Rates and Reasons for Use of Tobacco Products by Clients in SUD Treatment

  • Although cigarette smoking among adults in the United States declined to a rate of 15.5% by 2016, there are vulnerable populations for whom smoking rates remain high. Individuals in substance use disorder (SUD) treatment smoke at rates as high as 84% and die from tobacco-related illnesses at higher rates than the general population. 
  • Understanding how individuals perceive health risks associated with use of tobacco products, and documenting their reasons for use, may help providers better support people trying to quit or cut back.

    • This study examined rates of use, health risk perceptions, and reasons for use of combustible and non-combustible tobacco products among clients enrolled in substance use disorder treatment across the United States. It was conducted in 24 SUD treatment programs affiliated with the NIDA Clinical Trials Network (CTN).

    Participants (N=1153) completed tobacco use surveys and rated health risk perception of all products. Users of non-cigarette products reported their main reason for use of each product. Researchers examined associations between health risk perceptions and product use, including combustible cigarette use, and between reasons for use and non-cigarette product use.

    Rates of use of different combustible and non-combustible products by the study participants were:

  • Cigarettes: 77.5%
  • e-Cigarettes: 26.6%
  • Little filtered cigars (LFCs)/cigarillos: 15.4%
  • Smokeless tobacco: 11.4%
  • Cigars: 8.4%

    Lower perceived health risk of cigarettes was associated with smoking cigarettes. Lower perceived health risk of e-cigarettes was associated with e-cigarette use.

    Users of cigars and users of LFCs/cigarillos (versus other product use) were more likely to report their main reason for use as “enjoying flavor/taste,” and smokeless tobacco users were more likely to report “at times when can’t smoke” as their main reason for use compared to other reasons.

    E-cigarette users were more likely to report to “reduce/quit cigarettes” as their main reason for use as compared to all other reasons except “reduce health risk.”

    Conclusions: This study provides important information about rates of use, reasons for use, and perceived health risks of a range of tobacco products in a sample of individuals in substance use disorder treatment from a vulnerable, high smoking population. When treating smoking in SUD treatment settings, providers should assess all tobacco product use, accuracy of their clients’ health risk perceptions, and use of e-cigarettes to reduce/quit smoking, in order to promote cessation of combustible tobacco.

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    Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.

    Articles were written based on the following published research:

    Campbell BK, et al. Health Risk Perceptions and Reasons for Use of Tobacco Products Among Clients in Addictions Treatment. Addictive Behaviors 2018 (in press). [doi: 10.1016/j.addbeh.2018.08.037]