Daily e-cigarette use boosted odds of cigarette discontinuation in those without a plan to quit

Among smokers who did not have an initial plan to stop smoking, daily e-cigarette use was associated with higher odds of cigarette discontinuation, according to results published in JAMA Network Open.

“Most population studies that look at vaping and cigarette quitting exclude smokers who are not trying to quit. We instead wanted to focus specifically on this group of smokers — they are usually very addicted to nicotine and it’s hard for them to think about going even 1 day without smoking a cigarette. They often have smoked a lot of cigarettes for a long time and are at the highest risk for experiencing adverse health outcomes caused by smoking,” Andrew Hyland, PhD, chair of the department of health behavior at Roswell Park Comprehensive Cancer Center in Buffalo, New York, told Healio. “Results from our study suggest that daily vaping may give hope to this group of smokers to break out of this cycle and eventually become a former cigarette smoker.”

Hyland and colleagues conducted a cohort study using data from the longitudinal Population Assessment of Tobacco and Health (PATH) Study on 1,600 U.S. adults who reported daily cigarette smoking who were not using e-cigarettes at the time and had no plan to stop smoking. The researchers analyzed data from four waves (2014-2015, 2015-2016, 2016-2017, 2018-2019).

Among the adult daily cigarette smokers who were not using e-cigarettes and had no plans for smoking cessation, 56.1% were men; 10.1% were Hispanic, 10.1% were non-Hispanic Black, 75.6% were non-Hispanic white and 4.2% were other non-Hispanic race; and 7.2% were aged 18 to 24 years, 24.3% 25 to 39 years, 30.4% 40 to 54 years, 29.3% 55 to 69 years and 8.9% 70 years and older. One-third graduated from high school without continuing their education, 36.8% did not graduate from high school, 22.9% completed some college or had an associate degree, 6% completed their bachelor’s degree or more education and 0.7% had unknown educational attainment. Fifty-five percent of participants had an annual household income of less than $25,000. Thirty-seven percent reported smoking 20 to 29 cigarettes per day and 12.7% 30 or more cigarettes per day.

During follow-up, 6.2% of participants reported discontinuing cigarette smoking. The researchers reported higher discontinuation rates among those who reported subsequent daily e-cigarette use during follow-up compared with those who did not report daily e-cigarette use (28% vs. 5.8%; adjusted OR = 8.11; 95% CI, 3.14-20.97).

In addition, 10.7% of participants discontinued daily cigarette smoking, with higher discontinuation rates among those who reported daily e-cigarette use compared with those who did not use e-cigarettes daily (45.5% vs. 9.9%; aOR = 9.67; 95% CI, 4.02-23.25).

“It may be counterintuitive that those who seem furthest away from ever quitting smoking — those who have no plans to quit at all — experience such a strong association between daily vaping uptake and cigarette quitting. We speculate that in this group of cigarette smokers with no plans to quit who try vaping that some will realize that they may be able to go a day without smoking a cigarette because they are getting their nicotine from vaping. This is the first and most important step to change how these smokers think about their smoking and that it just might be possible for them to make that first cigarette-free day be the start of a cigarette-free lifetime,” Hyland said.

Researchers observed no association between non-daily e-cigarette use and cigarette discontinuation (aOR = 0.53; 95% CI, 0.08-3.35) or daily cigarette discontinuation (aOR = 0.96; 95% CI, 0.44-2.09).

“Sufficient nicotine dosing likely matters a lot when it comes to vaping and cigarette quitting,” Hyland said. “Further research into the optimal e-cigarette design features that can effectively reduce the cravings smokers’ experience when they are trying to stop smoking is important.”