Abstract
IntroductionAn estimated 60%–90% of people with schizophrenia smoke, compared with 15%–24% of the general population, exacerbating the already high morbidity and mortality rates observed in this population.Aims and MethodsThis study aimed to assess the feasibility of using a new-generation high strength nicotine e-cigarette to modify smoking behavior in individuals with schizophrenia spectrum disorders who smoke cigarettes. A single-arm pilot study was conducted with 40 adults with schizophrenia spectrum disorders who smoked and did not intend to reduce or quit smoking. Participants were given a 12-week supply of a JUUL e-cigarette loaded with a 5% nicotine pod. The primary outcome was smoking cessation at week 12. Additional outcomes included: smoking reduction, continuous abstinence at week 24, adoption rate, adherence to the e-cigarette, feasibility, acceptability, and subjective effects.ResultsSixteen (40%) participants quit by the end of 12 weeks. For the whole sample, we observed an overall, sustained 50% reduction in smoking or smoking abstinence in 37/40 (92.5%) of participants and an overall 75% reduction in median cigarettes per day from 25 to six was observed by the end of the 12 weeks (p < .001).ConclusionsA high strength nicotine e-cigarette has the potential to help people with schizophrenia spectrum disorders to quit or reduce smoking. Further research with a larger sample and a comparator group is needed. The results provide useful information and direction to augment the existing body of knowledge on smoking cessation for people with schizophrenia spectrum disorders.ImplicationsConsidering that most people with schizophrenia spectrum disorders continue smoking, alternative and efficient interventions to reduce or prevent morbidity and mortality are urgently needed. This study showed that adults who smoke and were not motivated to quit, when provided a new-generation e-cigarette with high nicotine content, demonstrated substantially decreased cigarette consumption without causing significant side effects. Although not specifically measured in this study, nicotine absorption in new-generation devices has been shown to be consistently superior compared with the first generation of e-cigarette devices, and this may help explain the lower quit rates in studies using earlier generation devices.
Highlights
An estimated 60%–90% of people with schizophrenia smoke, compared with 15%– 24% of the general population, exacerbating the already high morbidity and mortality rates observed in this population
The majority of participants (77.5%) reported no aversion to the use of the e-cigarette use and moderate to significant enjoyment (76.1%). 30.1% reported a moderate craving reduction associated with e-cigarette use (Supplementary Table 3). In this single-arm study, we assessed whether participants with schizophrenia spectrum disorder could be recruited, examined the feasibility of offering an e-cigarette, assessed changes to smoking behavior, and evaluated the acceptability of an e-cigarette
Participants were recruited within a 2-month period and the majority (92.5%) completed the study
Summary
An estimated 60%–90% of people with schizophrenia smoke, compared with 15%– 24% of the general population, exacerbating the already high morbidity and mortality rates observed in this population. An estimated 60%–90% of people with schizophrenia smoke, compared with 15%–24% of the adult general population[1,2,3,4,5,6,7]; this group smokes more heavily and is more dependent on tobacco than those without mental illness.[8] Individuals with schizophrenia extract more nicotine from cigarettes compared with those without mental illness and have higher blood levels of nicotine after smoking.[9] Nicotine’s addiction liability is confirmed by the high smoking rates and low quit success rates observed despite its well-known adverse impact on health.[10]. As a result of high smoking rates, people with a mental health condition have high rates of morbidity and mortality compared with the general population.[12,13] quitting smoking is important for this group
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