Objective Individuals with mental illness and substance use disorders smoke at elevated rates and tend to have greater difficulty quitting smoking as compared to the general population. Some believe that e-cigarettes may reduce harm associated with smoking, but little is known about e-cigarette use, perceptions, and motivations for their use among individuals with mental health and/or substance use disorders. Methods Rates and correlates of e-cigarette use, perceptions, and sources of information about e-cigarettes among smokers seeking mental health and/or substance use services (N=188) at the VA Connecticut Healthcare System were assessed via a brief survey. The Pearson χ2 test of independence was used to compare veterans who currently used e-cigarettes with those who did not. Logistic regression was used to examine independent attitudinal differences controlling for potentially confounding variables. Results Participants were generally male (90%), Caucasian (54%), and over the age of 50 (69%), with high rates of at least one mental health condition (82%), at least one substance use disorder (73%), and comorbid mental health and substance use disorders (55%). A relatively high proportion of the sample (30.9%) used e-cigarettes. These participants, compared to those who did not use e-cigarettes, were more likely to have a mental health disorder and less likely to have a substance use disorder, started smoking later in life, spent less money on smoking, and were more likely to have tried to quit “cold turkey.” Knowledge of e-cigarettes originated most often from TV, radio or personal contacts. Respondents held generally positive perceptions and motivations regarding e-cigarette use (i.e., it is socially acceptable, may help reduce/quit smoking, less harmful to others). Despite positive attributions, rates of dual use of e-cigarettes and traditional cigarettes was high (86.2%), and very few people using e-cigarettes (6.9%) indicated that e-cigarettes actually helped them quit smoking, suggesting little related harm reduction. Conclusions E-cigarettes are commonly used by smokers with mental health conditions and/or substance use disorders, a high-risk group that feels positively about e-cigarettes. However, positive regard of e-cigarettes did not appear to translate to ability to reduce or quit cigarette smoking. Safety and effectiveness research on e-cigarettes is urgently needed.

The impact of computer-based cognitive-behavioral self-help therapy programs is limited by high attrition. This study explored reactions to computer-based cognitive-behavioral self-help therapy use among individuals not completing a full treatment course. Individuals receiving outpatient substance use disorder treatment at a Veterans Health Administration clinic who enrolled in a study implementing a computer-based cognitive-behavioral self-help therapy for insomnia, but subsequently dropped out prior to completion, were interviewed. Reactions to use and reasons for attrition were explored through thematic analysis of interviews. Among barriers to use, themes of competing demands, personal attributes, the computer-based format of computer-based cognitive-behavioral self-help therapies, and negative experiences with the specific program used were identified. Among facilitators of use, themes of personal support, the computer-based cognitive-behavioral self-help therapy format, and personal attributes were identified. Recommendations for future implementation efforts to include additional person-to-person contact during computer-based cognitive-behavioral self-help therapy participation were made. These themes may be employed to develop strategies for computer-based cognitive-behavioral self-help therapy implementation in order to maximize program engagement and completion.

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Multiple choice testing is a common but often ineffective method for evaluating learning. A newer approach, however, using Immediate Feedback Assessment Technique (IF AT ® , Epstein Educational Enterprise, Inc.) forms, offers several advantages. In particular, a student learns immediately if his or her answer is correct and, in the case of an incorrect answer, has an opportunity to provide a second response and receive partial credit for a correct second attempt. For a multiple choice question with five possible answers, the IF AT ® form covers spaces labeled A through E with a thin opaque film; when the film is scratched away, a star indicates the correct answer. This study was conducted in order to assess learning after an initial incorrect answer. Based on random chance, students should have mathematically a 25% chance of guessing a correct second answer (i.e. 1 of 4 remaining answers on the IF AT ® form). Analysis of second responses for 8775 questions on IF AT ® forms in 22 classes over 3 years showed that the percent of correct second answers was 44.9%, significantly higher than one might expect from random guessing. This indicates that students learned from an incorrect answer and, possibly by re-reading the problem, were able to demonstrate some level of mastery of the material. This data leads us to conclude that IF AT ® forms are useful assessment tools.