Electronic nicotine delivery system use behaviour and loss of autonomy among American Indians: results from an observational study

Introduction:
This text provides an analysis of the use and dependence data on electronic nicotine delivery system (ENDS) users of American Indian (Al) descent, a minority population in the USA with high rates of tobacco-related disease and often under-represented in epidemiologic and clinical research. The study describes a novel method for assessing loss of autonomy, a core feature of dependence, in ENDS users by adapting the Hooked on Nicotine Checklist.

Key Points:

* The study focused on describing use behaviors and loss of autonomy, a core feature of dependence, in Al exclusive ENDS users and dual users of ENDS and cigarettes.
* Exclusive cigarette smokers of Al descent were also included for comparison purposes.
* Participants were recruited through community-based strategies and were required to be regular users of cigarettes and/or ENDS.
* Data on age, gender, marital status, education level, employment status, body mass index, and traditional tobacco use were collected.
* Participants were asked about their use of tobacco for sacred or ceremonial purposes.
* ENDS and dual users were asked to select the photo(s) which best represented the ENDS they currently used and to report all flavors they currently used.
* The frequency of ENDS use was assessed using a statement provided by the Ontario Tobacco Research Center.
* The Hooked on Nicotine Checklist (HONC), a 10-item screening tool, was used to assess loss of autonomy in both adolescents and adults and was reworded for ENDS.
* Dual users completed the HONC twice, once with regard to cigarettes and once with regard to ENDS.
* Loss of autonomy over cigarettes was summarized using both continuous scores (0-10) and a dichotomous measure (0=full autonomy; 2l=diminished autonomy).

Main Message:
The study provides important use and dependence data on ENDS users of Al descent, a minority population that is often under-represented in research. The results will be significant for regulatory authorities, such as the US FDA CTP, and public health officials who are actively trying to understand ENDS use behavior and dependence in priority populations such as Ais. The study demonstrates the need for further research in this area to fully understand ENDS use patterns and dependence levels in this population.

Carroll, Dana Mowls, Theodore L Wagener, David M Thompson, Lancer D Stephens, Jennifer D Peck, Janis E Campbell, and Laura A Beebe. “Electronic Nicotine Delivery System Use Behaviour and Loss of Autonomy among American Indians: Results from an Observational Study.” BMJ Open 7, no. 12 (December 2017): e018469. https://doi.org/10.1136/bmjopen-2017-018469.