E-cigarette Use in Veterans Seeking Mental Health and/or Substance Use Services

abstract

Objective: Individuals with mental illness and substance use disorders smoke at elevated rates and tend to have greater difficulty quitting smoking as compared to the general population. Some believe that e-cigarettes may reduce harm associated with smoking, but little is known about e-cigarette use, perceptions, and motivations for their use among individuals with mental health and/or substance use disorders. Methods: Rates and correlates of e-cigarette use, perceptions, and sources of information about e-cigarettes among smokers seeking mental health and/or substance use services (N = 188) at the VA Connecticut Healthcare System were assessed via a brief survey. The Pearson χ² test of independence was used to compare veterans who currently used e-cigarettes with those who did not. Logistic regression was used to examine independent attitudinal differences controlling for potentially confounding variables. Results: Participants were generally male (90%), Caucasian (54%), and older than 50 (69%), with high rates of at least one mental health condition (82%), at least one substance use disorder (73%), and comorbid mental health and substance use disorders (55%). A relatively high proportion of the sample (30.9%) used e-cigarettes. These participants, compared to those who did not use e-cigarettes, were more likely to have a mental health disorder and less likely to have a substance use disorder, started smoking later in life, spent less money on smoking, and were more likely to have tried to quit “cold turkey.” Knowledge of e-cigarettes originated most often from TV, radio, or personal contacts. Respondents held generally positive perceptions and motivations regarding e-cigarette use (i.e., it is socially acceptable, may help reduce/quit smoking, less harmful to others). Despite positive attributions, rates of dual use of e-cigarettes and traditional cigarettes was high (86.2%), and very few people using e-cigarettes (6.9%) indicated that e-cigarettes actually helped them quit smoking, suggesting little related harm reduction. Conclusions: E-cigarettes are commonly used by smokers with mental health conditions and/or substance use disorders, a high-risk group that feels positive about e-cigarettes. However, positive regard of e-cigarettes did not appear to translate to ability to reduce or quit cigarette smoking. Safety and effectiveness research on e-cigarettes is urgently needed.

KEYWORDS:

• E-cigarettes
• smoking
• mental health
• veterans
• substance use disorders
• dual diagnosis
• mental illness

Disclosures

All authors declare no financial relationships with commercial interest or potential conflicts of interest.

Funding

Dr. Hefner is supported by the VA Connecticut Healthcare System/VISN1 MIRECC and Yale University. Research reported in this publication was supported by the Office of Academic Affiliations, Advanced Fellowship Program in Mental Illness Research Education Clinical, Centers, Department of Veterans Affairs, and the National Institute on Drug Abuse of the National Institutes of Health under Award Number P50DA036151. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.