Attitudes and Risk Perceptions of Electronic Nicotine Delivery Systems (ENDS) Use Among Adults with Mental Health Disorders
Abstract
The rates of tobacco use among U.S. adults have been steadily decreasing over the past
few years; however, the decline in smoking has been replaced with an increase in the use
of Electronic Nicotine Delivery Systems (ENDS). ENDS are battery operated devices
which involve the heating of an “e-liquid” to produce a vapor or aerosol which is then
inhaled by the user, and are often referred to as “vapes, e-cigs, e-cigarettes, and vaporizers.”
Individuals with mental health disorders smoke combustible cigarettes and use ENDS
products at disproportionately higher rates than the general population. To date, research
has not examined the perceptions of ENDS use and their associated health risks and/or their
role in managing psychological symptoms among those with mental health disorders.
Additionally, no studies have examined the attitudes of those with mental health disorders
about secondhand vapors from ENDS products and how they impact their vaping behaviors
around others, including children. This study aims to address these gaps within the
literature. A total of 48 adult participants were enrolled in the study. Of the participants
enrolled, the majority were female (83.3%, n= 40), followed by males (10.4%, n= 5), two
Transgender individuals (4.2%), and one person who identified as “other” (2.1%). The
mean age of the sample was 33 years old, with an age range of 18-67 years. Participants
were categorized into ENDS users and Non-ENDS users; 72.9% (n= 35) were identified as ENDS users and 27.1% (n= 13) were categorized as Non-ENDS users. ENDS users
reported the most important reason for using ENDS products was for psychological
symptom management (34.3%; n= 12). Overall, participants reported high perceptions of
risks regarding health and ENDS use. Despite these risks, participants were more likely to
perceive e-cigarettes as less harmful than traditional cigarettes. Similarly, participants were
also significantly more likely to perceive the secondhand vapors from ENDS products as
less harmful to others than traditional cigarettes. Non-ENDS users had significantly higher
exposure risk perception scores (i.e. secondhand vapor exposure was harmful) than ENDS
users. However, whether participants used ENDS products was not significantly associated
with perceived harm from secondhand vapor exposure compared to secondhand exposure
to traditional cigarettes. Examination of risk perceptions and their association to ENDS
bans (i.e. restrictions) revealed 52.1% (n= 25) have a complete ban on vaping in the home,
while 43.8% (n= 21) of participants had a complete vaping ban in the vehicle.
Approximately 36% of the sample had a complete ban on vaping in the home and vehicle.
Participants were less likely to have a complete ban on vaping within the vehicle than
within the home. Adults with mental health disorders, therefore, are likely to expose those
who reside and travel with them to potentially toxic secondhand vapors. The information
obtained by this study will be helpful in designing targeted interventions to assist in the
reduction of tobacco, ENDS, and dual use as well as promote homes and vehicles that are
smoke-and vapor-free among a highly vulnerable population.