Feasibility and Acceptability of Switching to E-cigarettes Among Cigarette Smokers Engaged in SUD Treatment

Feasibility and Acceptability of Switching to E-cigarettes Among Cigarette Smokers Engaged in SUD Treatment

Feasibility and Acceptability of Switching to E-cigarettes Among Cigarette Smokers Engaged in Substance Use Disorder Treatment

The purpose of the proposed study is to examine the feasibility of integrating a smoking harm reduction program featuring provision of e-cigarettes and tailored instructions to switch into an existing substance use disorder treatment program. This longitudinal study includes three weeks of micro-surveys delivered via text messages to evaluate the intervention's feasibility and acceptability, gather initial effectiveness data, and understand participants' lived experience of smoking and vaping while engaged in substance use disorder treatment.

Up to 30 daily cigarette smokers who are engaged in a substance use disorder treatment program and are not interested in quitting nicotine use but are interested in reducing the harm from smoking will be enrolled in the study. As people gain access to substance use disorder treatment and the acute risk of death due to overdose diminishes, there is a significant need for data-driven, novel, and scalable smoking harm reduction approaches that meet people in recovery "where they are" and help them live longer, healthier lives by either significantly reducing their smoking frequency or switching completely to a much lower harm nicotine product. Our overall aims are to: Aim 1. Examine the feasibility (e.g., enrollment, attrition), acceptability (e.g., e-cigarette use rates, user experience), and effectiveness (e.g., % who reduced smoking by at least 50% in Week 3 vs. Week 1; % who switched completely at Week 3) of the intervention on cigarette smoking among people engaged in substance use disorder treatment. It is anticipated that of the 30 people enrolled, 20 will complete the protocol. In Week 1, participants will report their usual smoking to establish baseline behavior. In Week 2, participants will be provided with an e-cigarette, nicotine liquid, and instructions to switch developed in Aim 1. In Week 3, participants' nicotine liquid supply will be replenished and data collection will continue. Aim 2. Describe participants' understanding of the meaning and utility of cigarettes and e-cigarettes in their lives. Up to 20 participants will take part in a semi-structured interview at the end of Week 3. Interviews will focus on their experience trying to switch while engaged in substance use disorder treatment and how their cognitions, expectancies, social relationships, and norms evolved over the 2 weeks of e-cigarette use. Qualitative data will add context and explanation to quantitative data collected in Aim 1 and will identify opportunities to improve the intervention.

Participants will receive the NIDA Standardize Research E-Cigarette (SREC), nicotine pods (1 of each available flavor, for a total of 4 pods), and tailored instructions to switch. Participants will use the SREC ad libitum for 14 days, reporting their cigarette use, e-cigarette use, mood, and nicotine crazing every day via text message surveys.

The Standardized Research E-Cigarette (SREC) was developed by NIDA to help researchers assess uncertainties in electronic nicotine delivery devices. Nicotine pods: Sealed, pre-filled, non-refillable 1.9 mL e-liquid with 5% w/w nicotine (placebo also available) Approx 300 (280-330) puffs/pod Nicotine liquid characteristics: Volume of liquid per pod 1.9 mL Active (nicotine USP 5% wt/wt) and placebo (nicotine 0%) Propylene Glycol USP & Vegetable Glycerin USP - PG/VG Ratio 0.77 Lactic Acid USP Battery characteristics: USB Rechargeable Storage Capacity ~ 400 mAh Approx 200 (3s) puffs / charge 300 charge cycles to > 80% initial capacity Time to full charge 75 - 85 min Voltage / Temperature settings not user adjustable

Inclusion Criteria: currently engaged in outpatient treatment the Mathewson Institute (medication, behavioral, or combination treatment) aged 21+ interested in switching from cigarettes to e-cigarettes, assessed by the item "Are you interested in replacing some or all of your cigarettes with e-cigarettes?" has a cellphone with an unlimited text message plan has had the same phone number for at least 1 month uses text messages at least once a week self-reports daily smoking records an exhaled air carbon monoxide (CO) level >6ppm at baseline study visit has the capacity to understand the participant materials and follow the study procedures (e.g. sufficient English language ability). Exclusion Criteria: Individuals who meet any the following criteria will not be enrolled in this study: have used an e-cigarette to quit smoking in the past month are currently pregnant or breast-feeding.