Department of Psychiatry, Geisel School of Medicine at Dartmouth, Concord, NH, USA.
C. Everett Koop Institute, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
Nicotine Tob Res. 2022 Aug 6;24(9):1405-1412. doi: 10.1093/ntr/ntac082.
High cigarette smoking prevalence and low quit rates in people with serious mental illness (SMI) contribute to disparate rates of chronic disease and premature death. This prospective trial tested the impact of switching to a potentially lower-harm nicotine-containing product on smoking in this population.
A total of 240 cigarette smokers with SMI who tried but were currently unwilling to quit were randomly assigned to receive disposable e-cigarettes for 8 weeks or not, with assessments at baseline, 2, 4, 6, 8, 13, and 26 weeks. Generalized linear mixed models examined the effects of e-cigarette provision on e-cigarette appeal, cigarettes per day (CPD), breath carbon monoxide (CO), nicotine dependence, and side effects. Clinical Trial registration: NCT03050853.
Self-reported smoking was similar between groups at baseline (mean = 18.7 CPD). By week 2, 79% of the e-cigarette group were using e-cigarettes daily. During weeks 2-8, CPD and CO decreased in the e-cigarette versus assessment-only group (eg, 7.5 CPD [95% CI = 5.9, 9.2] vs. 18.1 CPD [CI = 16.4, 19.8] and 16.4 ppm [CI = 13.4, 19.5] vs. 25.4 ppm [CI = 22.4, 28.9], respectively, at week 2). Additionally, 19%-22% in the e-cigarette group reported smoking no cigarettes in weeks 2-8 compared to 0% in the assessment-only group. By 13 and 26 weeks, group differences in CPD, but not CO, remained significant. Nicotine dependence did not increase and side effects were minor.
Providing e-cigarettes for 8 weeks to smokers with SMI resulted in substantial reductions in CPD and CO. Enhancing and maintaining switching from cigarettes to e-cigarettes warrant further study.
This was the first prospective study to compare e-cigarette provision with assessments only to evaluate the appeal and impact of e-cigarettes on smoking behavior, carbon monoxide exposure, and nicotine dependence among smokers with SMI who had tried but were unable to quit and were not currently interested in cessation treatment. The finding that e-cigarette provision led to significant reductions in smoking and carbon monoxide without increasing nicotine dependence has implications for reducing harm not only among the millions of smokers with SMI who struggle to quit, but also for other vulnerable smokers who cannot achieve cessation.
在患有严重精神疾病（SMI）的人群中，吸烟率高且戒烟率低，这导致他们慢性病和过早死亡的比例存在差异。这项前瞻性试验测试了在该人群中改用潜在危害较小的含尼古丁产品对吸烟的影响。
共有 240 名尝试过但目前不愿意戒烟的 SMI 香烟吸食者被随机分配接受一次性电子烟 8 周或不接受，在基线、2、4、6、8、13 和 26 周进行评估。广义线性混合模型检查了电子烟供应对电子烟吸引力、每日吸烟量（CPD）、呼气一氧化碳（CO）、尼古丁依赖和副作用的影响。临床试验注册：NCT03050853。
两组在基线时的自我报告吸烟量相似（平均 CPD = 18.7）。到第 2 周，79%的电子烟组每天都在使用电子烟。在第 2-8 周期间，电子烟组的 CPD 和 CO 与仅评估组相比有所下降（例如，第 2 周的 CPD 降低 7.5 CPD [95%CI = 5.9, 9.2]，而第 2 周的 CPD 降低 18.1 CPD [CI = 16.4, 19.8]，CO 降低 16.4 ppm [CI = 13.4, 19.5]，而第 2 周的 CO 降低 25.4 ppm [CI = 22.4, 28.9]）。此外，电子烟组中有 19%-22%的人在第 2-8 周内报告没有吸烟，而仅评估组中没有报告。到第 13 和 26 周时，CPD 的组间差异仍然显著，但 CO 没有差异。尼古丁依赖没有增加，副作用也较小。
为 SMI 吸烟者提供 8 周的电子烟，可显著降低 CPD 和 CO。进一步研究增强和维持从香烟到电子烟的转换对吸烟行为、一氧化碳暴露和尼古丁依赖的影响是必要的。
这是第一项前瞻性研究，比较了电子烟供应与仅评估，以评估电子烟对尝试戒烟但未能成功且目前对戒烟治疗不感兴趣的 SMI 吸烟者的吸烟行为、一氧化碳暴露和尼古丁依赖的吸引力和影响。电子烟供应导致吸烟和一氧化碳显著减少而不会增加尼古丁依赖的发现，不仅对数百万难以戒烟的患有 SMI 的吸烟者减少危害有影响，而且对其他无法戒烟的弱势吸烟者也有影响。
