Electronic Cigarettes: an Overlooked Tool to Alleviate Disparities in Tobacco Use Disorder Among People with Mental Health and Substance Use Disorders

Abstract

The remarkable decline in cigarette smoking since 1964 has plateaued; approximately 12.5% of Americans still smoke. People who continue to smoke are largely members of marginalized groups, such as people with behavioral health conditions (BHC), encompassing both mental health and substance use disorders. Certified smoking cessation interventions can increase smoking abstinence in trials in people with BHC, yet smoking rates remain markedly increased, leading to increased mortality from smoking-related diseases, and worsening health disparities. A novel approach tailored to the unique needs, characteristics, and circumstances of people with BHC is mandated. One promising approach, the electronic cigarette, has not been embraced in the USA, likely due to an understandable concern for non-smoking young people among whom electronic cigarettes have been popular. Recent data confirm that electronic cigarette use is declining among young people, yet cigarette smoking is not declining among people with BHC. We propose smoking cessation trials utilizing electronic cigarettes in people with BHC. To this goal, the UK has already begun allowing companies to submit their products for approval as medically licensed electronic cigarettes that can be prescribed as smoking cessation aids. Our proposal is timely, backed by evidence, and aims to save hundreds of thousands of American lives.

Arrhythmogenic effects of acute electronic cigarette compared to tobacco cigarette smoking in people living with HIV

“…Within the PLWH study group, we recognized two distinct populations: PLWH who were currently using recreational drugs as evidenced by self‐report and confirmed by urine toxicology screen, and PLWH who were not. Initially we considered excluding PLWH who had a positive toxicology screen, but we realized that by doing so we would be excluding a group chronically understudied, those with behavioral health conditions, who also carry the heaviest smoking burden (Vuong et al., 2023 ). In our post‐hoc analysis of these subgroups, we found that at baseline, demographics were not different between the PLWH‐Drug and PLWH‐No Drug subgroups.…”

“…Switching to electronic cigarettes (ECs), which deliver comparable levels of nicotine accompanied by lower levels of non‐nicotine toxicants and carcinogens compared to combusted TCs, has been proposed as a harm reduction approach in vulnerable populations with high smoking prevalence, such as PLWH, who are unable or unwilling to stop smoking (Cioe et al., 2020 ; Vuong et al., 2023 ). It is important to examine the evidence that forms the foundation of this harm reduction proposal, that is, that ECs, while not harmless, are less harmful than TCs.…”