Implications of E-cigarette for Behavioral Health Populations Sharon Cummins, Ph.D. UCSD
The Debate: Electronic Cigarettes with Sharon Cummins, PhD
Jan 14, 2015
From the the first Annual National Conference on Tobacco and Behavioral Health, which occurred May 19-20, 2014 in Bethesda, MD and was hosted by the Central East Addiction Technology Transfer Center, a program of The Danya Institute. You can see videos from the conference on our website www.ceattc.org (go to “Tobacco and Behavioral Health Resources” under “Special Topics”).
The panel will discuss what we know about the use of e-cigarettes and explore the upside (benefits), and the downside (harm), of use. The goal is a thoughtfully informed discussion on this controversial issue.
Sharon Cummins, PhD is an Assistant Professor in the Department of Family and Preventive Medicine at the University of California, San Diego. She also serves as Director of Research and Evaluation at the California Smokers’ Helpline and as faculty for the Center for Tobacco Cessation, both operated through the Moores Cancer Center. Dr. Cummins was trained as a clinical psychologist and maintained a clinical practice for many years. Her research focuses on tobacco use and health disparities. She has been highly involved in conducting large randomized trials testing telephone counseling, pharmacological interventions, and incentives with vulnerable and underserved populations such as low income smokers, pregnant women, smokers with co-morbid substance abuse and depression or other mental health issues, Asian immigrants, and hospitalized smokers. Her recent research has focused on the use of e-cigarettes by individuals with mental health conditions.
The panel will discuss what we know about the use of e-cigarettes and explore the upside (benefits), and the downside (harm), of use. The goal is a thoughtfully informed discussion on this controversial issue.
Sharon Cummins, PhD is an Assistant Professor in the Department of Family and Preventive Medicine at the University of California, San Diego. She also serves as Director of Research and Evaluation at the California Smokers’ Helpline and as faculty for the Center for Tobacco Cessation, both operated through the Moores Cancer Center. Dr. Cummins was trained as a clinical psychologist and maintained a clinical practice for many years. Her research focuses on tobacco use and health disparities. She has been highly involved in conducting large randomized trials testing telephone counseling, pharmacological interventions, and incentives with vulnerable and underserved populations such as low income smokers, pregnant women, smokers with co-morbid substance abuse and depression or other mental health issues, Asian immigrants, and hospitalized smokers. Her recent research has focused on the use of e-cigarettes by individuals with mental health conditions.
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Implications of E-cigarette for Behavioral Health Populations
Sharon Cummins, Ph.D.UCSD
Disclaimer•Not FDA approved•Unknown safety profile•Insufficient data on efficacy•Not endorsing or suggesting you
recommend
Acknowledgements
•Gary Tedeschi PhD•Lesley Copeland MA•Leslie Zoref PhD•Shu-Hong Zhu PhD• Supported by a grant from the NIH/NCI #U01 CA154280
through the State and Community Tobacco Control (SCTC) initiative
Potential problems with e-cigarettes
•Possible gateway for nonsmokers to cigarettes
•Not safe—▫“Water vapor”▫Not all use good product manufacturing
processes▫Calls to poison centers are up
•Could delay or prevent quitting among smokers—end up with dual use
Why consider e-cigarettes?
•E-cigarettes have the potential to act as a nicotine replacement therapy▫Could help individuals quit cigarettes▫Broader appeal = greater reach▫Potential population impact?
•There is no product likely to be deadlier than cigarettes▫Orders of magnitude▫Looking for “game changer”
Most Important reason?
•Credibility
Why consider the behavioral health population in this discussion?•High rates of smoking•Both greater uptake and less cessation•High rates of morbidity and mortality
from smoking•A tobacco disparity population
▫Important that regulations not result in disproportionate harm
Tobacco control among those with behavioral health conditions•Many myths around quitting•Excluded from much of the research•Changing
▫Smoke-free policies in facilities▫Recommendation of greater assistance▫Recognition
Need to quit Want to quit Can quit
E-cigarettes and behavioral health•It’s already happening•High consumers of cigarettes•E-cigarettes are most salient to smokers•Bring data to bear
A way to view e-cigarettes•Perceptions from clinicians—what would
you do if someone wanted to quit using e-cigarettes?▫Physicians▫Paraprofessional cessation counselors
•Data from a national probability survey▫Focus on those with Mental Health
Conditions•Clinical practice implications
Methods•Family Physicians (N=21) from Family
Medicine Department at the UCSD School of Medicine
•Cessation counselors (N=57)
Patient/client interest% Yesof MDs
% Yesof Cessation Counselors
Patients/clients asking
70.0 96.5
Physicians/coaches seeking advice
0 66.7
Beliefs About Health Risks% of MDs % of Cessation
Counselors
Riskier than NRT 14.3 40.4
Riskier than varenicline
33.3 49.1
% Strongly agree % Strongly agree
Exposure to secondhand e-cigarette vapor is harmful
5.0 14.3
E-cigarettes are highly addictive
30.0 33.9
Beliefs About EffectivenessE-cigarettes are an effective quitting aid
% of MDs % of Cessation Counselors
Strongly agree 15.0 0
Somewhat agree 60.0 26.8
Somewhat disagree 15.0 60.7
Strongly disagree 10.0 12.5
Beliefs About Regulation% of MDs
Strongly agree
% of Cessation Counselors
Strongly agree
Should be illegal in places where smoking is illegal
47.6 58.9
Use by minors should be illegal
57.1 73.7
Should be taxed like regular cigarettes
25.0 64.3
Advertisement should be banned like regular cigarettes
33.3 54.4
Summary of Perceptions
•E-cigarettes are relevant•See them as higher in health risks than
NRT or varenicline•See them as not very effective• Important to clinicians that FDA has not
approved them as quit aid•With little data to go on, they are erring on
the side of being against e-cigarettes▫Treat like cigarettes—taxes, advertising,
youth access, use in smoking-restricted areas
Likely answer?
•If a smoker wanted to quit smoking by using e-cigarettes, what would you do?▫Most would discourage him from using
e-cigarettes to quit smoking▫Offer alternative to e-cigarettes such as
NRT, bupropion, varenicline▫Recommend and provide or refer to
behavioral cessation counseling
What if…?
•The patient had tried and been unsuccessful with all the recommended pharmacotherapies (as is true of many with behavioral health issues)?
•Insisted that he would only try to quit if he could use e-cigarettes?
•Was unwilling to give up smoking at all, but was willing to switch to e-cigarettes?
Then need to consider the likely impact of e-cigarettes?•Need to weigh:
▫Potential to prompt a quit attempt▫Ongoing nicotine addiction▫Potential to delay quitting cigarettes
Mental Health Conditions•High smoking prevalence•More difficulty quitting•Use of other tobacco products not known•E-cigarettes
▫Do they use them?▫If so, why?▫Are they likely to use them in the future?
Implications
•Beneficial? ▫Decrease cigarettes▫Increase quitting
•Detrimental?▫Maintain smoking▫Delay quitting
•Tobacco Control Policy▫Accessibility▫Pricing▫Advertising
Methods•Conducted through GfK’s Knowledge
Panel•National probability sample (N=10,041)•Asked about diagnosis of Anxiety
Disorder, Depression, or “Other Mental Health Condition”
•Early 2012
Mental Health Condition by Smoking Status
Never smok-ers (N=3254)
Long-term former
smokers (N=3263)
Recent former smokers (N=413)
Current smokers
(N=3111)
0
5
10
15
20
25
30
13.4
16.4
26.0
27.8
Use of E-cigarettes
Ever e-cig Current e-cig0
2
4
6
8
10
12
14
1614.8
3.1
6.6
1.1
Mental Health Condition
Perc
en
t
Ever Use of E-cigarettes by Smoking Status
Never smokers
(n=3,254)
Long-term former
smokers† (n=3,263)
Recent former
smokers‡ (n=413)
Current smokers
(n=3,111)
Mental Health Condition
0.5 (0-1.0)
3.3 1.1-5.6)
31.0 (19.2-42.8)
40.3(34.6-46.0)
No Mental Health Condition
1.1 (0.6-1.6)
2.2 (1.6-2.9)
25.7 (19.6-31.9)
28.7(25.5-31.9)
Over all1.0
(0.6-1.5)2.4
(1.7-3.1)
26.8(21.4-32.4)
32.2 (29.3-35.0)
† smokers who quit more than 12 months prior to survey‡ smokers who quit within 12 months of taking the survey
Reasons for Using E-cigarettes
Product
Mental Health Condition(N=359)
NoMental Health
Condition(N=813)
Safer than cigarettes54.6
(44.9-64.3)48.5
(42.3-54.7)
Cheaper than cigarettes
36.7 (27.5-45.9)
27.9(22.7-33.1)
Easy to use when I can’t smoke
50.4 (40.6-60.2)
42.5(36.6-48.4)
To try to quit smoking cigarettes
59.6(50.0-69.2)
52.9(46.8-59.0)
Susceptibility to Using E-cigarettes
Never smokers Long-term former
smokers
Recent former smokers
Current smokers
0
10
20
30
40
50
60
70
2.84.9
29.5
60.5
2.6 3.1
23.8
45.3
Mental Health Condition
Perc
en
t
Summary for Individuals with MHC•They are using e-cigarettes•Mostly appeals to smokers•And for the same reason as other smokers
▫To try and quit cigarettes▫Perceived as more safe than cigarettes
•MHC have tried many quitting aids ▫May be looking to try something new
•MHC have higher susceptibility▫Appeals to smokers, not nonsmokers
Clinical Implications
•Encourage long-term use?•Encourage short-term use?•Discourage any use?
Things to think about
•Absolute risk•Relative risk•Your own risk tolerance•Likelihood of quitting without it•Patient’s belief•Your goal
Related Documents
