E-Cigs Gain Popularity for Smoking Cessation

Speciality News

Close to 70% of adults who were dual users of cigarettes and e-cigarettes reported using the latter to quit smoking, according to a nationally representative survey, and four out of five vapers who were former cigarette smokers said they had used e-cigarettes to help them quit.

E-cigarette users who were current or former smokers tended to be older, while never-smokers who reported vaping were overwhelmingly younger adults, said Margaret Mayer, PhD, of the Tobacco Control Research Branch of the National Cancer Institute in Bethesda, Maryland. Close to two thirds of e-cigarette users who had never smoked cigarettes in the sample were between the ages of 18 and 24.

Results of the cross-sectional study, published online in JAMA Network Open, suggest that a large percentage of adult smokers who vape do so to help them stop smoking, Mayer and colleagues said, adding, however, that it is still not clear if this strategy is effective for smoking cessation.

“This type of study can’t really tell us whether or not vaping is effective in helping people quit smoking,” Mayer told MedPage Today. “That sort of question can really only be answered with longitudinal studies and with clinical trials.

What the cross-sectional analysis did was identify patterns associated with e-cigarette use among adults: “We saw that a high proportion of people across age groups who are former smokers or current smokers and are also vaping report that they are using e-cigarettes to help them try and quit,” Mayer said.

The study included data from the 2018-2019 Tobacco Use Supplement to the Current Population Survey, which is the largest nationally representative tobacco use survey of adults in the U.S.

The sample included just over 135,000 adults with data on both cigarette and e-cigarette use, including close to 74,000 women (weighted sample, 51.9%). Roughly 11%, 18%, and 70% of those included in the sample were, respectively, current smokers, former smokers and never smokers.

Estimating current e-cigarette use for 2.3% of U.S. adults (5.66 million adults), the survey found that among current e-cigarette users, 39% were also current cigarette smokers, 38% were former smokers, and 23% had never smoked cigarettes.

Across all demographic categories (sex, race/ethnicity, education) the majority of active e-cigarette users were either current or former cigarette smokers.

Among the main study findings:

  • 63.4% of never smokers who vaped (95% CI 58.2%-68.7%) were between the ages of 18 and 24, and 23.8% (95% CI 19.6%-28.1%) were 25 to 34
  • Among current dual users of cigarettes and e-cigarettes, 69.3% (95% CI 65.7%-72.7%) reported using e-cigarettes to try to quit smoking
  • Among former smokers who reported current vaping, 80.7% (95% CI 77.4%-83.5%) reported that they had used e-cigarettes to help stop smoking

Mayer said the high prevalence of e-cigarette use among 18- to 24-year-olds who had never smoked cigarettes is concerning: “At this age the brain is still developing, and we know that nicotine can affect brain development.”

She added that the health effects of dual cigarette and e-cigarette use are still not known, while vaping among former cigarette smokers has been associated with smoking relapse.

According to the CDC, 3.2% of adults in the U.S. were current users of e-cigarettes in 2018, and about half of these individuals also smoked cigarettes (dual users).

A CDC investigation published in 2017 found that 35% of adult smokers trying to quit used e-cigarettes as a means to help them do so. But the data also suggest that a large percentage of adults who vape also smoke cigarettes, calling into question the effectiveness of e-cigarette use for smoking cessation.

A 2016 Cochrane review of two randomized controlled trials that followed participants for at least 6 months found that use of e-cigarettes with nicotine was more effective for smoking cessation than use without nicotine, but the reviewers judged the quality of the evidence as low.

A 2019 randomized trial found e-cigarette use to be more effective for smoking cessation than nicotine-replacement therapy (NRT), with a 1-year abstinence rate of 18% reported in the e-cigarette group vs 9.9% in the NRT group.

But at the end of the year-long follow-up, 80% of people who used e-cigarettes for smoking cessation were still vaping, while just 9% of those in the NRT arm were still using nicotine-replacement products.

The U.S. Preventive Services Task Force concluded in a 2015 report that the evidence is insufficient to recommend for or against the use of electronic nicotine-delivery systems for smoking cessation in adults.

Instead, the group advised that healthcare providers recommend interventions with proven efficacy, such as in-person or phone counseling or FDA-approved pharmacotherapy.

Disclosures

Funding for the study was provided by the National Institute on Minority Health and Health Disparities.

Mayer and co-authors reported no conflicts of interest.

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