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Impact of e-cigarette use among a cohort of American Indian cigarette smokers: associations with cigarette smoking cessation and cigarette consumption
  1. Ashley L Comiford1,
  2. Dorothy A Rhoades2,
  3. Paul Spicer3,
  4. Justin D Dvorak4,
  5. Kai Ding4,
  6. Theodore L. Wagener5,6,
  7. Mark P Doescher2
  1. 1 Community Health Promotions, Cherokee Nation, Tahlequah, Oklahoma, USA
  2. 2 Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
  3. 3 Anthropology, University of Oklahoma, Norman, Oklahoma, USA
  4. 4 Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
  5. 5 Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
  6. 6 Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
  1. Correspondence to Dr Ashley L Comiford, Community Health Promotions, Cherokee Nation, Tahlequah, OK 74464, USA; ashley-comiford{at}


Introduction Despite American Indian/Alaska Native (AI/AN) people having the highest prevalence of cigarette smoking nationwide, few studies have evaluated e-cigarette use among AI/AN adults who smoke. The primary objective of this observational pilot cohort study was to determine if e-cigarette use is associated with cigarette smoking cessation or reduction among adult AI individuals who smoke.

Methods In 2016, we collected baseline survey and biomarker data among AI adults who smoke. The survey included questions about cigarette consumption and use of e-cigarettes and biomarkers, such as salivary cotinine markers and exhaled carbon monoxide. After 18 months, we repeated data collection, and asked about changes in cigarette smoking status and cigarettes per day (CPD). Comparisons between groups were performed using the χ2 test, Fisher’s exact test or Wilcoxon rank-sum test.

Results Of 375 baseline participants, 214 (57.07%) returned for follow-up and were included in analyses. Of these, 20 (9.3%) reported having stopped cigarette smoking and had biochemical verification of cigarette smoking abstinence. Among those who quit smoking, 15% were baseline e-cigarette users; while among those who continued to smoke at follow-up, about 11% were baseline e-cigarette users. This difference was not statistically significant (p=0.48). Among all those who continued to smoke at follow-up, there was no overall decrease in CPD, nor a significant difference in change in CPD between baseline e-cigarette users and non-users (p=0.98).

Conclusions E-cigarette use at baseline was not associated with smoking cessation or a change in CPD in this cohort of AI adults who smoke after an 18-month follow-up period.

  • cessation
  • electronic nicotine delivery devices
  • disparities

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  • Funding This project was supported by grants (P20CA202921, 5P20CA202923 and U54GM104938) from the National Institutes of Health.

  • Disclaimer The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or Cherokee Nation.

  • Competing interests JDD, coauthor, receives salary and equity interests from Bayesic Technologies.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Institutional Review Boards from Cherokee Nation and the University of Oklahoma Health Sciences Center.

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

  • Data availability statement No data are available.