Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA.
Department of Biostatistics & Data Science, University of Kansas School of Medicine, Kansas City, KS, USA.
Nicotine Tob Res. 2021 Oct 7;23(11):1972-1976. doi: 10.1093/ntr/ntab069.
Most adult cigarette smokers who use e-cigarettes are dual cigarette and e-cigarette (CC-EC) users, yet little is known about relative consumption of cigarettes to e-cigarettes and any associated harm reduction.
Rate of substitution from cigarettes to e-cigarettes at week 6 and change in biomarkers of exposure and potential harm were examined among dual dual cigarette and e-cigarette users [64/114 (56%); 35 Black, 29 Latino] in an e-cigarette switching randomized trial.
Dual users averaged 79% substitution of cigarettes for e-cigarettes at week 6, resulting in a reduction from baseline of 70.0 ± 54.1 cigarettes per week (p < .001). Total nicotine consumption remained stable (baseline: 1160.5 ± 1042.1 pg/mL of cotinine, week 6: 1312.5 ± 1725.9 pg/mL of cotinine, p = .47), while significant reductions were seen in the potent lung carcinogen 4-(methylnitrosamino)-1-(3-pyridul)-1-butanol (NNAL) (-55.9 ± 88.6 ng/ml, p < .001), carbon monoxide (-6.3 ± 8.6 ppm, p < .001), and self-reported respiratory symptoms (-3.3 ± 8.0, p = .002). No significant changes were found in blood pressure or spirometry. Greater substitution from cigarettes to e-cigarettes was associated with larger reductions in NNAL (r = -.29, p = .02).
The predominant dual-use pattern was characterized by regular e-cigarette and intermittent cigarette use. Findings demonstrate the short-term harm reduction potential of this dual-use pattern in Black and Latino smokers and suggest that the greatest benefit, aside from cessation of both products, is achieved by higher substitution of e-cigarettes for cigarettes. Findings need confirmation in a larger sample with longer follow-up in dual users with greater variability in the rate of substitution.
CLINICALTRIALS.GOV IDENTIFIER: NCT03511001.
Findings suggest short-term harm reduction potential of dual cigarette-e-cigarette use for Black and Latino smokers. Results also demonstrate the heterogeneity of dual-use, with the greatest harm reduction seen in dual users with higher rates of substitution from cigarettes to e-cigarettes. Study results should be confirmed in a full clinical trial with long-term follow-up to evaluate maintenance of dual-use patterns and associated harm reduction potential over time.
大多数使用电子烟的成年烟民都是同时使用香烟和电子烟的双重使用者（CC-EC 使用者），但人们对香烟与电子烟的相对消费情况以及任何相关的减害作用知之甚少。
在一项电子烟转换随机试验中，我们研究了 114 名双重使用者（64 名/114 名，35 名黑人，29 名拉丁裔）在第 6 周时从香烟向电子烟的替代率，以及暴露和潜在危害的生物标志物变化情况。
双重使用者在第 6 周时平均将 79%的香烟替换为电子烟，导致每周香烟消耗量从基线减少了 70.0±54.1 支（p<0.001）。总尼古丁摄入量保持稳定（基线：1160.5±1042.1 pg/ml 可替宁，第 6 周：1312.5±1725.9 pg/ml 可替宁，p=0.47），而在强肺致癌物 4-（甲基亚硝氨基）-1-（3-吡啶基）-1-丁醇（NNAL）方面观察到显著减少（-55.9±88.6 ng/ml，p<0.001），一氧化碳（-6.3±8.6 ppm，p<0.001）和自我报告的呼吸道症状（-3.3±8.0，p=0.002）。血压或肺活量计没有明显变化。从香烟到电子烟的替代率越高，NNAL 的减少幅度越大（r=-0.29，p=0.02）。
主要的双重使用模式是有规律地同时使用电子烟和间歇性地使用香烟。这些发现表明，在黑人和拉丁裔吸烟者中，这种双重使用模式具有短期的减害潜力，并表明除了同时停止使用两种产品外，最大的益处是通过更高比例的电子烟替代香烟来实现。这些发现需要在更大的样本中，在具有更大替代率变异性的双重使用者中进行更长时间的随访来证实。
临床试验.gov 标识符：NCT03511001。
研究结果表明，黑人和拉丁裔吸烟者同时使用香烟和电子烟具有短期的减害潜力。研究结果还表明，双重使用存在异质性，从香烟向电子烟的替代率越高，双重使用者的危害减少幅度越大。在一项具有长期随访的完整临床试验中，需要确认研究结果，以评估随着时间的推移，双重使用模式及其相关的减害潜力的维持情况。
