• Dorothy A Rhoades, Ashley L Comiford, Justin D Dvorak, Kai Ding, Leslie M Driskill, Audrea M Hopkins, Paul Spicer, Theodore L Wagener, and Mark P Doescher.
• Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Stephenson Cancer Center, Oklahoma City, Oklahoma. Electronic address: dorothy-rhoades@ouhsc.edu.
• Am J Prev Med. 2019 Sep 1; 57 (3): e59e68e59-e68.

IntroductionMany American Indian communities have a high prevalence of smoking and e-cigarette use, but factors associated with their dual use are rarely studied.MethodsIn 2016, a total of 375 American Indian adults who smoke completed paper surveys regarding cigarette and e-cigarette use and provided saliva for cotinine levels. In 2018, cross-sectional analyses were performed, comparing dual users (12%), defined as using e-cigarettes on some or every day for the past 30 days, with never users of e-cigarettes (37%).ResultsCompared with never users, dual users were younger, more often reported history of depression (56% and 29%, respectively; p<0.01) and family history of smoking-related disease (77% and 59%, respectively; p<0.05), had lower harm perceptions of e-cigarettes (27% and 47%, respectively; p<0.01) or vapor (14% and 35%, respectively; p<0.01), and more often perceived e-cigarettes as cessation aids (75% and 16%, respectively; p<0.01) and as less harmful than cigarettes (70% and 17%, respectively; p<0.01). Dual users were less often uncertain/unknowing about e-cigarette benefits or harms (p<0.01) and more often reported likelihood to quit smoking (49% and 24%, respectively; p<0.01) and prior attempt to quit smoking, ever (89% and 67%, respectively; p<0.01) or in the past year (55% and 32%, respectively; p=0.01). Cigarette consumption and cotinine levels did not differ between groups. Dual users more often tried other nicotine products (p<0.02) and more often lived with a vaping partner/spouse (45% and 6%, respectively; p<0.01).ConclusionsDual users perceived e-cigarettes as less harmful than cigarettes and more as cessation aids than cigarette-only users did, but cigarette consumption did not differ between groups. Whether e-cigarettes will reduce smoking-related disparities among American Indian people remains undetermined.Copyright © 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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