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.
Nicotine Tob Res. 2019 Aug 19;21(9):1279-1284. doi: 10.1093/ntr/nty231.
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.
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.
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.
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.
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.
电子烟（e-cigarettes）的出现极大地改变了烟草产品的格局。在美国，有近 600 万成年人同时使用可燃香烟和电子烟（即双重使用者）。本研究的目的是了解吸烟者和双重使用者在人口统计学、香烟依赖和致癌物暴露方面的差异。
一个观察性队列（吸烟者，n=166，≥5 支/天，持续 6 个月，且 3 个月内未使用电子烟；双重使用者，n=256，每天吸烟，过去 3 个月内至少每周使用电子烟一次）完成了人口统计学、烟草使用和依赖的基线评估。他们还提供了呼气样本进行一氧化碳（CO）检测，以及尿液样本进行可替宁、3-羟基可替宁和 4-（甲基亚硝氨基）-1-（3-吡啶基）-1-丁醇（NNAL）检测。
与吸烟者相比，双重使用者（平均电子烟使用量=5.5 天/周[SD=1.9]）年龄明显较小，且更有可能是白人、受教育程度更高、报告有精神共病病史，以及每天吸烟量较少。CO、可替宁或 3-羟基可替宁水平无差异；然而，双重使用者的 NNAL 水平明显低于吸烟者。大多数吸烟者和双重使用者在未来一年内没有戒烟计划；91%的双重使用者计划在未来至少一年内继续使用电子烟。
在这个社区样本中，双重使用者在用电子烟补充吸烟。与吸烟者相比，双重使用者每天吸烟量较少，且推迟了第一支香烟的时间，但戒烟意愿没有差异。
本研究对一个社区样本中的已确立的双重使用者和单纯吸烟者进行了比较，解决了在现实环境中双重使用的依赖和健康风险的关键问题。双重使用者更有可能是白人、年龄较小、受过高中以上教育、有精神病史。双重使用者吸烟量明显较少，NNAL（一种致癌物）水平较低，但与单纯吸烟者在 CO 或可替宁水平上没有差异，这表明他们通过电子烟补充了尼古丁摄入。
