Smoking Cessation Self-Help for Dual Users of Tobacco Cigarettes and E-Cigarettes

The first two aims of the present proposal are to adapt a validated self-help,
smoking-cessation intervention to meet the needs of current dual users, and to test this new
intervention in a randomized controlled trial (RCT). A third primary aim is to calculate the
cost-effectiveness of the intervention. A secondary aim is to gather longitudinal data
regarding the patterns of tobacco and e-cigarette use and the course of cessation of either
product among dual users.

Specific Aim 1. To create a minimal smoking-cessation intervention for current dual users of
tobacco cigarettes and e-cigarettes (Study I). The intervention will comprise a series of
booklets and pamphlets modeled after the Forever Free booklets found to be successful at
producing long-term abstinence among the general population of smokers, but adapted to the
special needs, circumstances, and risk factors of dual users.

Validated methodologies used for adapting the intervention mirror those used in our prior
smoking cessation studies, and reflect systematic approaches across two-phases informed by
individual interviews and learner verification methodologies. The intervention will provide
assistance for smoking cessation, and also encourage users to taper and eventually terminate
their e-cigarette use as per traditional nicotine replacement therapy (NRT). The end product
of Study I will be a series of booklets tentatively titled, "If You Vape: Guide to Quitting
Smoking," available both in printed and electronic formats.

Specific Aim 2. To evaluate the efficacy of the intervention via a randomized, controlled
clinical trial of current dual users (Study II). We will compare the intervention developed
under Specific Aim 1 with both an assessment-only condition and a generic self-help condition
comprising existing smoking cessation booklets. We hypothesize that recipients of our
targeted If You Vape booklets will show higher rates of tobacco abstinence at 6, 12, 18, and
24 months after enrollment, as compared to both comparison conditions. A secondary hypothesis
is that the new intervention will produce higher rates of abstinence from e-cigarettes
themselves. To identify mechanism of change, we will also test several a priori moderator and
mediator variables, including gender, socio-economic status, motivation to quit, nicotine
dependence, e-cigarette expectancies, and magnitude of e-cigarette use (frequency, dosage).

Specific Aim 3. To calculate and compare the cost-effectiveness of the interventions. Cost-
effectiveness data are vital for evaluating the real-world feasibility of an intervention.
Small improvements in treatment efficacy may not be justified if they require substantially
greater cost. We will compare the interventions not only on outcome efficacy, but on
cost-effectiveness with respect to cost per incremental cessation and expected life-years
saved.

Inclusion Criteria:

- Study I - First Phase - No Longer Recruiting

- Greater than 1 year history of daily smoking

- 1 month or more of e-cigarette use

- Able to speak and read English

- (1) current dual users (of tobacco cigarettes and e-cigarettes) without interest
in quitting smoking; (2) current dual users who have attempted, but not quit
smoking; (3) current e-cigarette users who have successfully quit smoking; and
(4) former dual users who have quit both products.

- Study I - Second Phase - No Longer Recruiting

- Current dual users (of tobacco cigarettes and e-cigarettes)

- Smoking at least one cigarette per day over the past year

- Using e-cigarettes at least once per week over the past month

- Not currently enrolled in a face-to-face smoking cessation program

- Able to speak and read English

- Study II - Actively Recruiting

- Current dual users (of tobacco cigarettes and e-cigarettes)

- Smoking at least one cigarette per week over the past year

- Using e-cigarettes at least once per week over the past month

- Not currently enrolled in a face-to-face smoking cessation program

- Able to speak and read English