title: E-cigarette Use in Veterans Seeking Mental Health and/or Substance Use Services.
abstract: Individuals with mental illness and substance use disorders smoke at elevated rates and tend to have greater difficulty quitting smoking as compared to the general population. Some believe that e-cigarettes may reduce harm associated with smoking, but little is known about e-cigarette use, perceptions, and motivations for their use among individuals with mental health and/or substance use disorders.
  
  
  
  Rates and correlates of e-cigarette use, perceptions, and sources of information about e-cigarettes among smokers seeking mental health and/or substance use services (N = 188) at the VA Connecticut Healthcare System were assessed via a brief survey. The Pearson χ(2) test of independence was used to compare veterans who currently used e-cigarettes with those who did not. Logistic regression was used to examine independent attitudinal differences controlling for potentially confounding variables.
  
  
  
  Participants were generally male (90%), Caucasian (54%), and older than 50 (69%), with high rates of at least one mental health condition (82%), at least one substance use disorder (73%), and comorbid mental health and substance use disorders (55%). A relatively high proportion of the sample (30.9%) used e-cigarettes. These participants, compared to those who did not use e-cigarettes, were more likely to have a mental health disorder and less likely to have a substance use disorder, started smoking later in life, spent less money on smoking, and were more likely to have tried to quit "cold turkey." Knowledge of e-cigarettes originated most often from TV, radio, or personal contacts. Respondents held generally positive perceptions and motivations regarding e-cigarette use (i.e., it is socially acceptable, may help reduce/quit smoking, less harmful to others). Despite positive attributions, rates of dual use of e-cigarettes and traditional cigarettes was high (86.2%), and very few people using e-cigarettes (6.9%) indicated that e-cigarettes actually helped them quit smoking, suggesting little related harm reduction.
  
  
  
  E-cigarettes are commonly used by smokers with mental health conditions and/or substance use disorders, a high-risk group that feels positive about e-cigarettes. However, positive regard of e-cigarettes did not appear to translate to ability to reduce or quit cigarette smoking. Safety and effectiveness research on e-cigarettes is urgently needed.
authors.affiliation: a Veterans Health Administration Mental Illness Research, Education and Clinical Center (MIRECC) , West Haven , Connecticut , USA.|b Department of Psychiatry , Yale University School of Medicine , New Haven , Connecticut , USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hefner
authors.affiliation: a Veterans Health Administration Mental Illness Research, Education and Clinical Center (MIRECC) , West Haven , Connecticut , USA.|b Department of Psychiatry , Yale University School of Medicine , New Haven , Connecticut , USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenheck
authors.affiliation: a Veterans Health Administration Mental Illness Research, Education and Clinical Center (MIRECC) , West Haven , Connecticut , USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Merrel
authors.affiliation: a Veterans Health Administration Mental Illness Research, Education and Clinical Center (MIRECC) , West Haven , Connecticut , USA.|b Department of Psychiatry , Yale University School of Medicine , New Haven , Connecticut , USA.
authors.forename: Marcedes
authors.initials: M
authors.lastname: Coffman
authors.affiliation: a Veterans Health Administration Mental Illness Research, Education and Clinical Center (MIRECC) , West Haven , Connecticut , USA.|b Department of Psychiatry , Yale University School of Medicine , New Haven , Connecticut , USA.
authors.forename: Gerry
authors.initials: G
authors.lastname: Valentine
authors.affiliation: a Veterans Health Administration Mental Illness Research, Education and Clinical Center (MIRECC) , West Haven , Connecticut , USA.|b Department of Psychiatry , Yale University School of Medicine , New Haven , Connecticut , USA.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Sofuoglu
mesh_terms: D000293:Adolescent; D000328:Adult; D017831:Diagnosis, Dual (Psychiatry); D066300:Electronic Nicotine Delivery Systems / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology*; D008605:Mental Health Services; D008875:Middle Aged; D009042:Motivation; D012907:Smoking / Q000523:psychology*; D016540:Smoking Cessation; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology*; D014728:Veterans / Q000523:psychology*; D055815:Young Adult
keywords: E-cigarettes; dual diagnosis; mental health; mental illness; smoking; substance use disorders; veterans