Leslie Driskill

Significance: American Indians (AI) have a higher prevalence of smoking, higher prevalence of electronic cigarette (EC) use, and higher cancer mortality than most other racial groups, particularly in Oklahoma. However, AI are rarely included in studies of EC use among smokers. As many individuals who smoke also use ECs to reduce harms from cigarettes, understanding correlates of using both products by AI merits greater attention. Methods: In Oklahoma in 2016, 375 AI who smoke and were ages 18 years and older completed a survey collecting demographic information, personal and family history of cancer, perceptions of EC harm and benefits, measures of smoking and dependence, other tobacco use, and EC use by spouse or partner. We defined dual users as using EC within 30 days and every day or some days (n = 44; 12%) and compared dual users to EC never users (n = 137; 37%). Results: Dual users were younger than never users (median 36 vs. 46 years, respectively; p = .01) but did not differ significantly by sex, education, or income. Dual users did not differ significantly from never users in self-reported general health status, personal history of cancer, or other smoking-related medical conditions. Dual users more often reported history of depression (56% vs. 29%; p < .01) and a family history of cancer (lung, head, neck, other) marginally more often than did never users (58% vs. 41%, p = 0.05). While no significant differences were noted for perceived harms of smoking or secondhand smoke, low perceived harm of ECs was more frequent among dual users than never users (64% vs. 24%; p < .01) as well as secondhand vapor (77% vs. 29%; p < .01). Dual users agreed more often that ECs help to quit smoking (75% vs. 16%; p < .01) and are less harmful than smoking (70% vs. 17%; p < .01). Only 9% of dual users did not know or were uncertain about EC harms or benefits, compared to 29% of never users for harms (p < .01) and 38% for benefits (p < .01). Differences between groups were not significant for cigarette consumption, salivary cotinine levels, or smoking dependence scales, but dual users reported a likelihood to quit smoking more often than never users (86% vs. 65%; p = .01), and more often tried to quit in past 12 months (55% vs. 32%; p = .01). Dual users significantly (p ≤ .01) more often ever tried snus (36% vs. 10%), cigars (68% vs. 46%), cigarillos (82% vs. 56%), and hookah (50% vs. 14%) but no differences in ever use of other smokeless tobacco. Among those living with a spouse/partner, dual and never users did not differ in spouse/partner smoking, but dual users much more frequently lived with a spouse/partner who uses ECs (45% vs. 6%; p < .01). Conclusions: EC use is a potential, albeit unproven, harm reduction strategy for people who smoke. The American Cancer Society strongly discourages dual use of EC and cigarettes. This exploratory study of AI found several significant associations with dual EC and cigarette use, but cigarette consumption was similar between groups. It remains to be determined whether ECs will have a role in smoking cessation or reducing cancer health disparities among AI. This abstract is also being presented as Poster A004. Citation Format: Dorothy A. Rhoades, Ashley L. Comiford, Justin D. Dvorak, Kai Ding, Leslie Driskill, Michelle Hopkins, Theodore L. Wagener, Paul Spicer, Mark P. Doescher. Factors associated with dual use of electronic cigarettes among adult American Indians who smoke: A Cherokee Nation cohort study [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr PR01.

IntroductionOne possible reason for the rapid proliferation of waterpipe (WP) smoking is the pervasive use of flavoured WP tobacco. To begin to understand the impact of WP tobacco flavours, the current study examined the impact of a preferred WP tobacco flavour compared with a non-preferred tobacco flavoured control on user’s smoking behaviour, toxicant exposure and subjective smoking experience.MethodThirty-six current WP smokers completed two, 45-minute ad libitum smoking sessions (preferred flavour vs non-preferred tobacco flavour control) in a randomised cross-over design. Participants completed survey questionnaires assessing subjective smoking experience, exhaled carbon monoxide (eCO) testing, and provided blood samples for monitoring plasma nicotine. WP smoking topography was measured continuously throughout the smoking session.ResultsWhile participants reported an enhanced subjective smoking experience including greater interest in continued use, greater pleasure derived from smoking, increased liking and enjoyment, and willingness to continue use after smoking their preferred WP tobacco flavour (p values <0.05), no significant differences were observed in nicotine and carbon monoxide boost between flavour preparations. Greater average puff volume (p=0.018) was observed during the non-preferred flavour session. While not significant, measures of flow rate, interpuff interval (IPI), and total number of puffs were trending towards significance (p values <0.10), with decreased IPI and greater total number of puffs during the preferred flavour session.DiscussionThe current study is the first to examine flavours in WP smoking by measuring preferred versus control preparations to understand the impact on subjective experience, smoking behaviour and toxicant exposure. The pattern of results suggests that even this relatively minor manipulation resulted in significant changes in subjective experience. These results indicate a possible need for regulations restricting flavours in WP tobacco as with combustible cigarettes.

Waterpipe (WP) tobacco smoking delivers many of the same harmful toxicants as cigarette smoking and is on the rise in the US. This study evaluated the feasibility and efficacy of a brief personalized feedback intervention in affecting changes in WP smoking among current WP smokers. Participants (N=109) were recruited as they entered WP lounges and completed a questionnaire and exhaled carbon monoxide (eCO) testing before entering the WP lounge. Participants were cluster-randomized to assessment-only control (AOC) or intervention conditions. The intervention condition received health risk information and personalized feedback on pre- and post-WP session eCO levels. Participants completed a survey at the end of the WP session and at 3-month follow-up. Compared to control, the intervention was effective in increasing knowledge of WP-related harms, correcting risk perceptions, increasing importance of quitting WP smoking, and increasing confidence in ability to quit WP smoking at post-W...

IntroductionOne possible reason for the rapid proliferation of waterpipe (WP) smoking is the pervasive use of flavoured WP tobacco. To begin to understand the impact of WP tobacco flavours, the current study examined the impact of a preferred WP tobacco flavour compared with a non-preferred tobacco flavoured control on user’s smoking behaviour, toxicant exposure and subjective smoking experience.MethodThirty-six current WP smokers completed two, 45-minute ad libitum smoking sessions (preferred flavour vs non-preferred tobacco flavour control) in a randomised cross-over design. Participants completed survey questionnaires assessing subjective smoking experience, exhaled carbon monoxide (eCO) testing, and provided blood samples for monitoring plasma nicotine. WP smoking topography was measured continuously throughout the smoking session.ResultsWhile participants reported an enhanced subjective smoking experience including greater interest in continued use, greater pleasure derived fro...

Significance: American Indians (AI) have a higher prevalence of smoking, higher prevalence of electronic cigarette (EC) use, and higher cancer mortality than most other racial groups, particularly in Oklahoma. However, AI are rarely included in studies of EC use among smokers. As many individuals who smoke also use ECs to reduce harms from cigarettes, understanding correlates of using both products by AI merits greater attention. Methods: In Oklahoma in 2016, 375 AI who smoke and were ages 18 years and older completed a survey collecting demographic information, personal and family history of cancer, perceptions of EC harm and benefits, measures of smoking and dependence, other tobacco use, and EC use by spouse or partner. We defined dual users as using EC within 30 days and every day or some days (n = 44; 12%) and compared dual users to EC never users (n = 137; 37%). Results: Dual users were younger than never users (median 36 vs. 46 years, respectively; p = .01) but did not differ...