Acceptability, Patterns of Use and Safety of Electronic Cigarette in People with Mental Illness: a Pilot Study(APUS-eCig) | C4C

People with serious mental illness (SMI) are more likely to smoke, are more severely nicotine-dependent, and have higher rates of tobacco-related morbidity and mortality than those in the general population. These smokers attain higher nicotine boosts from smoking, experience stronger positive and negative reinforcing effects of smoking, and have lower smoking cessation rates than equally-dependent smokers without SMI. Smokers who use nicotine replacement therapy (NRT) products for smoking cessation or smoking reduction are more likely to be successful in their attempt than people who do not use NRT. Recently a new electronic nicotine delivery system (ENDS), also known as electronic cigarette (e-cigarette) is rapidly gaining popularity. Little is known about the potential positive and negative effects of novel nicotine delivery devices such as electronic cigarettes in people with SMI. It is possible that people with SMI will substitute e-cigarettes for conventional cigarettes, resulting in reductions in tobacco toxicant exposure and respiratory symptoms without exacerbation of psychiatric symptoms. On the other hand, because of the severity of their nicotine dependence, people with SMI may be prone to dual-use of e-cigs and cigarettes, and lower cessation rates. Given the escalating popularity of e-cigs, there is an urgent need to improve our understanding of both the potential benefits and risks of e-cigs use in this vulnerable population. To do so we propose to conduct a pilot study in 50 people with SMI who are not intending to quit smoking in the near future to undergo a 1-week baseline period in which they continue to smoke their usual cigarettes, a 6-week period in which they are provided with free e-cigs and we observe their e-cig and cigarette use behavior, a 4-week period in which they do not receive free e-cigs and we monitor which products participants choose in the marketplace, and a 24-week follow-up visit at which e-cig and cigarette use behavior is assessed. In weekly study visits, we will assess e-cig and tobacco cigarette use, biomarkers of total nicotine intake and tobacco toxicant exposure, respiratory symptoms, as well as e-cig acceptability, reinforcement, and perceived benefits and risks.