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Electronic nicotine delivery system use behaviour and loss of autonomy among American Indians: results from an observational study
  1. Dana Mowls Carroll1,
  2. Theodore L Wagener2,
  3. David M Thompson3,
  4. Lancer D Stephens4,
  5. Jennifer D Peck3,
  6. Janis E Campbell3,
  7. Laura A Beebe3
  1. 1 Tobacco Research Programs, University of Minnesota, Minneapolis, Minnesota, USA
  2. 2 Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
  3. 3 Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
  4. 4 Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
  1. Correspondence to Dr Dana Mowls Carroll; dcarroll{at}


Objective American Indians (AI) have a high prevalence of electronic nicotine delivery system (ENDS) use. However, little information exists on (ENDS) use, either alone or in combination with cigarettes (dual use), among AI. The objective of this small-scaled study was to examine use behaviours and dependence among exclusive ENDS users and dual users of AI descent. Exclusive smokers were included for comparison purposes.

Setting Oklahoma, USA.

Participants Adults of AI descent who reported being exclusive ENDS users (n=27), dual users (n=28) or exclusive cigarette smokers (n=27).

Measures Participants completed a detailed questionnaire on use behaviours. The Hooked on Nicotine Checklist (HONC) was used to assess loss of autonomy over cigarettes and was reworded for ENDS. Dual users completed the HONC twice. Sum of endorsed items indicated severity of diminished autonomy. Comparisons were made with non-parametric methods and statistical significance was defined as P<0.05.

Results Median duration of ENDS use was 2 years among ENDS users and 1 year among dual users. Most ENDS and dual users reported <20 vape sessions per day (72.0% vs 72.0%) with ≤10 puffs per vape session (70.4% vs 69.2%). Severity of diminished autonomy over ENDS was similar among ENDS and dual users (medians: 4 vs 3; P=0.6865). Among dual users, severity of diminished autonomy was lower for ENDS than cigarettes (medians: 3 vs 9; P=<0.0001). Comparing ENDS users with smokers, ENDS users had a lower severity of diminished autonomy (4 vs 8; P=0.0077). Comparing dual users with smokers, median severity of diminished autonomy over cigarettes did not differ (P=0.6865).

Conclusions Severity of diminished autonomy was lower for ENDS than cigarettes in this small sample of AI. Future, adequately powered studies should be conducted to fully understand ENDS use patterns and dependence levels in this population.

  • epidemiology
  • public health
  • psychiatry

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  • Contributors Conceptualisation: DMC, TLW, DMT, LDS, JDP, JEC, LAB. Funding acquisition: DMC, TLW, LAB. Methodology: DMC, TLW, DMT, LDS, JDP, JEC, LAB. Project administration: DMC, LAB. Supervision: TLW, DMT, LDS, JDP, JEC, LAB. Data analysis: DMC, LAB. Writing of original draft: DMC, LAB. Review and editing: DMC, TLW, DMT, LDS, JDP, JEC, LAB.

  • Funding This work was supported by the National Institute on Drug Abuse at the National Institutes of Health (grant number 1R36DA042208-01). Facility support has been provided by the Oklahoma Shared Clinical and Translational Resources (grant number U54GM104938).

  • Competing interests None declared.

  • Ethics approval University of Oklahoma Health Sciences Center (No. 6317) and the Oklahoma City Area Indian Health Service Institutional Review Board (No. P-16-01-OK).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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