Electronic cigarettes for smokers with schizophrenia spectrum disorders

Abstract

Tobacco use is the greatest threat to public health worldwide, killing more than seven million people annually. Globally, people with schizophrenia smoke disproportionately more than the general population and those with other mental illnesses. Consequently, they carry the burden of smoking-attributable morbidity and premature mortality. The risk of serious disease diminishes rapidly after stopping smoking and life-long abstinence is known to reduce the risk of lung cancer, heart disease, stroke, chronic lung disease and other cancers.This research involved three novel contributions to the literature. First, a qualitative study was conducted with 30 current smokers with schizophrenia spectrum disorders, some motivated to stop smoking and others with no intention to quit. This study explored their views regarding traditional cigarettes compared with e-cigarettes and licensed cessation aids or e-cigarettes for smoking cessation or smoking reduction. In interviews, about half of participants (16 of 30) reported an interest in using e-cigarettes to quit or reduce smoking. Of these, four were from the less motivated group, suggesting that e-cigarettes may appeal to schizophrenic smokers not currently considering cessation.Secondly, a quantitative, prospective single-arm pilot study was conducted that investigated the role of e-cigarettes in smoking cessation or reduction for smokers with schizophrenia spectrum disorders. Forty smokers were recruited and 37 of these completed the study. Sixteen participants were CO verified as abstinent from smoking at the end of the study (40%) and 21 (52.5%) significantly reduced their cigarette consumption. The e-cigarette and study procedures were deemed feasible and acceptable to participants. Some adverse events were noted but were rare. Finally, building on these earlier studies, a full protocol for a large multicenter randomised controlled study with long term follow-up was prepared. This protocol could guide the development of a research proposal for a future trial.