. This trend is increasingly problematic, as many of these individuals report never using traditional tobacco cigarettes, but nevertheless are using e-cigarettes. The present study sought to develop the Risks and Benefits of E-cigarettes (RABE) questionnaire to assess the perceptions about e-cigarette use among college students. College students (N = 734) completed the RABE via online survey. Principal components analysis yielded two reliable scales representing perceptions about e-cigarette use. Based on the two-factor solution, subscales were named according to item content. The resulting 30 items demonstrated excellent internal consistency (Risks scale α = 0.92; Benefits scale α = 0.89). Subsequent confirmatory factor analysis generally supported the 2-factor structure. As an initial measure of construct validity, scale scores were compared across smoking status groups. Smoking status groups were defined by the following: “e-cigarette users” were current daily users of e-cigarettes, “conventional smokers” were daily traditional cigarette users, and “dual users” were individuals who used both e-cigarettes and traditional cigarettes daily. Scale scores for perceived Benefits of e-cigarette use differed significantly across groups (p < 0.001), whereby students who reported using e-cigarettes or traditional cigarettes reported benefits associated with e-cigarette use. Scale scores for perceived Risks of e-cigarette use across smoking status groups did not significantly differ. The present results indicate that the RABE is a reliable instrument to measure college student's perceived risks and benefits of e-cigarettes.     

Electronic cigarette use and risk perception in a Stop Smoking Service in England

Introduction: Electronic cigarette (e-cigarette) use rose substantially within the UK in recent years but currently, Stop Smoking Services in England do not prescribe them due to a lack of regulation. Previous research has examined e-cigarette use and attitudes within English Stop Smoking Services using samples of practitioners and managers; the current study recruited a sample of service users. Methods: Participants (N?=?319) aged 18–60 years old were recruited from Roy Castle FagEnds, Liverpool, England (Stop Smoking Service). A cross-sectional questionnaire was completed, which recorded demographic variables, e-cigarette use alongside risk perception, and lastly, smoking behaviour i.e. smoking duration, cigarettes per day, and nicotine dependence. Results: Most participants were female (57.1%), current smokers (53.0%), and current or former e-cigarette users (51.7%). Participants who perceived e-cigarettes as less harmful than smoked tobacco were more likely to have smoked fewer cigarettes per day (p?=?0.008). Furthermore, those who felt uncertain whether e-cigarettes were safer than smoked tobacco, were less likely to have tried them (p?<?0.001). Conclusion: This study suggests that e-cigarette use is becoming common among users of Stop Smoking Services (despite e-cigarettes being unavailable from such services) and that e-cigarette risk perception is related to e-cigarette status. The results highlight the importance of providing smokers intending to quit smoking with current and accurate e-cigarette information. Findings may inform future Stop Smoking Services provision and the results demonstrate that further research is warranted.     

Differences among cigarette-only smokers compared to dual users of cigarettes and little cigars/cigarillos in the criminal justice population

IntroductionThe FDA has restrictions on cigarettes; however, little cigars and cigarillos (LCCs) remain largely absent from these regulations. Due to their low prices and flavoring, many engage in dual use of both LCCs and cigarettes. Dual use is particularly prevalent among low income racial/ethnic minority groups. The purpose of this study was to (U.S. Department of Health and Human Services, 2014) conduct an exploratory examination among cigarette users compared to dual users on smoking characteristics; and (Centers for Disease Control and Prevention, 2016) to examine racial differences (White and Black) among cigarette users compared to dual users.MethodsParticipants (N = 500) were recruited from community corrections (i.e., parole/probation) and categorized as either cigarette-only (66.4%) or dual users (33.6%) if they used little cigars or cigarillos over a one-year period during a smoking cessation clinical trial.ResultsDual users were more likely to be younger, Black, males with lower educational attainment compared to cigarette-only smokers. Smokers with increased nicotine dependence were 17% more likely to be cigarette-only smokers compared to dual users. Racial differences revealed that White/cigarette-only smokers were more likely to report non-menthol use and higher cigarette consumption at the end of treatment compared to Black/cigarette-only or Black/dual users.ConclusionsThis study contributes to our understanding of dual use among a disenfranchised group of smokers. Overall, dual users were more likely to be younger, Black, and male with lower reported nicotine dependence compared to cigarette-only users. Racial differences revealed that non-menthol smokers as well as smokers with greater cigarettes smoked at the end of treatment were more likely White/cigarette-only smokers.