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

J Dual Diagn. 2016 Apr-Jun;12(2):109-17. doi: 10.1080/15504263.2016.1172895. Epub 2016 Apr 11.

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 χ(2) 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; dual diagnosis; mental health; mental illness; smoking; substance use disorders; veterans.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Diagnosis, Dual (Psychiatry)
  • Electronic Nicotine Delivery Systems / psychology*
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Male
  • Mental Disorders / epidemiology
  • Mental Disorders / psychology*
  • Mental Health Services
  • Middle Aged
  • Motivation
  • Smoking / psychology*
  • Smoking Cessation
  • Substance-Related Disorders / epidemiology
  • Substance-Related Disorders / psychology*
  • Veterans / psychology*
  • Young Adult