Arizona Nurse - April 2021

April, May, June 2021 Arizona Nurse • Page 7
E-Cigarette and Subsequent Smoking Use and Relationship
to E-Cigarette Quit Attempts Among College Students
Michelle Correa, RN
Electronic cigarette (e-cigarette) use increased three-fold from 2011
to 2013 and continues to gain prevalence among preteens, adolescents,
and young adults (Centers for Disease Control and Prevention [CDC],
2014). E-cigarettes, including vape, JUUL, and wax pens, are defined as a
device that does not contain tobacco but may include nicotine, flavorings,
and other chemicals (National Cancer Institute, n.d.). With multiple
marketing methods, e-cigarettes dominate in sales by targeting young
and old generations (CDC, 2014). Many youth and young adults believe
that e-cigarettes are cheaper, cleaner, safer, and healthier than traditional
smoking (Gorukanti et al., 2017; Kong et al., 2015). Related to these
perceptions, many young users (40.36%) believe that e-cigarettes help
people discontinue cigarette smoking (Gorukanti et al., 2017). Both nonusers,
who have never used e-cigarettes or cigarettes, and e-cigarette users
agree that e-cigarettes do not contain tar, are not addictive nor considered
a tobacco product, and solely produce vapor with water (Gorukanti et al.,
2017).
Though perceived as a “safer” alternative to cigarettes, e-cigarettes are
still not safe. Research indicates that while e-cigarettes may be a cessation
aid for cigarette smokers, the product may produce the adverse effect of
a nicotine addiction and/or combustible tobacco product use (Kong et al.,
2015; Pattinson et al., 2018). Individuals not aware of the consequences
of e-cigarettes may exacerbate current medical problems (i.e., asthma,
respiratory-related issues, hypertension, cardiovascular diseases), continue
their nicotine addiction through e-cigarette use, or initiate a nicotine
addiction had they not smoked before (CDC, 2014). The U.S. Department
of Health and Human Services (2016) reported consequences related to
e-cigarette use, like addiction, brain development and subsequent mental
health issues, chronic disease development, and death.
In 2020, I conducted a cross-sectional study that included an
anonymous screening survey and a survey that assessed e-cigarette use
and non-electronic smoking, e-cigarette withdrawal and cessation, and
non-electronic smoking quit attempts. I recruited 65 eligible* participants
via flyer advertisements, social media advertisements, ASU online
advertisements, and email notices. The study revealed that participants
who used non-electronic smoking also frequently used cigarettes or
marijuana. Participants who used both electronic and non-electronic
smoking preferred using e-cigarettes to non-electronic forms. Participants
who attempted to quit e-cigarettes believed that they would successfully
withdraw from e-cigarettes by switching to marijuana or avoiding nonelectronic
smoking altogether.
Using these findings and previous research, youth and young adults
seeking e-cigarette cessation need nursing education and intervention. We
can help this population quit by applying principles of the nursing process.
Ask patients about their e-cigarette habits, such as e-cigarette frequency,
perceived e-cigarette harm to self, e-cigarette device, primary flavor
use, nicotine presence, and reason for e-cigarette use. A more objective
scale to assess for e-cigarette use and potential withdrawal severity is the
Fagerström Test for Nicotine Dependence (Carpenter et al., 2010). Find
the most appropriate nursing diagnosis for the patient, such as risk-prone
health behavior. Use motivational interview techniques to promote the
patient to self-assess their willingness and readiness to quit e-cigarettes
(Hettema et al., 2005). Therapeutically communicate with the patient. Hold
your judgment or personal beliefs about the situation because you are
their biggest advocate and ally right now. Offer them interventions to help
them successfully quit e-cigarettes. Start with less invasive options: avoid
triggers such as people or situations; distract yourself with a hobby or task;
talk to someone who has experienced what you’re currently experiencing;
or call the substance abuse helpline (Mayo Clinic Staff, 2016; Malucky,
2010; Substance Abuse and Mental Health Services Administration, 2019).
We can also talk to the provider and ask for medication to help with the
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withdrawal process. Medication may help manage symptoms like anxiety
or depression. All these options give patients the freedom to choose
how they want to quit. They feel in control after a time where they felt
e-cigarettes controlled their life.
We spend the most time with these patients. We are the first line of
defense for identifying and intervening in an e-cigarette user’s habits. We
must uphold that nurse-patient trust and advocate for our patients’ health.
The more we educate ourselves about e-cigarettes and inform our patients,
the more promising outcomes for e-cigarette cessation in the future, like
decreasing e-cigarette popularity and increasing health awareness and
promotion.
*Eligibility criteria included that participant must have been: an ASU student,
at least 18 years old, and “current” e-cigarette user.
Michelle Corerra, BSN, RN, is a nurse with HonorHealth’s COVID-19/Stroke
Unit.
References
Carpenter, M. J., Baker, N. L., Gray, K. M., & Upadhyaya, H. P. (2010). Assessment
of nicotine dependence among adolescent and young adult smokers: A
comparison of measures. Addictive Behaviors, 35(11), 977-982. https://doi-org.
ezproxy1.lib.asu.edu/10.1016/j.addbeh.2010.06.013
Centers for Disease Control and Prevention. (2014). More than a quarter-million
youth who had never smoked a cigarette used e-cigarettes in 2013. Retrieved
from https://www.cdc.gov/media/releases/2014/p0825-e-cigarettes.html
Gorukanti, A., Delucchi, K., Ling, P., Fisher-Travis, R. & Halpern-Felsher, B. (2017).
Adolescents’ attitudes towards e-cigarette ingredients, safety, addictive
properties, social norms, and regulation. Preventive Medicine, 94, 65-71.
https://doi-org.ezproxy1.lib.asu.edu/10.1016/j.ypmed.2016.10.019
Hettema, J., Steele, J., & Miller, W. R. (2005). Motivational interviewing. Annual
Review of Clinical Psychology, 1, 91-111. https://doi.org/10.1146/annurev.
clinpsy.1.102803.143833
Kong, G., Morean, M. E., Cavallo, D. A., Camenga, D. R., & Krishnan-Sarin, S.
(2015). Reasons for electronic cigarette experimentation and discontinuation
among adolescent and young adults. Nicotine and Tobacco Research, 17(7),
847-854. https://doi-org.ezproxy1.lib.asu.edu/10.1093/ntr/ntu257
Mayo Clinic Staff. (2016). Quitting smoking: 10 ways to resist tobacco cravings.
Retrieved from https://www.mayoclinic.org/healthy-lifestyle/quit-smoking/indepth/nicotine-craving/art-20045454
Malucky, A. (2010). Brief evidence-based interventions for nurse practitioners to
aid patients in smoking cessation. The Journal for Nurse Practitioners, 6(2),
126-131. https://doi-org.ezproxy1.lib.asu.edu/10.1016/j.nurpra.2009.05.017
National Cancer Institute. (n.d.). NCI dictionary of cancer terms. Retrieved
from https://www.cancer.gov/publications/dictionaries/cancer-terms/def/
electronic-cigarette
Pattinson, J., Lewis, S., Bains, M., Britton, J., & Langley, T. (2018). Vape shops: Who
uses them and what do they do? BMC Public Health, 18, 541. https://doi.
org/10.1186/s12889-018-5467-9
Substance Abuse and Mental Health Services Administration. (2019). National
helpline. Retrieved from https://www.samhsa.gov/find-help/national-helpline
U.S. Department of Health and Human Services. (2016). E-cigarette use among
youth and young adults: A report of the surgeon general [PDF file]. Retrieved
from https://www.cdc.gov/tobacco/data_statistics/sgr/e-cigarettes/pdfs/2016_
sgr_entire_report_508.pdf
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