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Implications of E-cigarette for Behavioral Health Populations

Implications of E-cigarette for Behavioral Health Populations. Sharon Cummins, Ph.D. UCSD. Disclaimer. Not FDA approved Unknown safety profile Insufficient data on efficacy Not endorsing or suggesting you recommend. Acknowledgements. Gary Tedeschi PhD Lesley Copeland MA Leslie Zoref PhD

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Implications of E-cigarette for Behavioral Health Populations

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  1. Implications of E-cigarette for Behavioral Health Populations Sharon Cummins, Ph.D. UCSD

  2. Disclaimer • Not FDA approved • Unknown safety profile • Insufficient data on efficacy • Not endorsing or suggesting you recommend

  3. Acknowledgements • Gary Tedeschi PhD • Lesley Copeland MA • Leslie Zoref PhD • Shu-Hong Zhu PhD • Supported by a grant from the NIH/NCI #U01 CA154280 through the State and Community Tobacco Control (SCTC) initiative

  4. Potential problems with e-cigarettes • Possible gateway for nonsmokers to cigarettes • Not safe— • “Water vapor” • Not all use good product manufacturing processes • Calls to poison centers are up • Could delay or prevent quitting among smokers—end up with dual use

  5. Why consider e-cigarettes? • E-cigarettes have the potential to act as a nicotine replacement therapy • Could help individuals quit cigarettes • Broader appeal = greater reach • Potential population impact? • There is no product likely to be deadlier than cigarettes • Orders of magnitude • Looking for “game changer”

  6. Most Important reason? • Credibility

  7. Why consider the behavioral health population in this discussion? • High rates of smoking • Both greater uptake and less cessation • High rates of morbidity and mortality from smoking • A tobacco disparity population • Important that regulations not result in disproportionate harm

  8. Tobacco control among those with behavioral health conditions • Many myths around quitting • Excluded from much of the research • Changing • Smoke-free policies in facilities • Recommendation of greater assistance • Recognition • Need to quit • Want to quit • Can quit

  9. E-cigarettes and behavioral health • It’s already happening • High consumers of cigarettes • E-cigarettes are most salient to smokers • Bring data to bear

  10. A way to view e-cigarettes • Perceptions from clinicians—what would you do if someone wanted to quit using e-cigarettes? • Physicians • Paraprofessional cessation counselors • Data from a national probability survey • Focus on those with Mental Health Conditions • Clinical practice implications

  11. Methods • Family Physicians (N=21) from Family Medicine Department at the UCSD School of Medicine • Cessation counselors (N=57)

  12. Patient/client interest

  13. Beliefs About Health Risks

  14. Beliefs About Effectiveness

  15. Beliefs About Regulation

  16. Summary of Perceptions • E-cigarettes are relevant • See them as higher in health risks than NRT or varenicline • See them as not very effective • Important to clinicians that FDA has not approved them as quit aid • With little data to go on, they are erring on the side of being against e-cigarettes • Treat like cigarettes—taxes, advertising, youth access, use in smoking-restricted areas

  17. Likely answer? • If a smoker wanted to quit smoking by using e-cigarettes, what would you do? • Most would discourage him from using e-cigarettes to quit smoking • Offer alternative to e-cigarettes such as NRT, bupropion, varenicline • Recommend and provide or refer to behavioral cessation counseling

  18. What if…? • The patient had tried and been unsuccessful with all the recommended pharmacotherapies (as is true of many with behavioral health issues)? • Insisted that he would only try to quit if he could use e-cigarettes? • Was unwilling to give up smoking at all, but was willing to switch to e-cigarettes?

  19. Then need to consider the likely impact of e-cigarettes? • Need to weigh: • Potential to prompt a quit attempt • Ongoing nicotine addiction • Potential to delay quitting cigarettes

  20. Mental Health Conditions • High smoking prevalence • More difficulty quitting • Use of other tobacco products not known • E-cigarettes • Do they use them? • If so, why? • Are they likely to use them in the future?

  21. Implications • Beneficial? • Decrease cigarettes • Increase quitting • Detrimental? • Maintain smoking • Delay quitting • Tobacco Control Policy • Accessibility • Pricing • Advertising

  22. Methods • Conducted through GfK’s Knowledge Panel • National probability sample (N=10,041) • Asked about diagnosis of Anxiety Disorder, Depression, or “Other Mental Health Condition” • Early 2012

  23. Mental Health Condition by Smoking Status

  24. Use of E-cigarettes

  25. Ever Use of E-cigarettes by Smoking Status † smokers who quit more than 12 months prior to survey ‡ smokers who quit within 12 months of taking the survey

  26. Reasons for Using E-cigarettes

  27. Susceptibility to Using E-cigarettes

  28. Summary for Individuals with MHC • They are using e-cigarettes • Mostly appeals to smokers • And for the same reason as other smokers • To try and quit cigarettes • Perceived as more safe than cigarettes • MHC have tried many quitting aids • May be looking to try something new • MHC have higher susceptibility • Appeals to smokers, not nonsmokers

  29. Clinical Implications • Encourage long-term use? • Encourage short-term use? • Discourage any use?

  30. Things to think about • Absolute risk • Relative risk • Your own risk tolerance • Likelihood of quitting without it • Patient’s belief • Your goal

  31. Questions? • scummins@ucsd.edu

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