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.