E-Cigarette Use Among Adult Primary Care Patients: Results from a Multisite Study
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Primary care settings provide opportunities to identify electronic-cigarette (e-cigarette) use and to implement strategies for changing tobacco use behavior. However, a better understanding of the extent and associated characteristics of e-cigarette use among primary care patients are needed to inform such efforts.
To describe patient demographic and substance use characteristics by e-cigarette use status among a large sample of primary care patients. To examine the prevalence and correlates of e-cigarette use among tobacco users in the sample.
Cross-sectional analysis from a multisite validation study of a substance use screening instrument.
Adult primary care patients aged 18 and older (n = 2000) recruited across 5 primary care clinics in the Eastern USA from 2014 to 2015.
Patients reported past 3-month e-cigarette use, sociodemographics, tobacco use, and other substance use. Current nicotine dependence and DSM-5 criteria for past-year substance use disorders were also assessed.
Among the total sample, 7.7% (n = 154) adults reported past 3-month e-cigarette use. Adults who reported e-cigarette use (vs. no use) were more likely to be younger, white, or have frequent tobacco use, nicotine dependence, or past-year illicit drug use/disorders. Among past 3-month tobacco users, 16.3% reported e-cigarette use. Adjusted logistic regression indicated that odds of e-cigarette use were greater among tobacco users who had some college education or more (vs. < high school) or were daily/almost daily tobacco users (vs. not); odds were lower among Blacks/African-Americans (vs. whites). E-cigarette use among tobacco users was associated with increased odds of current nicotine dependence or tobacco use disorder as well as more severe dependence/disorder.
Enhanced surveillance of e-cigarette use among adult tobacco users in primary care, particularly among those who use tobacco frequently, may have implications for helping patients with tobacco cessation using established approaches including behavioral support, pharmacotherapy, or referral to specialized care.
KEY WORDSprimary care tobacco electronic cigarette e-cigarette vaping
This original data source (CTN-0059) was supported by the US National Institutes of Health (UG1DA040317, UG1DA013034, UG1DA013035, U10DA013727). The secondary data analysis and preparation of this manuscript was made possible by the US National Institutes of Health (UG1DA040317 and R01MD007658). The sponsoring agency had no further role in the study design and analysis, the writing of the report, or the decision to submit the paper for publication. The opinions expressed in this paper are solely those of the authors. The authors thank the study team of the CTN-0059 and all study participants for their time and contributions. The authors thank He Zhu, PhD, for providing help with data analysis.
Compliance with Ethical Standards
Conflict of Interest
Li-Tzy Wu also has received research funding from Patient-Centered Outcomes Research Institute, Duke Endowment, and Centers for Disease Control and Prevention. William S. John also has received research funding from Patient-Centered Outcomes Research Institute. Robert Schwartz has provided consultation to Verily Life Sciences. The other authors have no conflicts of interest to disclose.
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