E-Cigarettes Popular among Smokers with Existing Illnesses

Current and former smokers suffering from illnesses like chronic lung or cardiovascular disease are more likely to use e-cigarettes, reports the American Journal of Preventive Medicine

Ann Arbor, MI, February 21, 2017

In the U.S. more than 16 million people with smoking-related illnesses continue to use cigarettes. According to a new study in the American Journal of Preventive Medicine, current and former smokers who suffer from disease are more likely to have reported using an e-cigarette, meaning these patients may see e-cigarettes as safer or less harmful than combustible cigarettes and a way to reduce the risks posed by traditional smoking.

Use of electronic cigarettes has significantly increased in recent years. In 2010, only 2% of American adults had ever used an e-cigarette, but by 2014, that number had jumped to 12.6%. While most people see e-cigarettes as a safer alternative to traditional combustible smoking, many questions remain unanswered about their effects.

Using data from the 2014 and 2015 National Health Interview Survey (NHIS), investigators found that current smokers who also suffered from one or more medical conditions were more likely to have used an e-cigarette than “healthy” smokers (those without any comorbidities). The study included 36,697 adults in 2014 and 33,672 adults in 2015.

“This large sample provides the first national estimates of the prevalence of e-cigarette use among U.S. adults with medical comorbidities,” explained lead investigator Gina R. Kruse, MD, MPH, Assistant Professor of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. “Current smokers with medical comorbidities use e-cigarettes at higher rates than smokers without medical comorbidities. Very few never smokers with medical comorbidities have ever used e-cigarettes, except in the youngest age groups.”

The data revealed that not only are smokers with comorbidities more likely to use e-cigarettes, but that e-cigarette use continues to rise, especially among present smokers (47.6% in 2014 vs. 53.5% in 2015). Current smokers with asthma, COPD, or cardiovascular disease reported e-cigarette use more often than other groups. Among former smokers, individuals with COPD reported more e-cigarette use compared to those without chronic disease; however, former smokers with cancer had lower odds of current e-cigarette use.

“Smokers with asthma, COPD, or cardiovascular disease probably use e-cigarettes for the same reasons as other adults: to quit cigarettes, reduce cigarette consumption, or reduce the harms from smoking,” said Dr. Kruse. “Smokers with these chronic diseases may feel an urgent need to quit or reduce combustible cigarette use and may be willing to try new products. Conversely, among adults with cancer, the low prevalence of e-cigarette use may be because even a reduced harm product is seen as too late to help them.”

While health care providers and researchers are still trying to fully understand possible health risks associated with e-cigarettes, there is a growing consensus that their use can possibly help people quit combustible cigarettes and curb tobacco-related risks. Switching to e-cigarettes might have greater positive impact for current smokers with health problems.

“E-cigarette use by current and former smokers with medical comorbidities is substantial, especially among individuals with chronic lung or cardiovascular disease. Clinicians should routinely ask these patients about e-cigarette use, assessing potential risks and benefits in terms of reducing or quitting combustible cigarette use. Clinicians should also actively consider all pathways to help their patients quit combustible cigarettes and recommend evidence-based treatments,” commented Dr. Kruse.

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Notes for editors
The article is "Use of Electronic Cigarettes Among U.S. Adults With Medical Comorbidities," by Gina R. Kruse MD, MPH, Sara Kalkhoran, MD, MAS, Nancy A. Rigotti, MD (http://dx.doi.org/10.1016/j.amepre.2016.12.004). It will appear in the American Journal of Preventive Medicine, volume 52, issue 6 (June, 2017), published by Elsevier.

Full text of this article is available to credentialed journalists upon request; contact Jillian B. Morgan at +1 734-936-1590 or ajpmmedia@elsevier.com. Journalists wishing to interview the authors should contact Julie Cunningham at +1 617 724-6433 or julie.cunningham@mgh.harvard.edu.

Dr. Kruse is supported by the National Institute on Drug Abuse (grant #1K23DA038717-01A1). Dr. Rigotti is supported by the National Heart Lung and Blood Institute (grant #1-R01-HL111821).

About the American Journal of Preventive Medicine
The American Journal of Preventive Medicine is the official journal of The American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials.

The American Journal of Preventive Medicine, with an Impact Factor of 4.465, is ranked 14th in Public, Environmental, and Occupational Health titles and 16th in General & Internal Medicine titles for total number of citations according to the 2015 Journal Citation Reports® published by Thomson Reuters, 2016.

About Elsevier
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Media contact
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Managing Editor, AJPM
+1 734-936-1590
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