Electronic Nicotine Delivery Systems and Smoking Cessation in Arkansas, 2014

Abstract

Objectives: As of October 2015, evidence needed to make a recommendation about the use of electronic nicotine delivery systems (ENDS) for smoking cessation was limited. We used the 2014 Arkansas Behavioral Risk Factor Surveillance System with additional state-specific questions to determine the prevalence of ENDS use, the impact of ENDS use on smoking cessation, and beliefs about ENDS use in Arkansas. Our objectives were to determine if (1) ENDS use was associated with lower odds of quitting smoking, (2) ENDS users believed that ENDS use was not harmful to their health, and (3) ENDS users believed that switching to ENDS reduced their tobacco-related health risks. Methods: We conducted a cross-sectional study of 4465 respondents to the Arkansas Behavioral Risk Factor Surveillance System and used weighted analyses to account for the complex survey design. We used a subset of records formed by (1) formers smokers who quitted smoking in the last 5 years and (2) current smokers to assess the odds of quitting.Results: In 2014, 6.1% (95% confidence interval [CI], 5.0%-7.4%) of Arkansas adults were currently using ENDS. Of the 1083 participants who were current smokers or had quit smoking within the past 5 years, 515 (54.1%) had used ENDS. Of the 515 ENDS users, 404 (80.3%) had continued smoking. ENDS use was significantly associated with reduced odds of quitting smoking (weighted odds ratio ¼ 0.53; 95% CI, 0.34-0.83). Although 2437 of 3808 participants (62.5%) believed that it was harmful for nonsmokers to start using ENDS and 1793 of 3658 participants (47.0%) believed that switching to ENDS did not reduce tobacco-related health risks, only 80 of 165 (41.3%) and 50 of 168 (33.9%) ENDS users shared these same respective beliefs. Conclusions:Most smokers who indicated smoking in the past 5 years and who tried ENDS did not stop smoking. ENDS use was inversely associated with smoking cessation. Tobacco cessation programs should tell cigarette smokers that ENDS use may not help them quit smoking. KeywordsArkansas, beliefs, electronic cigarettes, prevalence, smoking cessation Electronic nicotine delivery systems (ENDS) were introduced in the United States in 2007.1 ENDS refers to disposable and refillable electronic cigarettes, known as e-cigarettes, and newer devices, such as cartomizers and atomizers. By 2015, an estimated 24.1% of high school students in the United States were current ENDS users, making ENDS the most commonly used tobacco product among teenagers, whereas current cigarette smoking was at

Use of Electronic Nicotine Delivery Systems (ENDS) by pregnant women I: Risk of small-for-gestational-age birth

“…In this study population of a low-risk pregnancy clinic, consisting of low-income pregnant women residing in an ethnically diverse population, we estimated a 6.8% prevalence for current ENDS use during pregnancy. This is consistent with the 6.1% estimate of current ENDS-using adults from the 2014 Arkansas BRFSS 33 and a national study of pregnant women 1 . Consistent with the latter source, we also found that 75.0% of ENDS users were current cigarette smokers.…”

“…The Behavioral Risk Factor Surveillance System (BRFSS) estimated the prevalence of smoking in adults in Arkansas to be 24.8% in 2014, among the highest in the nation 31,32 . Given the high-risk for ENDS use, we had analyzed data from the Arkansas BRFSS on ENDS use and found that 6.1% of adults reported using ENDS within the past month 33 . Considering highly relevant a study to describe the prevalence of current ENDS use in pregnant women, we aim to: 1) assess the validity of self-reported ENDS use and cigarette smoking using salivary cotinine, exhaled carbon monoxide (CO), and hair nicotine as gold-standards; 2) examine the association of ENDS use during pregnancy with birth weight and the risk of SGA; and 3) reassess the association with the risk of SGA correcting for misclassification by self-report of tobacco use.…”

Use of electronic nicotine delivery systems by pregnant women II: Hair biomarkers for exposures to nicotine and tobacco-specific nitrosamines

“…The GM for nicotine in hair samples of pregnant smokers are in agreement with reports of studies that examined nicotine in the hair of non-pregnant smokers 38 . Surprisingly, instead of observing lower levels of nicotine in dual ENDS users in our population of pregnant women, we found that nicotine, cotinine, NNK, and NNAL levels, in hair samples of dual users were consistently higher (although not statistically significantly higher) than those in hair samples of smokers.…”

“…The introduction and marketing of ENDS has changed the method of delivery and behaviors involved in nicotine consumption, adding a layer of complexity to the study of tobacco use 37 . Social media marketing of ENDS often promotes these devices as ‘safer’ than regular cigarettes, and often claims are made that ENDS ‘aid’ smoking cessation 38 . A higher percentage of current smokers than non-smokers in Arkansas believe they can reduce the harmful effects of smoking by switching or substituting cigarettes with ENDS 38 .…”

“…Social media marketing of ENDS often promotes these devices as ‘safer’ than regular cigarettes, and often claims are made that ENDS ‘aid’ smoking cessation 38 . A higher percentage of current smokers than non-smokers in Arkansas believe they can reduce the harmful effects of smoking by switching or substituting cigarettes with ENDS 38 .…”