Combined expectancies of alcohol and e-cigarette use relate to higher alcohol use

Abstract

Electronic cigarettes (e-cigs) were created to approximate the look, feel, and experience of using a cigarette. Since cigarette and alcohol use co-occur, we hypothesized that e-cig and alcohol use also co-occur, likely due to shared positive drug expectations. Using self-report data from two independent samples of community-dwelling alcohol using adults, the present study: (1) modified the Nicotine and Other Substance Interaction Expectancy Questionnaire (NOSIE) to assess expectancies of combined e-cig and alcohol use (i.e. the individuals perceived likelihood of using e-cigs and alcohol together; NOSIE-ER); and (2) examined the relationships among e-cig use, expectancies, and alcohol use across e-cig use status. In the first sample (N=692, mean age=32.6, SD = 9.74, 50.7% female, 82.2% Caucasian), exploratory factor analysis suggested the presence of two factors: (1) alcohol use leads to e-cig use (Scale 1; α=0.85); and (2) e-cig use leads to alcohol use (Scale 2; α=0.91). In the second sample (N=714, mean age=34.1, SD=10.89, 47.8% female, 75.6% Caucasian), confirmatory factor analysis supported this factor structure (χ2=47.00, p<0.01, df=19; RMSEA=0.08, 90% CI=0.05–0.11; TLI=0.99; CFI=0.99). Compared to non e-cig users, e-cig users had significantly higher problematic alcohol use in both samples (b’s=0.09 to 0.14, p’s<.05). Expectancies of combined e-cig and alcohol use were significantly related to problematic alcohol use (b’s=−0.92 to 0.26, p’s<.05). In sum, e-cig use is related to alcohol use and expectancies of combined e-cig and alcohol use; consequently, reshaping of beliefs about needs or desires to co-use could be a prime point of intervention.

Transitioning From Cigarettes to Electronic Cigarettes Increases Alcohol Consumption

“…This item had four response options: “A few times a month,” “A few times a week,” “A few times a day”, and “At least ten times per day.” This item has previously been shown to correspond with social versus regular use, with social users reporting less frequent e-cig use than regular users (Hershberger, et al, 2016). Participants were also asked how long they had been using e-cigs (“When did you start using an electronic cigarette?…”

“…This item had three response options: “No”, “Yes, I use e-cigarettes regularly [daily]”, and “Yes, I use e-cigarettes, in social contexts only.” Participants also responded to one cigarette use item (“Have you ever been a cigarette smoker?”). This item had four response options: “No”, “Yes, I smoke cigarettes regularly [daily]”, “Yes, I smoke cigarettes, in social contexts only”, “Yes, I used to smoke cigarettes.” Measures of social versus regular use have been validated as a proxy for e-cig use frequency, and have been shown to differentially predict alcohol use (Hershberger et al, 2016). …”

“…Interestingly, the e-cig use prevalence rate among individuals with substance use disorders (SUDs) is 17% (Peters et al, 2015) and over 50% of these individuals endorse using e-cigs for smoking cessation (Peters et al, 2015). Similar to cigarettes, e-cigs are related to problematic alcohol use (Hershberger, et al, 2016), past 30-day binge drinking (Saddleson et al, 2015), and daily alcohol consumption (Cohn, et al, 2015); as such, this could be particularly worrisome for those with a SUD. In particular, social e-cig users (less frequent users) have higher alcohol use than regular e-cig users (more frequent users); relatedly, this effect has also been shown for those that use both cigarettes and e-cigs (“dual users”; d =0.35; Hershberger, et al, 2016).…”

“…Similar to cigarettes, e-cigs are related to problematic alcohol use (Hershberger, et al, 2016), past 30-day binge drinking (Saddleson et al, 2015), and daily alcohol consumption (Cohn, et al, 2015); as such, this could be particularly worrisome for those with a SUD. In particular, social e-cig users (less frequent users) have higher alcohol use than regular e-cig users (more frequent users); relatedly, this effect has also been shown for those that use both cigarettes and e-cigs (“dual users”; d =0.35; Hershberger, et al, 2016). Thus, alcohol use patterns have been examined in social, regular, and dual e-cig users.…”

“…Although an association has been found between varying types of e-cig use and alcohol use (Cohn, et al, 2015; Hershberger, et al, 2016; Saddleson, et al, 2015), no research has investigated the relationship between alcohol use and e-cig use in former smokers that have transitioned to e-cigs, especially as compared to former smokers not using e-cigs. Such research would help inform e-cig use for smoking cessation; of note, if alcohol use is found to be higher in former smokers that have transitioned to e-cigs, e-cigs could be inadvertently increasing or perpetuating alcohol use and may not be an ideal tool for smoking cessation.…”