December 4, 2014

Stanton A. Glantz, PhD

E-cigarettes are not helping people with mental illness quit smoking

The harm reduction enthusiasts often point to the fact that people with mental illness have hihger smoking rates than thee general public and suggest that this group would particularly benefit from using e-cigarettes.
 
Jodi Prochaska and Rachel Grana examined the relationship between e-cigarette use and quitting cigarettes in people with serious mental illness enrolled in a clinical trial of different smoking cessation therapies (usual care, brief treatment, and extended treatment).  While the trial was not examining e-cigarettes as one of the interventions -- the trial started before the e-cigarette market started growing rapidly -- the investigators recorded e-cigarette use among participants.
 
They found that e-cigarette use grew over time, but was not associated with increased quitting or even greater cigarette consumption than people not using e-cigarettes.
 
Here is the abstract:
 
Background
We examined electronic cigarette (EC) use, correlates of use, and associated changes in smoking behavior among smokers with serious mental illness in a clinical trial.
Methods
Adult smokers were recruited during acute psychiatric hospitalization (N = 956, 73% enrollment among approached smokers) in the San Francisco Bay Area between 2009–2013. At baseline, participants averaged 17 (SD = 10) cigarettes per day for 19 (SD = 14) years; 24% intended to quit smoking in the next month. Analyses examined frequency and correlates of EC use reported over the 18-month trial and changes in smoking behavior by EC use status.
Findings
EC use was 11% overall, and by year of enrollment, increased from 0% in 2009 to 25% in 2013. In multiple logistic regression, the likelihood of EC use was significantly greater with each additional year of recruitment, for those aged 18–26, and for those in the preparation versus precontemplation stage of change, and unlikely among Hispanic participants. EC use was unrelated to gender, psychiatric diagnosis, and measures of tobacco dependence at baseline. Further, over the 18-month trial, EC use was not associated with changes in smoking status or, among continued smokers, with reductions in cigarettes per day.
Interpretation
Within a clinical trial with smokers with serious mental illness, EC use increased over time, particularly among younger adults and those intending to quit tobacco. EC use was unrelated to changes in smoking. The findings are of clinical interest and warrant further study.
 
The full paper, "E-Cigarette Use among Smokers with Serious Mental Illness," is available for free in PLoS One here.

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