Smokers Unmotivated to Quit Smoke More With e-Cigarettes

Ingrid Hein

May 22, 2020

Not only does the use of e-cigarettes not help cigarette smokers who are unmotivated to quit, it has the opposite effect, according to results from a new study.

"In our study, people vaping in addition to smoking actually started smoking more," said study lead investigator Nancy Anoruo, MD, from the University of Massachusetts Medical School in Worcester.

This is "completely contradictory to what the e-cigarette manufacturers are telling us," she told Medscape Medical News.

In their study, Anoruo and her colleagues looked at whether people were more likely to quit if they smoked e-cigarettes in addition to conventional cigarettes. The research is a substudy of the ongoing Take a Break project, funded by the National Institutes of Health, which is assessing whether a smoking-cessation motivation app helps smokers quit.

In a cohort of 405 smokers who were unmotivated to quit, 248 were defined as dual smokers after responding "yes" to "ever having used" e-cigarettes, and 157 were defined as traditional smokers who only smoked combustible cigarettes. The majority of participants, 82%, were white, 8.8% were black, and 49% were women.

More dual smokers than traditional smokers were younger than 40 years (27% vs 16%; (P = .02), Anoruo reported during her virtual presentation at the American Thoracic Society 2020 International Conference.

The dual smokers reported smoking an average of 16 cigarettes a day, compared with 14 a day for the traditional smokers.

All the smokers were encouraged to consider a 3-week period of abstinence from combustible cigarettes. At the end of that period, the researchers compared outcomes reported by participants.

Abstinence Challenge

Average abstinence intervals were shorter for dual smokers than for traditional smokers (0.93 vs 1.8 days; P = .01). And dual smokers reported having a harder time quitting completely (6.3% vs 13.0%; P = .02).

At 6-month follow-up, dual smokers were smoking more cigarettes than traditional smokers (daily average, 12.0 vs 9.4; P = .04). And the reduction in cigarette use from baseline was smaller for dual smokers than for traditional smokers (21% vs 33%; P = .04).

"E-cigarettes are not a special magic bullet to get people to quit smoking," said Anoruo.

In this study, smoking cessation was defined as abstinence from combustible cigarettes, but that did not mean participants were abstinent from nicotine.

"If, at the end, they stopped smoking traditional cigarettes, we considered that successful smoking cessation," Anoruo explained. This definition is in line with the school of thought that e-cigarettes are a harm-reduction tool.

"But we now know that e-cigarettes are not necessarily safe," she added.

Still, it might be the lesser evil. "You end up taking in less dangerous chemicals, so we consider it quitting if you get off regular cigarettes," she said.

"We would like to study the psychology of cigarette smokers to find out if they see e-cigarettes as a smoking-cessation aid," Anoruo said, and to see if "their belief is driven by the advertising they see about e-cigarette use."

A Meager Reduction

Similar results were shown last month in a study by Megan Piper, PhD, from UW–Madison in Wisconsin, and her colleagues, who reported that dual e-cigarette and combustible cigarette use "did not appear to be an effective path to cessation of combustible cigarettes."

After 1 year, dual smokers smoked three cigarettes less each day than traditional smokers, which is "a meager reduction," Piper said in a news release.

"Typically, you can't have one foot in both camps. Most can't be vaping and smoking and hope to quit smoking," she added. "That sustained pattern is not going to help most people quit."

American Thoracic Society (ATS) 2020 International Conference: Poster 201. Presented online May 17, 2020.

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