O'Brien Brigid, Knight-West Oliver, Walker Natalie, Parag Varsha, Bullen Christopher
National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand.
Tob Induc Dis. 2015 Mar 24;13(1):5. doi: 10.1186/s12971-015-0030-2. eCollection 2015.
People with mental illness have higher rates of smoking than the general population and are at greater risk of smoking-related death and disability. In smokers from the general population, electronic cigarettes (e-cigarettes) have been shown to have a similar effect on quit rates as nicotine replacement therapy, but little is known about their effect in smokers with mental illness.
Secondary analysis of data from the ASCEND trial involving 657 dependent adult smokers motivated to quit, randomised to 16 mg nicotine e-cigarette, 21 mg nicotine patch, or 0 mg nicotine e-cigarette, with minimal behavioural support. Using self-reported medication use and the Anatomical Therapeutic Chemical Classification System, we identified 86 participants with mental illness and analysed their cessation and smoking reduction outcomes.
For e-cigarettes alone, and all interventions pooled, there was no statistically significant difference in biochemically verified quit rates at six months between participants with and without mental illness, nor in smoking reduction, adverse events, treatment compliance, or acceptability. Rates of relapse to smoking were higher in participants with mental illness. Among this group, differences between treatments were not statistically significant for cessation (patch 14% [5/35], 16 mg e-cigarette 5% [2/39], 0 mg e-cigarette 0% [0/12], p = 0.245), adverse events or relapse rates. However, e-cigarette users had higher levels of smoking reduction, treatment compliance, and acceptability.
The use of e-cigarettes for quitting appears to be equally effective, safe, and acceptable for people with and without mental illness. For people with mental illness, e-cigarettes may be as effective and safe as patches, yet more acceptable, and associated with greater smoking reduction.
Australian New Zealand Clinical trials Registry, number: ACTRN12610000866000.
患有精神疾病的人群吸烟率高于普通人群，且因吸烟导致死亡和残疾的风险更高。在普通人群吸烟者中，电子烟已被证明在戒烟率方面与尼古丁替代疗法有相似效果，但对于其在患有精神疾病的吸烟者中的效果知之甚少。
对ASCEND试验的数据进行二次分析，该试验涉及657名有戒烟意愿的成年依赖吸烟者，随机分为使用16毫克尼古丁电子烟、21毫克尼古丁贴片或0毫克尼古丁电子烟组，行为支持极少。我们通过自我报告的药物使用情况和解剖治疗化学分类系统，识别出86名患有精神疾病的参与者，并分析了他们的戒烟和减少吸烟量的结果。
仅就电子烟而言，以及将所有干预措施合并来看，在6个月时，有精神疾病和无精神疾病的参与者在经生化验证的戒烟率方面，以及在减少吸烟量、不良事件、治疗依从性或可接受性方面，均无统计学上的显著差异。患有精神疾病的参与者复吸率更高。在这一组中，不同治疗方法在戒烟（贴片组14% [5/35]，16毫克电子烟组5% [2/39]，0毫克电子烟组0% [0/12]，p = 0.245）、不良事件或复吸率方面的差异无统计学意义。然而，使用电子烟的参与者减少吸烟量的程度更高、治疗依从性更好且可接受性更强。
对于有或没有精神疾病的人来说，使用电子烟戒烟似乎同样有效、安全且可接受。对于患有精神疾病的人而言，电子烟可能与贴片一样有效和安全，但更易接受，且能带来更大程度的吸烟量减少。
澳大利亚新西兰临床试验注册中心，编号：ACTRN126100008
