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Dual Users Compared to Smokers: Demographics, Dependence, and Biomarkers.
Nicotine Tob Res. 2019 08 19; 21(9):1279-1284.NT

Abstract

INTRODUCTION

The availability of electronic cigarettes (e-cigarettes) has profoundly changed the tobacco product landscape. In the United States, almost 6 million adults use both combustible and e-cigarettes (ie, dual users). The goal of this study was to understand how smokers and dual users differ in terms of demographics, cigarette dependence, and exposure to carcinogens.

METHODS

An observational cohort (smokers, n = 166, ≥5 cigarettes/day for 6 months and no e-cigarette use in 3 months; dual users, n = 256, smoked daily for 3 months and used e-cigarettes at least once/week for the past 3 months) completed baseline assessments of demographics, tobacco use, and dependence. They also provided breath samples for carbon monoxide (CO) assay and urine samples for cotinine, 3-hydroxycotinine, and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) assays.

RESULTS

Compared to smokers, dual users (mean e-cigarette use = 5.5 days/week [SD = 1.9]) were significantly younger and more likely to be white, have more education, report a history of psychiatric co-morbidity, and smoke fewer cigarettes per day. There were no differences in CO, cotinine, or 3-hydroxycotinine levels; however, dual users had significantly lower levels of NNAL than did smokers. Most smokers and dual users had no plans to quit smoking within the next year; 91% of dual users planned to continue using e-cigarettes for at least the next year.

CONCLUSIONS

In this community sample, dual users are supplementing their smoking with e-cigarette use. Dual users, versus smokers, smoked fewer cigarettes per day and delayed their first cigarette of the day, but did not differ in quitting intentions.

IMPLICATIONS

This comparison of a community sample of established dual users and exclusive smokers addresses key questions of dependence and health risks of dual use in real-world settings. Dual users were more likely to be white, younger, have more than a high school education and have a psychiatric history. Dual users also smoked significantly fewer cigarettes and had lower levels of NNAL (a carcinogen), but they did not differ from exclusive smokers in CO or cotinine levels, suggesting that they supplemented their nicotine intake via e-cigarettes.

Authors+Show Affiliations

Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI.Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI.Center for Tobacco Control Research and Education, Department of Medicine, University of California San Francisco, San Francisco, CA.Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI.Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI.

Pub Type(s)

Comparative Study
Journal Article
Observational Study
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

30365010

Citation

Piper, Megan E., et al. "Dual Users Compared to Smokers: Demographics, Dependence, and Biomarkers." Nicotine & Tobacco Research : Official Journal of the Society for Research On Nicotine and Tobacco, vol. 21, no. 9, 2019, pp. 1279-1284.
Piper ME, Baker TB, Benowitz NL, et al. Dual Users Compared to Smokers: Demographics, Dependence, and Biomarkers. Nicotine Tob Res. 2019;21(9):1279-1284.
Piper, M. E., Baker, T. B., Benowitz, N. L., Kobinsky, K. H., & Jorenby, D. E. (2019). Dual Users Compared to Smokers: Demographics, Dependence, and Biomarkers. Nicotine & Tobacco Research : Official Journal of the Society for Research On Nicotine and Tobacco, 21(9), 1279-1284. https://doi.org/10.1093/ntr/nty231
Piper ME, et al. Dual Users Compared to Smokers: Demographics, Dependence, and Biomarkers. Nicotine Tob Res. 2019 08 19;21(9):1279-1284. PubMed PMID: 30365010.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dual Users Compared to Smokers: Demographics, Dependence, and Biomarkers. AU - Piper,Megan E, AU - Baker,Timothy B, AU - Benowitz,Neal L, AU - Kobinsky,Kate H, AU - Jorenby,Douglas E, PY - 2018/06/06/received PY - 2018/10/23/accepted PY - 2018/10/27/pubmed PY - 2020/4/21/medline PY - 2018/10/27/entrez SP - 1279 EP - 1284 JF - Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco JO - Nicotine Tob Res VL - 21 IS - 9 N2 - INTRODUCTION: The availability of electronic cigarettes (e-cigarettes) has profoundly changed the tobacco product landscape. In the United States, almost 6 million adults use both combustible and e-cigarettes (ie, dual users). The goal of this study was to understand how smokers and dual users differ in terms of demographics, cigarette dependence, and exposure to carcinogens. METHODS: An observational cohort (smokers, n = 166, ≥5 cigarettes/day for 6 months and no e-cigarette use in 3 months; dual users, n = 256, smoked daily for 3 months and used e-cigarettes at least once/week for the past 3 months) completed baseline assessments of demographics, tobacco use, and dependence. They also provided breath samples for carbon monoxide (CO) assay and urine samples for cotinine, 3-hydroxycotinine, and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) assays. RESULTS: Compared to smokers, dual users (mean e-cigarette use = 5.5 days/week [SD = 1.9]) were significantly younger and more likely to be white, have more education, report a history of psychiatric co-morbidity, and smoke fewer cigarettes per day. There were no differences in CO, cotinine, or 3-hydroxycotinine levels; however, dual users had significantly lower levels of NNAL than did smokers. Most smokers and dual users had no plans to quit smoking within the next year; 91% of dual users planned to continue using e-cigarettes for at least the next year. CONCLUSIONS: In this community sample, dual users are supplementing their smoking with e-cigarette use. Dual users, versus smokers, smoked fewer cigarettes per day and delayed their first cigarette of the day, but did not differ in quitting intentions. IMPLICATIONS: This comparison of a community sample of established dual users and exclusive smokers addresses key questions of dependence and health risks of dual use in real-world settings. Dual users were more likely to be white, younger, have more than a high school education and have a psychiatric history. Dual users also smoked significantly fewer cigarettes and had lower levels of NNAL (a carcinogen), but they did not differ from exclusive smokers in CO or cotinine levels, suggesting that they supplemented their nicotine intake via e-cigarettes. SN - 1469-994X UR - https://www.unboundmedicine.com/medline/citation/30365010/Dual_Users_Compared_to_Smokers:_Demographics_Dependence_and_Biomarkers_ DB - PRIME DP - Unbound Medicine ER -