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标题：Smokers Who Try E-Cigarettes to Quit Smoking: Findings From a Multiethnic Study in Hawaii
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作者：Pallav Pokhrel ; Pebbles Fagan ; Melissa A. Little 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2013
卷号：103
期号：9
页码：e57-e62
DOI：10.2105/AJPH.2013.301453
语种：English
出版社：American Public Health Association
摘要：Objectives. We characterized smokers who are likely to use electronic or “e-”cigarettes to quit smoking. Methods. We obtained cross-sectional data in 2010–2012 from 1567 adult daily smokers in Hawaii using a paper-and-pencil survey. Analyses were conducted using logistic regression. Results. Of the participants, 13% reported having ever used e-cigarettes to quit smoking. Smokers who had used them reported higher motivation to quit, higher quitting self-efficacy, and longer recent quit duration than did other smokers. Age (odds ratio [OR] = 0.98; 95% confidence interval [CI] = 0.97, 0.99) and Native Hawaiian ethnicity (OR = 0.68; 95% CI = 0.45, 0.99) were inversely associated with increased likelihood of ever using e-cigarettes for cessation. Other significant correlates were higher motivation to quit (OR = 1.14; 95% CI = 1.08, 1.21), quitting self-efficacy (OR = 1.18; 95% CI = 1.06, 1.36), and ever using US Food and Drug Administration (FDA)–approved cessation aids such as nicotine gum (OR = 3.72; 95% CI = 2.67, 5.19). Conclusions. Smokers who try e-cigarettes to quit smoking appear to be serious about wanting to quit. Despite lack of evidence regarding efficacy, smokers treat e-cigarettes as valid alternatives to FDA-approved cessation aids. Research is needed to test the safety and efficacy of e-cigarettes as cessation aids. Electronic cigarettes, or e-cigarettes, are battery-powered devices that generate vaporized nicotine or non-nicotine vapor that may be inhaled orally in the manner in which conventional cigarettes are smoked. E-cigarettes deliver the vapor when a cartridge containing nicotine solution is heated. Because e-cigarettes are likely to contain lower levels of toxins or carcinogens than combustible tobacco products, 1 e-cigarettes are commonly promoted as safer alternatives to regular cigarettes and even as smoking cessation aids. 2,3 Currently, the US Food and Drug Administration (FDA) lacks regulations for e-cigarettes as therapeutic drug delivery devices and intends to regulate them as tobacco products. 3 Whether e-cigarettes deserve consideration as possibly effective cessation aids is a subject of ongoing debate. 1,4 Much of the debate has been fueled by the uncertainties regarding the public health risks and benefits of e-cigarette use. 5,6 The FDA has maintained that most available e-cigarettes lack quality control, tend to deliver inconsistent levels of nicotine (which at higher doses can be lethal), and may not be entirely free of toxins or carcinogens. 3 Moreover, the FDA is concerned that e-cigarette use may facilitate tobacco use initiation and increased nicotine addiction among youths and young adults. 3 Recently, however, researchers have drawn attention to the promising aspects of e-cigarettes as cessation or harm reduction devices. 4,7–10 E-cigarettes appear promising as cessation aids because e-cigarettes not only deliver nicotine in the manner in which nicotine replacement therapy does but also closely simulate the experience of smoking combustible tobacco. Moreover, e-cigarettes may have a comparative advantage over current FDA-approved cessation aids in terms of user satisfaction because e-cigarettes seem better suited to address both the pharmacological and the sensorimotor aspects of smoking. 7,11 However, at present the research examining the efficacy of e-cigarettes as cessation aids is in its early stages. In a study involving 40 non–treatment-seeking daily smokers who were assigned to use a particular brand of e-cigarette with the purpose of helping them quit or reduce smoking, 22.5% of participants showed sustained abstinence at 24-week follow-up and an additional 32.5% were found to have reduced their cigarette consumption by half. 12 In another study, a group of first-time purchasers of a brand of e-cigarettes were contacted 6 months after the purchase date. 13 Of the 4.5% of potential participants who responded, 31% reported point prevalence abstinence. Thus, the studies that have suggested that e-cigarettes are likely to be effective as cessation aids have been nonexperimental and based on convenience samples. In addition, although studies have tended to agree that e-cigarettes reduce craving and withdrawal symptoms in abstinent smokers, 14–16 whether e-cigarettes are efficient as nicotine delivery devices is not clear. 14,15,17,18 Hence, the usefulness of e-cigarettes as cessation aids is not certain. However, the popularity of e-cigarettes has continued to soar in the United States and elsewhere. 19–22 According to a recent study, approximately 6% of all adults and 21% of adult current daily smokers in the United States report ever using e-cigarettes. 19 Although the majority of current e-cigarette users seem to report smoking cessation or reduction as the primary motive for e-cigarette use, 11,23–24 limited evidence currently exists regarding smokers’ use of e-cigarettes as cessation aids, especially in the United States. 22 Moreover, limited or no data are available on how smokers’ sociodemographic characteristics, nicotine dependence, smoking behavior, motivation and self-efficacy to quit, quit attempts, and use of FDA-approved cessation aids are related to the likelihood of having ever used e-cigarettes as cessation aids. We addressed these gaps in the literature. Specifically, we examined the prevalence of use of e-cigarettes as cessation aids in a multiethnic sample of adult current daily smokers from Hawaii and examined the associations of sociodemographic factors and smoking- and cessation-related characteristics with ever having used e-cigarettes for smoking cessation. Thus, the results of this study will help guide future research by quantifying the nature of the relationships between e-cigarette use for cessation and smokers’ characteristics, including their cessation-related attitudes and behavior. For example, knowledge about the extent of statistically significant associations of e-cigarette use with demographic and cognitive correlates will help guide the design and analytic aspects of future studies on the etiology of e-cigarette use among current smokers. In addition, the results of this study will help guide future studies testing the efficacy of e-cigarettes as cessation aids. For example, cessation-related variables found to be significant correlates of e-cigarette use for cessation may be tested as potential moderators of the efficacy of e-cigarettes as cessation aids. Thus, this study is likely to advance the research on e-cigarette use, especially among smokers.