Dual Users Compared to Smokers: Demographics, Dependence, and Biomarkers

Piper, Megan E.; Baker, Timothy B.; Benowitz, Neal L.; Kobinsky, Kate; Jorenby, Douglas E.

doi:10.1093/ntr/nty231

Cited by 63 publications

(45 citation statements)

References 33 publications

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“…Of the 422 participants who were enrolled at baseline, 322 (76.3%) completed the year 1 assessment. Table 1 shows that the smokers and dual users who completed the year 1 assessment differed on multiple baseline variables including race, education, and cigarettes smoked per day, consistent with the findings published previously using the full sample 36 . With respect to attrition during the first year of this observational trial, among the dual users, women were more likely to complete the year 1 assessments than were men (87.8% vs. 74.3%, χ 2 = 7.34, p = .01) and year 1 completers were significantly older than were noncompleters (40.57 [SD = 13.82] vs. 32.51 [SD = 11.93], t = −4.18, p < .001).…”

Section: Resultssupporting

confidence: 86%

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Changes in Use Patterns Over 1 Year Among Smokers and Dual Users of Combustible and Electronic Cigarettes

Piper

Baker

Benowitz

et al. 2019

Nicotine &Amp; Tobacco Research

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Background Dual use of combustible and electronic cigarettes (e-cigarettes) is a growing use pattern; more than half of e-cigarette users are dual users. However, little is known regarding the course of dual use; for example, the likelihood of discontinuation of either combustible or e-cigarettes or both. Methods Adult daily smokers and dual users (daily smokers who also vaped at least once per week) who did not intend to quit use of either product in the next 30 days participated in a longitudinal, observational study (N = 322, 51.2% women, 62.7% white, mean age = 42.27 [SD = 14.05]). At baseline, participants completed demographics and smoking and vaping history assessments. They also reported daily cigarette and e-cigarette use via timeline follow-back assessment and provided a breath sample for carbon monoxide assay at 4-month intervals for 1 year. Results Of those who completed the year 1 follow-up, 1.9% baseline smokers and 8.0% dual users achieved biochemically confirmed seven-day point-prevalence abstinence from combustible cigarettes (χ2 = 4.57, p = .03). Of initial dual users, by 1 year 43.9% were smoking only, 48.8% continued dual use, 5.9% were vaping only, and 1.4% abstained from both products. Among baseline smokers, 92.3% continued as exclusive smokers. Baseline dual users who continued e-cigarette use were more likely to be white and report higher baseline e-cigarette dependence. Conclusions In this community sample, the majority of dual users transitioned to exclusive smoking. A higher percentage of dual users quit smoking than smokers, but attrition and baseline differences between the groups compromise strong conclusions. Sustained e-cigarette use was related to baseline e-cigarette dependence. Implications This research suggests that dual use of combustible and e-cigarettes is not a sustained pattern for the majority of dual users, but it is more likely to be a continued pattern if the user is more dependent on e-cigarettes. There was evidence that dual users were more likely to quit smoking than exclusive smokers, but this may be due to factors other than their dual use.

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Section: Resultssupporting

confidence: 86%

“…See Table 2 for additional baseline e-cigarette use characteristics among dual users. 36 Product Use and Transitions Over 1 Year…”

Section: Resultsmentioning

confidence: 99%

Changes in Use Patterns Over 1 Year Among Smokers and Dual Users of Combustible and Electronic Cigarettes

Piper

Baker

Benowitz

et al. 2019

Nicotine &Amp; Tobacco Research

Self Cite

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“…Termed ‘dual use’, many individuals report concurrent use of electronic cigarettes (e‐cigarettes) and combustible cigarettes (cigarettes) . Dual use could attenuate harm by reducing use of cigarettes with partial substitution of nicotine from e‐cigarettes or increase harm by delaying quitting cigarettes and increasing cumulative exposure to tobacco toxicants . Recent data suggest that, for many, dual use is not a path towards cigarette quitting .…”

Section: Introductionmentioning

confidence: 99%

“…Dual use could attenuate harm by reducing use of cigarettes with partial substitution of nicotine from e‐cigarettes or increase harm by delaying quitting cigarettes and increasing cumulative exposure to tobacco toxicants . Recent data suggest that, for many, dual use is not a path towards cigarette quitting . For example, although most report using e‐cigarettes for smoking cessation , 88% of dual users have continued dual use (44.3%) or cigarette‐only use (43.5%) over 1 year in one study .…”

Section: Introductionmentioning

confidence: 99%

Twenty‐four‐hour subjective and pharmacological effects of ad‐libitum electronic and combustible cigarette use among dual users

et al. 2020

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Background and Aims Relative pharmacological effects of e-cigarettes and cigarettes during 24 hours of ad-libitum use have not been described. In this study, 24-hour blood plasma nicotine concentrations and 48-hour subjective effects with use of cigarettes and e-cigarettes were measured among dual users. Design Two-arm within-subject cross-over design with preferred e-cigarette or cigarette ad-libitum use over 48 hours. Setting Hospital research ward in San Francisco, California, USA. Participants Thirty-six healthy dual users of e-cigarettes and cigarettes (n = 8, 25% females). Measurements Twenty-four-hour blood plasma nicotine and cotinine concentrations and 48-hour self-reported nicotine withdrawal symptoms and rewarding effects. Findings Analyses used analysis of variance (ANOVA)-based mixed models with order of product (e-cigarette or cigarette) and product type (combustible cigarette or type of e-cigarette) as fixed effects, and subject as a repeated effect. During a 24-hour period, e-cigarettes produced lower nicotine exposure than cigarettes for the majority of users, although 25% received more nicotine from e-cigarettes, which was predicted by more frequent e-cigarette use or greater dependence. Compared to cigarette smoking, nicotine exposure for variable-power tank users was similar, while cig-a-like (t (30) = 2.71, P = 0.011, d = 0.745) and fixed-power tank users (t (30) = 3.37, P = 0.002, d = 0.993) were exposed to less nicotine. Cigarettes were rated higher than e-cigarettes on some desirable subjective effects (e.g. psychological reward, t (322) = 7.24 P < 0.001, d = 0.432), but withdrawal symptom reduction was comparable. No differences were found between e-cigarette types, but Bayes factors indicate that these measures were insensitive.Conclusions During a 24-hour period in a hospital setting in the United States, nicotine exposure for dual users of ecigarettes and cigarettes was similar when using cigarettes or variable-power tank devices only but was lower for those using cig-a-like or fixed-power devices only. Despite lower nicotine levels, all types of e-cigarette were effective in preventing withdrawal symptoms. E-cigarettes were rated less rewarding than cigarettes.

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“…Initial studies also suggest significant associations between cigarette QF self‐reports and biological measures among nondaily smokers, 24,25 although a study of Italian teens found poor sensitivity of self‐report relative to hair analysis 26 . Similar studies have indicated strong correlations between QF measures and biomarkers among adolescent vapers 27 and adult daily smokers who also used e‐cigarettes 28 …”

Section: Introductionmentioning

confidence: 98%

Associations Between Self‐Reported and Biological Measures of Nicotine Consumption Among Young Adult Nondaily Cigarette Smokers

et al. 2020

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Background and Objectives Intermittent, dual use of cigarettes and e‐cigarettes is a common pattern among youth and young adults. However, little is known about the validity of self‐report measures of nicotine consumption in these populations. The goal of the present study was to examine associations between self‐reported frequency of cigarette and e‐cigarette use and nicotine levels in hair samples at two assessments 1 year apart. Methods Participants (n = 90; 65% female) were 19‐ to 25‐year‐old intermittent cigarette smokers recruited from the community for a longitudinal study of tobacco use. They submitted hair samples via mail, 1 and 2 years after enrollment in the parent study. Results Findings indicated that days of use of both cigarettes and e‐cigarettes in the past 30 days independently predicted hair nicotine in the full sample, and when examining only timepoints at which any cigarette use was reported. Timepoints when any e‐cigarette use was reported, hair nicotine was positively associated with e‐cigarette but not cigarette frequency. Discussion and Conclusions Data suggest that self‐report measures are valid methods of assessing intermittent use of both cigarettes and e‐cigarettes. Findings also suggest that dual users may tend to consume more nicotine and thus be at greater risk for dependence than single product users. Scientific Significance These results are among the first to indicate that hair analysis can be used to detect intermittent nicotine exposure via both cigarettes and e‐cigarettes. (Am J Addict 2020;29:471–475)

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Dual Users Compared to Smokers: Demographics, Dependence, and Biomarkers

Cited by 63 publications

References 33 publications

Changes in Use Patterns Over 1 Year Among Smokers and Dual Users of Combustible and Electronic Cigarettes

Changes in Use Patterns Over 1 Year Among Smokers and Dual Users of Combustible and Electronic Cigarettes

Twenty‐four‐hour subjective and pharmacological effects of ad‐libitum electronic and combustible cigarette use among dual users

Associations Between Self‐Reported and Biological Measures of Nicotine Consumption Among Young Adult Nondaily Cigarette Smokers

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