John B. Correa

Electronic Nicotine Delivery Systems (''E-cigarettes''): Review of Safety and Smoking Cessation Efficacy

Background and Objectives Cigarette smoking is common among cancer patients and is associated with negative outcomes. Electronic nicotine delivery systems (“e-cigarettes”) are rapidly growing in popularity and use, but there is limited information on their safety or effectiveness in helping individuals quit smoking. Data Sources The authors searched PubMed, Web of Science, and additional sources for published empirical data on safety and use of electronic cigarettes as an aid to quit smoking. Review Methods We conducted a structured search of the current literature up to and including November 2013. Results E-cigarettes currently vary widely in their contents and are sometimes inconsistent with labeling. Compared to tobacco cigarettes, available evidence suggests that e-cigarettes are often substantially lower in toxic content, cytotoxicity, associated adverse effects, and secondhand toxicity exposure. Data on the use of e-cigarettes for quitting smoking are suggestive but ultimately inconclusive. Conclusions Clinicians are advised to be aware that the use of e-cigarettes, especially among cigarette smokers, is growing rapidly. These devices are unregulated, of unknown safety, and of uncertain benefit in quitting smoking. Implications for Practice In the absence of further data or regulation, oncologists are advised to discuss the known and unknown safety and efficacy information on e-cigarettes with interested patients and to encourage patients to first try FDA-approved pharmacotherapies for smoking cessation.

Expectancies for Cigarettes, E-Cigarettes, and Nicotine Replacement Therapies Among E-Cigarette Users (aka Vapers)

INTRODUCTION Use of e-cigarettes has been increasing exponentially, with the primary motivation reported as smoking cessation. To understand why smokers choose e-cigarettes as an alternative to cigarettes, as well as to US Food and Drug Administration (FDA)--approved nicotine replacement therapies (NRT), we compared outcome expectancies (beliefs about the results of drug use) for the three nicotine delivery systems among vapers, i.e., e-cigarette users, who were former smokers. METHODS Vapers (N = 1,434) completed an online survey assessing 14 expectancy domains as well as perceived cost and convenience. We focused on comparisons between e-cigarettes and cigarettes to determine the attraction of e-cigarettes as a smoking alternative and between e-cigarettes and NRT to determine perceived advantages of e-cigarettes over FDA-approved pharmacotherapy. RESULTS Participants believed that e-cigarettes, in comparison to conventional cigarettes, had fewer health risks; caused less craving, withdrawal, addiction, and negative physical feelings; tasted better; and were more satisfying. In contrast, conventional cigarettes were perceived as better than e-cigarettes for reducing negative affect, controlling weight, providing stimulation, and reducing stress. E-cigarettes, compared to NRT, were perceived to be less risky, cost less, cause fewer negative physical feelings, taste better, provide more satisfaction, and be better at reducing craving, negative affect, and stress. Moderator analyses indicated history with ad libitum forms of NRT was associated with less positive NRT expectancies. CONCLUSIONS The degree to which expectancies for e-cigarettes differed from expectancies for either tobacco cigarettes or NRT offers insight into the motivation of e-cigarette users and provides guidance for public health and clinical interventions to encourage smoking-related behavior change.

Gender differences in use and expectancies of E-cigarettes: Online survey results

INTRODUCTION Given the rapid increase in e-cigarette use, it is important to understand factors that may contribute to their initiation and maintenance. Because gender differences in tobacco use, product preferences, and expectancies are well established, similar gender differences may exist with e-cigarettes. The aim of this study was to identify gender differences among e-cigarette users in patterns of use, reasons for initiation and maintenance, and outcome expectancies regarding e-cigarettes. METHODS Participants (N=1815) completed an online survey from August through November, 2013. We assessed sociodemographics, smoking and e-cigarette history and use, and expectancies about e-cigarettes. RESULTS We found gender differences in type of e-cigarette used, flavors used, nicotine dosage, source of information about e-cigarettes, place of purchase, and use of e-cigarettes where smoking is prohibited. In addition, males were more likely to report initiating e-cigarette use to quit smoking due to health concerns, whereas females were more likely to report initiation based on recommendations from family and friends. Males reported higher attributions for maintenance of e-cigarette use related to positive reinforcement (enjoyment), whereas females reported higher negative reinforcement attributions (stress reduction or mood management). Males reported more positive expectancies about e-cigarettes, including taste, social facilitation, and energy, whereas women rated e-cigarettes higher for weight control. Males also reported greater addiction-related e-cigarette expectancy than females. CONCLUSIONS Many of the gender differences with e-cigarettes parallel those previously found with traditional cigarette smoking. Although effect sizes associated with these differences were small, the results may help advance research and intervention development with respect to e-cigarette initiation, maintenance and cessation.

Smoking cessation interventions within the context of Low-Dose Computed Tomography lung cancer screening: A systematic review

The integration of smoking cessation interventions (SCIs) within the context of lung cancer screening programs is strongly recommended by screening guidelines, and is a requirement for Medicare coverage of screening in the US. In Europe, there are no lung cancer screening guidelines, however, research trials are ongoing, and prominent professional societies have begun to recommend lung cancer screening. Little is known about the types and efficacy of SCIs among patients receiving low-dose computed tomography (LDCT) screening. This review addresses this gap. Based on a systematic search, we identified six empirical studies published prior to July 1, 2015, that met inclusion criteria for our review: English language, SCI for LDCT patients, and reported smoking-related outcomes. Three randomized studies and three single-arm studies were identified. Two randomized controlled trials (RCTs) evaluated self-help SCIs, whereas one pilot RCT evaluated the timing (before or after the LDCT scan) of a combined (counseling and pharmacotherapy) SCI. Among the single-arm trials, two observational studies evaluated the efficacy of combined SCI, and one retrospectively assessed the efficacy of clinician-delivered smoking assessment, advice, and assistance. Given the limited research to date, and particularly the lack of studies reporting results from RCTs, assumptions that SCIs would be effective among this population should be made with caution. Findings from this review suggest that participation in a lung screening trial promotes smoking cessation and may represent a teachable moment to quit smoking. Findings also suggest that providers can take advantage of this potentially teachable moment, and that SCIs have been successfully implemented in screening settings. Continued systematic and methodologically sound research in this area will help improve the knowledge base and implementation of interventions for this population of smokers at risk for chronic disease.

E-cigarette use in adults: a qualitative study of users' perceptions and future use intentions.

Abstract Background There has been an exponential increase in the prevalence of e-cigarette use, particularly among youth. However, adult use is also rising, and there have been relatively few qualitative studies with adult users to understand their reasons for use and future use intentions. Such information is needed to inform both prevention and cessation approaches. Method Thirty-one e-cigarette users participated in one of several focus groups assessing the appeal of e-cigarettes as well as comparisons to combustible cigarettes and approved smoking cessation aids. We also obtained perspectives on future use intentions and interest in e-cigarette cessation interventions. Verbatim transcripts were analyzed using the constant comparative method. Results Participants reported several aspects of e-cigarette appeal as compared to approved cessation treatment options. These included similarities to combustible cigarettes, fewer side effects, and control of e-cigarettes to suit personal preferences. Participants were split on whether they preferred flavors that mimicked or contrasted with their combustible cigarettes (i.e. tobacco vs. alternative flavors, such as candy). Some participants who were unmotivated to quit smoking reported an unanticipated disinterest in continuing use of combustible cigarettes shortly after initiating e-cigarettes. Despite strong interest in reducing nicotine dosage, the majority did not intend to fully discontinue e-cigarettes. Conclusions Understanding e-cigarette users’ perspectives can inform policy and treatment development. Regulatory and policy initiatives will need to balance the appealing characteristics of e-cigarettes with the potential for negative public health outcomes.

Smoking as alternative to eating among restrained eaters: effect of food prime on young adult female smokers.

OBJECTIVE Restrained eaters attempt to employ cognitive control over decisions to eat, which leaves them prone to eat in a disinhibited manner. This eating style is associated with elevated rates of smoking compared to the general population. The current study merged smoking and eating research methodology to investigate a mechanism that may underlie this association by testing whether a food prime, which has been found to elicit disinhibited eating in restrained eaters, could also motivate smoking as an alternative to eating. METHOD Using a randomized, 2-arm (Prime/No-Prime) between-subjects design, it was hypothesized that young adult female smokers who endorsed elevated dietary restraint and received a food prime would smoke more when given the option, compared to smokers who did not receive the food prime. RESULTS As predicted, restraint score moderated the effect of the food prime upon smoking behavior (latency to first puff, β = 1, t = 3.8, df = 123, p < .001) and cigarette craving (β = -.79, t = -2.9, df = 127, p < .005), suggesting that after a food prime, restrained-eating smokers may opt to smoke to prevent further food intake. CONCLUSION This study identified a pathway, namely violation of dietary restraint, linking eating and smoking behaviors that may contribute to the population-based covariance between disordered eating and tobacco use.

Effects of experimental negative affect manipulations on ad libitum smoking: a meta-analysis.

AIMS To quantify the effect of negative affect (NA), when manipulated experimentally, upon smoking as measured within laboratory paradigms. Quantitative meta-analyses tested the effects of NA versus neutral conditions on (1) latency to smoke and (2) number of puffs taken. METHODS Twelve experimental studies tested the influence of NA induction, relative to a neutral control condition (n = 1190; range = 24-235). Those providing relevant data contributed to separate random-effects meta-analyses to examine the effects of NA on two primary smoking measures: (1) latency to smoke (nine studies) and (2) number of puffs taken during ad libitum smoking (11 studies). Hedges g was calculated for all studies through the use of post-NA cue responses relative to post-neutral cue responses. This effect size estimate is similar to Cohens d, but corrects for small sample size bias. RESULTS NA reliably decreased latency to smoke (g = -0.14; CI = -0.23 to -0.04; P = 0.007) and increased number of puffs taken (g = 0.14; CI = 0.02 to 0.25; P = 0.02). There was considerable variability across studies for both outcomes (I(2)  = 51 and 65% for latency and consumption, respectively). Potential publication bias was indicated for both outcomes, and adjusted effect sizes were smaller and no longer statistically significant. CONCLUSIONS In experimental laboratory studies of smokers, negative affect appears to reduce latency to smoking and increase number of puffs taken, but this could be due to publication bias.

Perceived Medication Assignment during a Placebo-Controlled Laboratory Study of Varenicline: Temporal Associations of Treatment Expectancies with Smoking-Related Outcomes

RationaleExpectancies regarding treatment assignment may influence outcomes in placebo-controlled trials above and beyond actual treatment assignment. For smoking pharmacotherapies, guessing enrollment in the active medication treatment is associated with higher abstinence rates. However, placebo-controlled trials of smoking pharmacotherapies rarely assess perceived treatment assignment and those that do only collect this information after reaching full dosage.ObjectivesTo determine the temporal relationship between treatment expectancies and smoking-related variables, we assessed the impact of treatment guess during a placebo-controlled laboratory study of varenicline on measures of craving, smoking reward, and smoking reinforcement. We hypothesized that treatment guess at mid-titration would influence smoking-related measures at full dosage, above and beyond actual medication effects. We also explored factors related to guess stability and differences in blind fidelity between mid-drug titration and full dosage.MethodsEighty-eight participants completed laboratory assessments at baseline, mid-titration, and full dosage that involved self-report and behavioral measures of tonic craving, cue-provoked craving, smoking reward, and smoking reinforcement. Participants guessed treatment assignment at mid-titration and full dosage.ResultsGeneralized linear models confirmed that, beyond actual treatment assignment, treatment guess improved model fit for both self-report and behavioral smoking-related measures. Further, accuracy of treatment guess improved from titration to full dosage, and specific demographic factors (e.g., gender, race) were associated with type of treatment guess and guess stability across time.ConclusionsThese results reinforce the importance of assessing perceived treatment assignment repeatedly during placebo-controlled trials and suggest that treatment expectancies during titration can affect outcomes once full dosage has been reached.

A case report demonstrating the efficacy of a comprehensive cognitive-behavioral therapy approach for treating anxiety, depression, and problematic eating in polycystic ovarian syndrome

Despite elevated prevalence of anxiety and depression among women with polycystic ovarian syndrome (PCOS), there is a dearth of evidence-based psychotherapies to treat mood-related symptoms among this population. This case report describes the efficacy of The PCOS Workbook in treating symptoms of anxiety, depression, and problematic eating in a 19-year-old female previously diagnosed with PCOS. Using the cognitive-behavioral framework presented in the workbook, the participant experienced a significant reduction in symptoms of anxiety, depression, problematic eating, and general psychosocial dysfunction while simultaneously losing a significant amount of weight during treatment. Six months after the termination of treatment, the participant maintained several improvements in psychological functioning, although she did report a resumption of problematic eating and experience weight regain. These findings provide initial empirical support for the efficacy of this manualized psychotherapy at improving psychosocial functioning in women with PCOS. Recommendations on ways to best utilize this resource and enhance its long-term efficacy, particularly when intervening for problematic eating, are also discussed.

Electronic cigarette use among patients with cancer: Reasons for use, beliefs, and patient-provider communication

Smoking tobacco cigarettes after a cancer diagnosis increases risk for several serious adverse outcomes. Thus, patients can significantly benefit from quitting smoking. Electronic cigarettes are an increasingly popular cessation method. Providers routinely ask about combustible cigarette use, yet little is known about use and communication surrounding e‐cigarettes among patients with cancer. This study aims to describe patterns, beliefs, and communication with oncology providers about e‐cigarette use of patients with cancer.