Myth: Alternative nicotine products don't help people stop smoking

From Safer nicotine wiki
Jump to navigation Jump to search




Myth: Alternative nicotine products don't help people stop smoking or prevent returning to smoking

There are claims that alternative nicotine products such as e-cigarettes, snus, nicotine pouches, and heated tobacco products don't help people stop smoking. The data dispels that myth, as many studies have shown that people are using these products to quit smoking successfully. The products are also helping people remain abstinent from smoking.


No Intention of Quitting Smoking (Accidental Quitters)

2024: Using pod based e-cigarettes and nicotine pouches to reduce harm for adults with low socioeconomic status who smoke: A pilot randomized controlled trial

  • This study provides novel evidence that e-cigarettes and nicotine pouches can be a harm reduction tool for individuals with lower SES who smoke and are not willing to quit smoking, contributing to reducing tobacco-related disparities in this population.

2023: Smoking reduction using electronic nicotine delivery systems in combination with nicotine skin patches

  • A critically important design component of this study was that it was not a smoking cessation treatment study, and hence smoking abstinence was not the primary outcome. Accordingly, no smoking cessation counseling was provided and smokers who expressed a desire to receive treatment for nicotine dependence were excluded from the study. Thus, the study was not expected to lead to high smoking abstinence rates but was instead designed to differentiate the pharmacologic impact of nicotine vs. no nicotine (in ENDS or patch) on smoking behavior.
  • ...there was a strong correlation between ENDS use and decrease in self-reported cigarette consumption in week 8 (end of treatment), but only in nicotine ENDS condition...
  • Smoking abstinence at week 8 was also related to ENDS use in the nicotine ENDS condition only; participants who were abstinent from smoking used more nicotine pods than non-abstinent participants
  • The main finding of this study was that the use of nicotine vs. no nicotine in ENDS was associated with a large and statistically significant reduction in expired air CO, an objective biomarker of smoking.

2023: Associations between nicotine vaping uptake and cigarette smoking cessation vary by smokers' plans to quit: longitudinal findings from the International Tobacco Control Four Country Smoking and Vaping Surveys

  • Uptake of nicotine vaping appears to be strongly associated with cigarette smoking cessation among smokers with no initial plans to quit smoking. Excluding smokers not planning to quit from studies on vaping and smoking cessation may underestimate potential benefit of daily vaping for daily smokers.

2022: E-cigarette use and change in plans to quit cigarette smoking among adult smokers in the United States: Longitudinal findings from the PATH Study 2014–2019

  • We evaluated adult daily cigarette smokers initially not planning to ever quit.
  • Subsequent daily e-cigarette use was related to changing plans to quit smoking.
  • E-cigarette research focused only on smokers motivated to quit limits full evaluation.

2021: Effect of Electronic Nicotine Delivery Systems on Cigarette Abstinence in Smokers with no Plans to Quit: Exploratory Analysis of a Randomized Placebo-Controlled Trial

  • Preprint
  • When smokers seeking to reduce smoking tried ENDS, few quit smoking in the short term. However, if smokers continued to use an ENDS with cigarette-like nicotine delivery, a greater proportion completely switched to ENDS, as compared with placebo or a cigarette substitute.
  • The extent to which use of electronic nicotine delivery systems (ENDS) for smoking reduction leads to cigarette abstinence in smokers with no plans to quit smoking was unclear. This randomized trial found that ENDS with nicotine delivery approaching that of a cigarette are more effective in helping ambivalent smokers to quit cigarette smoking.

2021: Association of e-Cigarette Use With Discontinuation of Cigarette Smoking Among Adult Smokers Who Were Initially Never Planning to Quit

2014: Effectiveness of the Electronic Cigarette: An Eight-Week Flemish Study with Six-Month Follow-up on Smoking Reduction, Craving and Experienced Benefits and Complaints

  • When people, ready to switch to an e-cig, are severely restricted in terms of accessibility of nicotine-containing e-liquids, the success of e-cigs may be endangered. For the e-cig to be and remain successful, it is important that people have easy access to nicotine containing e-liquids.
  • “In a series of controlled lab sessions with e-cig-naïve tobacco smokers, second-generation e-cigs were shown to be immediately and highly effective in reducing abstinence-induced cigarette craving and withdrawal symptoms, while not resulting in increases in eCO. Ad libitum use of e-cigs—in between and until six months after the lab sessions—resulted in remarkable reductions in or (biologically confirmed) complete abstinence from tobacco smoking in almost half of the participants who had no intention to quit smoking. Eight months after the start of the study 21% of all participants were completely abstinent from tobacco cigarettes. Similar reduction/cessation rates were obtained with guided versus non-guided switching to e-cigs. Part of the observed efficacy of e-cigs in this study may be related to the fact that they allowed to maintain relatively high blood nicotine levels and showed an excellent experienced benefits/complaints ratio, especially in comparison with continued tobacco smoking”...
  • E-cigarette is an attractive long-term alternative and safer source of nicotine to conventional cigarette. Since their invention in 2003, there has been constant innovation and development of more efficient and appealing products. Here we show for the first time that second generation PVs can substantially decrease cigarette consumption without causing significant side effects in smokers not intending to quit. Moreover, overall participants’ perception and acceptance of these products was very good, in particular for those who quit or reduced smoking. Compared to our earlier work with first generation “cig-alikes”, technical problems and difficulties in use familiarization with second generation PVs were negligible. Improved products reliability and attractiveness might have contributed to the very low number of study failures and lost to follow-up and high success rates thus confirming the notion that these products are attractive substitutes for conventional cigarettes. Although large and carefully conducted RCTs will be required to confirm these preliminary encouraging observations, the notion that second generation PVs can substantially decrease cigarette consumption in smokers not intending to quit should be taken into consideration by regulatory authorities seeking to adopt proportional measures for the vapour category
  • PDF Version

2014: Success rates with nicotine personal vaporizers: a prospective 6-month pilot study of smokers not intending to quit

  • Complete tobacco cessation is the best outcome for smokers, but the powerful addictive qualities of nicotine and of the ritualistic behavior of smoking create a huge hurdle, even for those with a strong desire to quit. Tobacco harm reduction (THR), the substitution of low-risk nicotine products for cigarette smoking, is a realistic strategy for smokers who have difficulty quitting. E-cigarettes are the newest and most promising products for THR. This approach has been recently exploited to reduce or reverse the burden of harm in smokers with mental health disorders and chronic airway disease.
  • PDF Version

2013: EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as Tobacco Cigarettes Substitute: A Prospective 12-Month Randomized Control Design Study

  • ECLAT is a prospective 12-month randomized, controlled trial that evaluates smoking reduction/abstinence in 300 smokers not intending to quit experimenting two different nicotine strengths of a popular e-cigarette model compared to its non-nicotine choice.
  • The study consisted of nine visits during which cig/day use and exhaled carbon monoxide (eCO) levels were measured. Smoking reduction and abstinence rates were calculated. Adverse events and product preferences were also reviewed.
  • In smokers not intending to quit, the use of e-cigarettes, with or without nicotine, decreased cigarette consumption and elicited enduring tobacco abstinence without causing significant side effects.
  • Caponnetto P, Campagna D, Cibella F, Morjaria JB, Caruso M, Russo C, Polosa R. PLoS One. 2013 Jun 24;8(6):e66317. doi: 10.1371/journal.pone.0066317

2011: Effect of an electronic nicotine delivery device (e-Cigarette) on smoking reduction and cessation: a prospective 6-month pilot study

  • Sustained 50% reduction in the number of cig/day at week-24 was shown in 13/40(32.5%) participants; their median of 25 cigs/day decreasing to 6 cigs/day (p < 0.001). Sustained 80% reduction was shown in 5/40(12.5%) participants; their median of 30 cigs/day decreasing to 3 cigs/day (p = 0.043). Sustained smoking abstinence at week-24 was observed in 9/40(22.5%) participants, with 6/9 still using the e-Cigarette by the end of the study. Combined sustained 50% reduction and smoking abstinence was shown in 22/40 (55%) participants, with an overall 88% fall in cigs/day.
  • The use of e-Cigarette substantially decreased cigarette consumption without causing significant side effects in smokers not intending to quit
  • PDF Version


Combined Intending and Not Intending to Quit Smoking

2024: Adult smokers’ Complete Switching Away from Cigarettes at 6, 9, and 12 Months after Initially Purchasing a JUUL e-Cigarette

  • "Approximately one-fifth of adult smokers reported 30-day point-prevalence abstinence at 6, 9, and 12 months after purchasing JUUL. Greater use of JUUL and stronger subjective reinforcing effects were associated with nonsmoking, validating the potential for ENDS to substitute for smoking, with potential for positive impacts on individual and population health."

2023: Electronic Cigarettes for Smoking Cessation: Cochrane Living Systematic Review

  • There is high certainty evidence that more people stop smoking for at least six months using nicotine e-cigarettes than using nicotine replacement therapy (NRT, such as patches, gum, or lozenges) (6 studies, 2378 people). There is moderate certainty evidence that more people stop smoking for at least six months using nicotine e-cigarettes than nicotine-free e-cigarettes (5 studies, 1447 people).

2021: Switching away from Cigarettes across 12 Months among Adult Smokers Purchasing the JUUL System

  • Rates of switching with JUUL increased over time. Over 50% of respondents reported complete switching away from cigarettes 12 months following purchase. Greater use of and dependence on JUUL predicted switching.

2021: Differences in Switching Away From Smoking Among Adult Smokers Using JUUL Products in Regions With Different Maximum Nicotine Concentrations: North America and the United Kingdom

  • In this longitudinal study of N.Am. and UK smokers who purchased JUUL, switch rates were higher in the N.Am. users, where smokers were using higher nicotine concentrations. The results were robust to multiple adjustments for differences between the two nicotine concentration policy regions across different statistical approaches, including PSM on relevant observable characteristics. These results have implications for regulatory policy, as the availability of ENDS with nicotine concentrations greater than 20 mg/mL may facilitate switching away from cigarette among adult smokers.

2021: Switching away from Cigarette Smoking with JUUL: Populations of Special Interest

  • Substantial rates of complete switching were consistently achieved across all medico-socio-demographic subgroups 12 months following the purchase of the JSK. The potential benefits of switching with JUUL on smokers are likely to be experienced by a wide range of adult smokers.

2020: Role of e-cigarettes and pharmacotherapy during attempts to quit cigarette smoking: The PATH Study 2013-16

  • Among US daily smokers who quit cigarettes in 2014-15, use of e-cigarettes in that attempt compared to approved cessation aids or no products showed similar abstinence rates 1-2 years later.

2019: Electronic Cigarette Use and Cigarette Abstinence Over 2 Years Among U.S. Smokers in the Population Assessment of Tobacco and Health Study

  • In this nationally representative longitudinal cohort study of US adult cigarette smokers, daily e-cigarette use, compared to no e-cigarette use, was associated with a 77% increased odds of prolonged cigarette smoking abstinence over the subsequent 2 years. Regular use of e-cigarettes may help some smokers to stop smoking combustible cigarettes.
  • PDF Version
  • Article: Daily e-cigarette use may help smokers quit regular cigarettes

2019: Association of prevalence of electronic cigarette use with smoking cessation and cigarette consumption in England: a time–series analysis between 2007 and 2017

  • The increase in prevalence of e‐cigarette use by smokers in England has been positively associated with an increase in success rates of quit attempts and overall quit rates
  • PDF Version

2019: Indicators of cigarette smoking dependence and relapse in former smokers who vape compared with those who do not: findings from the 2016 International Tobacco Control Four Country Smoking and Vaping Survey

  • Vapers were more likely than non-vapers to report: (1) having smoked within 5 minutes of waking; having smoked > 10 cigarettes/day; (2) perceiving themselves to be still very addicted to smoking and feeling extremely confident about staying quit.
  • In totality, therefore, our findings favour the first explanation, that in our sample the daily vapers had been a more highly dependent group than the non-vapers, which would support the suggestion that vaping might be offering a novel route out of smoking for this group of smokers, albeit maintaining their nicotine addiction.
  • PDF Version

2019: Tobacco Product Use Among Adults — United States, 2019

  • 4.3 million US adult nicotine vapers are ex-smokers.
  • PDF Version

2018: Discussions between health professionals and smokers about nicotine vaping products: results from the 2016 ITC Four Country Smoking and Vaping Survey

  • Despite the need for more evidence on their efficacy and long‐term safety, NVPs are now a more popular method for cessation than licensed NRT and prescription stop‐smoking medications in many countries.
  • In light of this, HPs should be prepared to provide balanced information about NVPs, particularly to smokers who are unable to stop smoking with approved cessation therapies, and for those who are requesting guidance regarding NVPs as a smoking cessation aid
  • Overall, the results from this study have shown that discussions between smokers and HPs about both quitting smoking, and the possible role NVPs could play as a cessation aid, were infrequent in the four countries in 2016. This may represent a lost opportunity for encouraging quitting smoking by providing a potentially attractive option to help smokers to quit.
  • PDF Version

2018: E-cigarette initiation and associated changes in smoking cessation and reduction: the Population Assessment of Tobacco and Health Study, 2013–2015

  • Daily e-cigarette initiators were more likely to have quit smoking cigarettes or reduced use compared with non-users. However, less frequent e-cigarette use was not associated with cigarette cessation/reduction. These results suggest incorporating frequency of e-cigarette use is important for developing a more thorough understanding of the association between e-cigarette use and cigarette cessation.
  • PDF Version

2017: E-cigarette use and associated changes in population smoking cessation: evidence from US current population surveys

  • This study, based on the largest representative sample of e-cigarette users to date, provides a strong case that e-cigarette use was associated with an increase in smoking cessation at the population level. We found that e-cigarette use was associated with an increased smoking cessation rate at the level of subgroup analysis and at the overall population level. It is remarkable, considering that this is the kind of data pattern that has been predicted but not observed at the population level for cessation medication, such as nicotine replacement therapy and varenicline. This is the first statistically significant increase observed in population smoking cessation among US adults in nearly a quarter of a century. These findings need to be weighed carefully in regulatory policy making and in the planning of tobacco control interventions.
  • PDF Version

2017: The Relationship of E-Cigarette Use to Cigarette Quit Attempts and Cessation: Insights From a Large, Nationally Representative U.S. Survey

  • Consistent with randomized trials and those observational studies that measure frequency of e-cigarette use, both quit attempts and quit success were positively associated with increased frequency of e-cigarette use. Frequency of e-cigarette use was important in gauging the nature of these relationships.
  • PDF Version

2017: Cohort study of electronic cigarette use: effectiveness and safety at 24 months

  • Of the e-cigarette users, 61.1% remained abstinent from tobacco (while 23.1% and 26.0% of tobacco-only smokers and dual users achieved tobacco abstinence).
  • PDF Version

2017: Attitudes of Europeans towards tobacco and electronic cigarettes

  • 7.5 million EU citizens have quit smoking with nicotine vapes (“e-cigarettes”)

2016: Association between electronic cigarette use and changes in quit attempts, success of quit attempts, use of smoking cessation pharmacotherapy, and use of stop smoking services in England: time series analysis of population trends

  • Changes in prevalence of e-cigarette use in England have been positively associated with the success rates of quit attempts. No clear association has been found between e-cigarette use and the rate of quit attempts or the use of other quitting aids, except for NRT obtained on prescription, where the association has been negative.
  • PDF Version

2016: Patterns of Electronic Cigarette Use Among Adults in the United States

  • Results: Current e-cigarette use is extremely low among never cigarette smokers (0.4%) and former smokers who quit cigarettes 4 or more years ago (0.8%). Although e-cigarette experimentation is most common among current cigarette smokers and young adults, daily use is highest among former smokers who quit in the past year (13.0%) and older adults. Compared to daily cigarette smokers, recently quit smokers were more than four times as likely to be daily users of e-cigarettes.
  • Conclusion: Extremely low e-cigarette use among never-smokers and longer term former smokers suggest that e-cigarettes neither promote widespread initiation nor relapse among adults. Recognition of the heterogeneity of smokers, including the time since quitting, is critical to draw accurate conclusions about patterns of e-cigarette use at the population level and its potential for public health benefit or harm.
  • PDF Version

2016: Electronic cigarette use in the European Union: analysis of a representative sample of 27 460 Europeans from 28 countries

  • E‐cigarette use in the European Union appears to be largely confined to current or former smokers, while current use and nicotine use by people who have never smoked is rare. More than one‐third of current e‐cigarette users polled reported smoking cessation and reduction.
  • PDF Version

2016: Patterns of Smoking and Snus Use in Sweden: Implications for Public Health

  • “Snus has both contributed to decreasing initiation of smoking and ...appears to facilitate smoking cessation. ...Snus has been a major factor behind Sweden’s record-low prevalence of smoking and lowest tobacco-related mortality among men in Europe.”
  • PDF Version

2015: E-Cigarettes and Smoking Cessation: Evidence from a Systematic Review and Meta-Analysis

  • “This systematic review and meta-analyses assessed the findings of six studies which reported smoking cessation after using e-cigarettes. We found an association between nicotine-enriched e-cigarette use and smoking cessation, suggesting that the devices may be an effective alternative smoking cessation method. We also found that use of e-cigarettes was also associated with a reduction in the number of cigarettes used, suggesting they may also have a role in tobacco harm reduction programs. To our knowledge, this is the most comprehensive evidence to date on this issue, and while there are a number of important implications for further research, these findings provide timely information to inform regulatory strategies.”
  • PDF Version

2015: A Longitudinal Study of Electronic Cigarette Use Among a Population-Based Sample of Adult Smokers: Association With Smoking Cessation and Motivation to Quit

  • Results: At follow-up, 23% were intensive users, 29% intermittent users, 18% had used once or twice, and 30% had not tried e-cigarettes. Logistic regression controlling for demographics and tobacco dependence indicated that intensive users of e-cigarettes were 6 times more likely than non-users/triers to report that they quit smoking. Daily use of electronic cigarettes for at least 1 month is strongly associated with quitting smoking at follow-up. Further investigation of the underlying reasons for intensive versus intermittent use will help shed light on the mechanisms underlying the associations between e-cigarette use, motivation to quit, and smoking cessation.
  • PDF Version

2015: Electronic Cigarettes Efficacy and Safety at 12 Months: Cohort Study

  • Follow-up data were available for 236 e-smokers, 491 tobacco smokers, and 232 dual smokers (overall response rate 70.8%). All e-smokers were tobacco ex-smokers. At 12 months, 61.9% of the e-smokers were still abstinent from tobacco smoking; 20.6% of the tobacco smokers and 22.0% of the dual smokers achieved tobacco abstinence. Adjusting for potential confounders, tobacco smoking abstinence or cessation remained significantly more likely among e-smokers...
  • PDF Version

2013: A fresh look at tobacco harm reduction: the case for the electronic cigarette

  • Smokers of any age can reap substantial health benefits by quitting. In fact, no other single public health effort is likely to achieve a benefit comparable to large-scale smoking cessation.
  • E-cigs might be the most promising product for tobacco harm reduction to date, because, besides delivering nicotine vapour without the combustion products that are responsible for nearly all of smoking’s damaging effect, they also replace some of the rituals associated with smoking behaviour.
  • Nicotine’s beneficial effects include correcting problems with concentration, attention and memory, as well as improving symptoms of mood impairments. Keeping such disabilities at bay right now can be much stronger motivation to continue using nicotine than any threats of diseases that may strike
  • Nicotine’s beneficial effects can be controlled, and the detrimental effects of the smoky delivery system can be attenuated, by providing the drug via less hazardous delivery systems. Although more research is needed, e-cigs appear to be effective cigarette substitutes for inveterate smokers, and the health improvements enjoyed by switchers do not differ from those enjoyed by tobacco/nicotine abstainers.
  • PDF Version

2013: E-Cigarettes: Prevalence and Attitudes in Great Britain

  • While we found evidence supporting the view that e-cigarette use may be a bridge to quitting, we found very little evidence of e-cigarette use among adults who had never smoked. British smokers would benefit from information about the effective use, risks, and benefits of e-cigarettes, as this might enable the use of e-cigarettes to improve public health.
  • PDF Version


Intending to Quit Smoking

2023: E-cigarette support for smoking cessation: Identifying the effectiveness of intervention components in an on-line randomized optimization experiment.

  • Kimber C, Sideropoulos V, Cox S, Frings D, Naughton F, Brown J, McRobbie H, Dawkins L. Addiction. 2023 Jul 16. doi: 10.1111/add.16294. Online ahead of print. PMID: 37455014
  • Measurements: The primary outcome was 4-week self-reported complete abstinence at 12 weeks post-randomization. Primary analyses were intention-to-treat (loss to follow-up recorded as smoking). Logistic regressions modelled the three- and two-way interactions and main effects, explored in that order.
  • Findings: In the adjusted model the only significant interaction was a two-way interaction, advice on flavour combined with text message support, which increased the odds of abstinence (odds ratio = 1.55, 95% confidence interval = 1.13–2.14, P = 0.007, Bayes factor = 7.25). There were no main effects of the intervention components.

2023 (News): Vaping: Government announces "swap to stop" scheme to cut smoking rates.

  • One million smokers in England will be given a free vaping starter kit as part of a government package of measures to get smoking rates below 5% by 2030

2023: Efficacy and Safety of E-Cigarette Use for Smoking Cessation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

  • Results: A total of 5 RCTs (n=3,253) were included. Compared with conventional smoking cessation therapies, the use of nicotine e-cigarettes was associated with an increase in abstinence, defined by the most rigorous criterion of abstinence reported (RR: 1.77; 95% CI: 1.29-2.44). Nicotine e-cigarettes also increased abstinence (defined by the most rigorous criterion) compared to non-nicotine e-cigarettes (RR: 1.56; 95% CI: 1.13-2.15). The incidence of death or SAEs was low across all trials at maximum follow-up.
  • Conclusions: Among individuals attempting to quit smoking, nicotine e-cigarettes are more efficacious than conventional nicotine replacement or behavioral smoking cessation therapies and may prove beneficial in reducing smoking-related health risks.

2023: An examination of quitting smoking as a reason for vaping by the type of nicotine vaping device used most often among adults who smoke and vape: Findings from the Canada, England and the United States 2020 ITC Smoking and Vaping Survey

  • In 2020, most adults who used NVPs and smoked cigarettes reported usually using either cartridge/pod or tank device types which were associated with greater odds of use to help with smoking cessation, compared to disposables. However, when we assessed this relationship separately within each country, significant associations were found in England and Canada, but not in the US. Adults who were vaping daily were more likely to report vaping to quit smoking, with the majority using tanks most often.

2023: Qualitative exploration of longer versus shorter quit attempts among adults using E-Cigarettes for combustible cigarette cessation

  • Most participants discussed using e-cigarette devices and flavors to either replace sensations similar to smoking combustible cigarettes (e.g., inhaling from a cylindrical object) or to distract themselves from cravings to smoke. E-cigarettes also were described by the majority of participants as useful for smoking cessation because they approximate combustible cigarette use, potentially reduce health-related harms, save money, and lead to reduced social stigma compared to smoking cigarettes. Those who reported shorter duration quit attempts shared e-cigarette product challenges, health concerns, needs for support. Study findings demonstrate the need for additional research on the factors that may increase the likelihood that using e-cigarettes will result in longer and sustained e-cigarette-based quit attempts among adults.

2022: Tobacco Harm Reduction with Vaporised Nicotine (THRiVe): A Feasibility Trial of Nicotine Vaping Products for Smoking Cessation Among People Living with HIV

  • This study found that the provision of NVPs for 12 weeks was associated with 7-day point prevalence tobacco smoking abstinence among 35% of a sample of PLHIV who smoked tobacco daily. These findings suggest that NVPs represent a potentially feasible and effective short-to-medium term tobacco smoking cessation aid and/or tobacco harm reduction strategy among PLHIV.

2021: Use of e-cigarettes (vapes) among adults in Great Britain

  • Nearly two thirds of current vapers are ex-smokers (64.6%), and the proportion continues to grow, while the proportion who also smoke (known as dual users) has fallen to 30.5% in 2021.
  • Fewer than 1% of never smokers are current vapers (amounting to 4.9% of vapers).
  • As in previous years the main reason given by ex-smokers for vaping is to help them quit (36%) then to prevent relapse (20%).
  • The main reason given by current smokers for vaping is to cut down (26%) then to help them quit (17%) and to prevent relapse (14%).
  • Nearly a third of smokers incorrectly believe vaping is more or equally as harmful as smoking (32% compared to 34% in 2020).

2021: Patterns of E-Cigarette Use Among Primary Care Patients at an Urban Community Center

  • Among primary care patients at a community health center, e-cigarette use was reported by a sizeable portion of the sample. Overall, odds of use were higher in certain patient populations, and individuals who formally used cigarettes were more likely to report e-cigarette use than individuals who currently smoke, suggesting that e-cigarettes may be functioning as a cessation aid or a strategy to reduce conventional cigarette use.
  • Reasons for e-cigarette use included “to help me quit smoking cigarettes”, “to help me reduce the number of cigarettes I smoke”, and “so that I can e-smoke in places where cigarette smoking is not allowed."
  • The mean frequency of e-cigarette use was higher among those who formerly smoked cigarettes than among those who currently smoked (t = 6.45, p < 0.001) and patients who currently smoked had less than half the odds of daily e-cigarette use compared to those who formerly smoked (OR = 0.39, p < 0.001).

2020: A magic bullet? The potential impact of e-cigarettes on the toll of cigarette smoking

  • The combination of assumptions produces 360 possible scenarios. 357 (99%) yield positive estimates of life-years saved (LYS) due to vaping by 2100, from 143,000 to 65 million.
  • The impact of vaping is greatest when it most helps smokers who otherwise have the greatest difficulty quitting smoking.
  • Vaping is highly likely to reduce smoking-produced mortality. Still, vaping is not “the” answer to the public health crisis created by smoking. Rather, it may well be a tool to add to the armamentarium of effective tobacco control measures.
  • Harm reduction can, and many would say should, be a part of the complex formula that will eventually bring about the demise of smoking.
  • PDF Version

2020: Using e-cigarettes for smoking cessation: evaluation of a pilot project in the North West of England

  • Of the 1022 participants who engaged with the pilot 614 were still engaged at 4 weeks, of whom 62% had quit smoking. Of those who still smoked tobacco at week 4, smoking had reduced from a baseline of 19.1 cigarettes/day to 8.7. Overall, 37% of those initially enrolled were confirmed to be using an e-cigarette on its own at follow-up. Successful quit was associated with occupation (unemployed, 33% vs intermediate, 47%) and residing in the less deprived quintiles of deprivation (50% vs 34% in the most deprived quintile.
  • E-cigarettes appear to be an effective nicotine replacement therapy
  • PDF Version

2019: Electronic Cigarette Use and Cigarette Abstinence Over 2 Years Among U.S. Smokers in the Population Assessment of Tobacco and Health Study

  • In this nationally representative longitudinal cohort study of US adult cigarette smokers, daily e-cigarette use, compared to no e-cigarette use, was associated with a 77% increased odds of prolonged cigarette smoking abstinence over the subsequent 2 years. Regular use of e-cigarettes may help some smokers to stop smoking combustible cigarettes.
  • PDF Version
  • Article: Daily e-cigarette use may help smokers quit regular cigarettes

2019: Indicators of cigarette smoking dependence and relapse in former smokers who vape compared with those who do not: findings from the 2016 International Tobacco Control Four Country Smoking and Vaping Survey

  • Vapers were more likely than non-vapers to report: (1) having smoked within 5 minutes of waking; having smoked > 10 cigarettes/day; (2) perceiving themselves to be still very addicted to smoking and feeling extremely confident about staying quit.
  • In totality, therefore, our findings favour the first explanation, that in our sample the daily vapers had been a more highly dependent group than the non-vapers, which would support the suggestion that vaping might be offering a novel route out of smoking for this group of smokers, albeit maintaining their nicotine addiction.
  • PDF Version

2018: Advice From Former-Smoking E-Cigarette Users to Current Smokers on How to Use E-Cigarettes as Part of an Attempt to Quit Smoking

  • This study describes the advice that former-smokers who used e-cigarettes to quit smoking would offer to smokers who are considering using an e-cigarette to support an attempt to quit smoking. Vapers advised smokers to find the right combination of device, flavors and nicotine strength, continue to smoke and vape for a while if they wished, not be deterred by past failed attempts to quit smoking, and expect health to improve after they have switched to vaping. Encouraging smokers to interact with vaping peers in vape shops and in online vaping-dedicated discussion forums may help significantly more smokers switch to vaping.
  • PDF Version

2018: E-cigarette Usage Is Associated With Increased Past-12-Month Quit Attempts and Successful Smoking Cessation in Two US Population–Based Surveys

  • Compared with 2006, past-12-month quit attempts and smoking cessation increased among adults aged 25–44 in recent years. Current e-cigarette use was associated with increased past-12-month quit attempts and successful smoking cessation among established smokers. These findings are relevant to future tobacco policy decisions.
  • PDF Version

2017: Patterns of and reasons for electronic cigarette use in primary care patients

  • In descriptive analyses, compared to never e-cigarette users, ever e-cigarette users were younger, non-Hispanic white, more educated, more likely to be daily smokers, smoked more cigarettes per day, and smoked their first cigarette within 30 min of waking.
  • Among current e-cigarette users, 84% reported using e-cigarettes to quit cigarettes, to cut down on cigarettes, or because they believe they are less harmful than cigarettes. The least common reason for use was cost (48%). Among former e-cigarette users, 78% reported using e-cigarettes to quit cigarettes, to cut down on cigarettes, or because they believe they are less harmful than cigarettes, and the least common reason was also cost (30%).
  • PDF Version

2016: Long-term e-cigarette use and smoking cessation: a longitudinal study with US population

  • E-cigarettes have grown popular. The most common pattern is dual use with conventional cigarettes. Dual use has raised concerns that it might delay quitting of cigarette smoking. This study examined the relationship between long-term use of e-cigarettes and smoking cessation in a 2-year period.
  • Dual use of e-cigarettes and cigarettes was not associated with a lower smoking cessation rate.
  • Among those making a quit attempt, use of e-cigarettes as a cessation aid surpassed that of FDA-approved pharmacotherapy.
  • Long-term use of e-cigarettes was associated with a higher rate of quitting smoking.
  • PDF Version

2014: Reasons for quitting cigarette smoking and electronic cigarette use for cessation help

  • Thus, this may be the first study to suggest that smokers who want to quit smoking for immediate, extrinsic rewards may be attracted to use e-cigarettes to stop smoking cigarettes than smokers who want to quit smoking for intrinsic reasons such as health concerns. In conclusion, e-cigarettes appear to provide a “smoking” alternative to a section of cigarette smokers who may not quit smoking for health reasons. Public health efforts may need to consider employing e-cigarettes to promote tobacco-related harm reduction.
  • PDF Version

2014: Cigarette Users’ Interest in Using or Switching to Electronic Nicotine Delivery Systems (ENDS) for Smokeless Tobacco for Harm Reduction, Cessation, or Novelty: A Cross-Sectional Survey of US Adults

  • This study highlights higher interest in ENDS versus smokeless tobacco and greater interest in both for harm reduction and cessation than due to novelty or smoking restrictions. Developing educational campaigns and informing practitioners about caveats around ENDS as cessation or harm reduction aids are critical.
  • PDF Version

2013: 'Vaping' profiles and preferences: an online survey of electronic cigarette users

  • Seventy-four percent of participants reported not smoking for at least a few weeks since using the e-cigarette and 70% reported reduced urge to smoke. *Seventy-two percent of participants used a 'tank' system, most commonly. Mean duration of use was 10 months. Only 1% reported exclusive use of non-nicotine containing liquid. E-cigarettes were generally considered to be satisfying to use; elicit few side effects; be healthier than smoking; improve cough/breathing; and be associated with low levels of craving. Among ex-smokers, 'time to first vape' was significantly longer than 'time to first cigarette' suggesting a lower level of dependence to e-cigarettes. Ex-smokers reported significantly greater reduction in craving than current smokers.
  • E-cigarettes are used primarily for smoking cessation, but for a longer duration than nicotine replacement therapy, and users believe them to be safer than smoking
  • PDF Version

2012: The electronic-cigarette: Effects on desire to smoke, withdrawal symptoms and cognition

  • The e-cigarette can reduce desire to smoke and nicotine withdrawal symptoms 20 minutes after use.
  • The nicotine content in this respect may be more important for males.
  • The first study to demonstrate that the nicotine e-cigarette can improve working memory.
  • PDF Version

2011: Successful smoking cessation with electronic cigarettes in smokers with a documented history of recurring relapses: a case series

  • The most important message from this case series is that these smokers, with a documented history of recurring relapses, were able to quit smoking and to remain abstinent for at least six months after taking up an electronic cigarette.
  • PDF Version

2011: Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy

  • Almost all (97%) used e‐cigarettes containing nicotine.
  • Most (96%) said the e‐cigarette helped them to quit smoking or reduce their smoking (92%).
  • Reasons for using the e‐cigarette included the perception that it was less toxic than tobacco (84%), to deal with craving for tobacco (79%) and withdrawal symptoms (67%), to quit smoking or avoid relapsing (77%), because it was cheaper than smoking (57%) and to deal with situations where smoking was prohibited (39%).
  • Most ex‐smokers (79%) feared they might relapse to smoking if they stopped using the e‐cigarette.
  • Users of nicotine‐containing e‐cigarettes reported better relief of withdrawal and a greater effect on smoking cessation than those using non‐nicotine e‐cigarettes.
  • PDF Version

2011: Electronic Cigarettes As a Smoking-Cessation Tool: Results from an Online Survey

  • A large percentage of respondents reported a reduction in the number of cigarettes they smoked (66.8%) and almost half reported abstinence from smoking for a period of time (48.8%). Those respondents using e-cigarettes more than 20 times per day had a quit rate of 70.0%. Of respondents who were not smoking at 6 months, 34.3% were not using e-cigarettes or any nicotine-containing products at the time.
  • The distinct and unique advantage of e-cigarettes is that they allow individuals to utilize one device that can simultaneously address nicotine withdrawal, psychological factors, and behavioral cues that serve as barriers to smoking abstinence.
  • PDF Version

2011: Interviews With “Vapers”: Implications for Future Research With Electronic Cigarettes

  • Experienced users report health gains typical for smoking cessation despite continued vaping.
  • There were pervasive themes including the language and culture of vaping; social and informational support among vapers, motives and perceived benefits of using e-cigs versus cigarettes including cigarette-like enjoyment, cost, restored sense of taste and smell, and improved breathing and exercise tolerance; rapidly reduced nicotine tolerance and dependence; and a strong interest in e-cig–related research and policy.
  • PDF Version

2010: Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery: randomised cross-over trial

  • Conclusions “The 16 mg Ruyan V8 ENDD alleviated desire to smoke after overnight abstinence, was well tolerated and had a pharmacokinetic profile more like the Nicorette inhalator than a tobacco cigarette. Evaluation of the ENDD for longer-term safety, potential for long-term use and efficacy as a cessation aid is needed.”
  • PDF Version

2010: Electronic cigarettes: a survey of users

  • Our results suggest that ecigarettes are used mainly to quit smoking, and may be useful for this purpose.
  • PDF Version

2006: Role of snus in initiation and cessation of tobacco smoking in Sweden

  • Use of snus in Sweden is associated with a reduced risk of becoming a daily smoker, and increased likelihood of stopping smoking

2005: Is Swedish snus associated with smoking initiation or smoking cessation?

  • “Among males participating in a large population based twin study in Sweden, snus use was associated with smoking cessation but not initiation.”
  • PDF Version


Consumer Products vs Medicinal Products

2023: Smoking reduction using electronic nicotine delivery systems in combination with nicotine skin patches.

  • Rose JE, Frisbee S, Campbell D, Salley A, Claerhout S, Davis JM. Psychopharmacology (Berl). 2023 Jul 17. doi: 10.1007/s00213-023-06401-y. Online ahead of print. PMID: 37458789
  • Results: The use of nicotine in ENDS led to significant reductions in smoking (ENDS nicotine vs. placebo difference in CO change = -9.2 ppm; 90% CI (-1.5 ppm, -16.9 ppm)) and was highly correlated with reductions in self-reported cigarettes per day (r=0.6).
  • The effect of nicotine in nicotine patches was not statistically significant (patch nicotine vs. placebo difference in CO change = -0.1 ppm; 90% CI (-7.8 ppm, 7.6 ppm)).

2023: Electronic Cigarettes for Smoking Cessation: Cochrane Living Systematic Review

  • There is high certainty evidence that more people stop smoking for at least six months using nicotine e-cigarettes than using nicotine replacement therapy (NRT, such as patches, gum, or lozenges) (6 studies, 2378 people). There is moderate certainty evidence that more people stop smoking for at least six months using nicotine e-cigarettes than nicotine-free e-cigarettes (5 studies, 1447 people).

2021: E-cigarettes versus nicotine replacement treatment as harm reduction interventions for smokers who find quitting difficult: Randomised controlled trial

  • Participants previously unable to stop smoking with conventional treatments.
  • Validated smoking reduction (including cessation) was achieved by 26.5% vs 6.0% of participants in the EC and NRT study arms, respectively. Sustained validated abstinence rates at 6 months were 19.1% vs 3.0%.
  • PDF Version

2021: Electronic cigarettes in standard smoking cessation treatment by tobacco counselors in Flanders: E-cigarette users show similar if not higher quit rates as those using commonly recommended smoking cessation aids

  • One third of the total sample was biochemically verified smoking abstinent 7 months after quit date, with e-cigarette users (40%) having significantly higher chances to be smoking abstinent than NRT users (23%).
  • PDF Version

2021: A systematic review of randomized controlled trials and network meta-analysis of e-cigarettes for smoking cessation

  • Smokers assigned to use nicotine e-cigarettes were more likely to remain abstinent from smoking than those assigned to use licensed NRT, and both were more effective than usual care or placebo conditions.

2020: QuitNic: A pilot randomised controlled trial comparing nicotine vaping products with nicotine replacement therapy for smoking cessation following residential detoxification

  • This pilot study showed that smoking cessation support involving options for nicotine replacement and Quitline-delivered cognitive behavioural counselling is attractive to people after they have been discharged from SUD (Substance Use Disorder) treatment.
  • Retention was 63% at 6-weeks and 50% at 12-weeks. At 12-weeks, 68% of the NRT group reported using combination NRT while 96% of the NVP group used the device. Acceptability ratings for the products were high in both groups. At 12-weeks, 14% of the NVP group and 18% of the NRT group reported not smoking at all in the last 7 days. Mean CPD (Cigarettes Per Day) among continued smokers decreased significantly between baseline to 12-weeks in both groups; from 19.91 to 4.72 for the NVP group (p<0.001) and from 20.88 to 5.52 in the NRT group (p<0.001). Cravings and withdrawal symptoms significantly decreased for both groups.
  • PDF Version

2020: Effectiveness of Electronic Cigarettes in Smoking Cessation: a Systematic Review and Meta-Analysis

  • Our results suggest that nicotine-ECs may be more effective in smoking cessation when compared to placebo ECs or NRT.
  • PDF Version

2019: A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy

  • A total of 886 participants underwent randomization. The 1-year abstinence rate was 18.0% in the e-cigarette group, as compared with 9.9% in the nicotine-replacement group (relative risk, 1.83; 95% confidence interval [CI], 1.30 to 2.58; P<0.001). Among participants with 1-year abstinence, those in the e-cigarette group were more likely than those in the nicotine-replacement group to use their assigned product at 52 weeks (80% [63 of 79 participants] vs. 9% [4 of 44 participants]). Overall, throat or mouth irritation was reported more frequently in the e-cigarette group (65.3%, vs. 51.2% in the nicotine-replacement group) and nausea more frequently in the nicotine-replacement group (37.9%, vs. 31.3% in the e-cigarette group). The e-cigarette group reported greater declines in the incidence of cough and phlegm production from baseline to 52 weeks than did the nicotine-replacement group (relative risk for cough, 0.8; 95% CI, 0.6 to 0.9; relative risk for phlegm, 0.7; 95% CI, 0.6 to 0.9). There were no significant between-group differences in the incidence of wheezing or shortness of breath.
  • Conclusion: E-cigarettes were more effective for smoking cessation than nicotine-replacement therapy, when both products were accompanied by behavioral support.
  • PDF Version

2019: E-cigarettes compared with nicotine replacement therapy within the UK Stop Smoking Services: the TEC RCT

  • The primary outcome was CO-validated sustained abstinence rates at 52 weeks. Participants lost to follow-up or not providing biochemical validation were included as non-abstainers.
  • The 1-year quit rate was 9.9% in the NRT arm and 18.0% in the e-cigarette arm.
  • The e-cigarette arm had significantly higher validated quit rates at all time points. Participants in the e-cigarette arm showed significantly better adherence and experienced fewer urges to smoke throughout the initial 4 weeks of their quit attempt than those in the NRT arm, and gave their allocated product more favourable ratings. They were also more likely to be still using their allocated product at 1 year
  • Participants assigned to e-cigarettes reported significantly less coughing and phlegm at 1 year than those assigned to NRT
  • A detailed economic analysis confirmed that, because e-cigarettes incur lower NHS costs than NRT and generate a higher quit rate, e-cigarette use is more cost-effective.
  • PDF Version

2019: Effect of Electronic Cigarettes on Smoking Reduction and Cessation in Korean Male Smokers: A Randomized Controlled Study

  • In our study, the effect of e-cigarettes on smoking cessation was similar compared with that of nicotine gum, a well-documented NRT. In addition, e-cigarettes were well tolerated by the study population. Therefore, the use of e-cigarettes as an NRT may be considered for smoking-cessation purposes.
  • PDF Version

2019: Cost‐effectiveness of e‐cigarettes compared with nicotine replacement therapy in stop smoking services in England (TEC study): a randomized controlled trial

  • Using e‐cigarettes as a smoking cessation aid with standard behavioural support in stop‐smoking services in England is likely to be more cost‐effective than using nicotine replacement therapy in the same setting.
  • PDF Version

2016: Long-term e-cigarette use and smoking cessation: a longitudinal study with US population

  • E-cigarettes have grown popular. The most common pattern is dual use with conventional cigarettes. Dual use has raised concerns that it might delay quitting of cigarette smoking. This study examined the relationship between long-term use of e-cigarettes and smoking cessation in a 2-year period.
  • Dual use of e-cigarettes and cigarettes was not associated with a lower smoking cessation rate.
  • Among those making a quit attempt, use of e-cigarettes as a cessation aid surpassed that of FDA-approved pharmacotherapy.
  • Long-term use of e-cigarettes was associated with a higher rate of quitting smoking.
  • PDF Version

2014: E-cigarette versus nicotine inhaler: comparing the perceptions and experiences of inhaled nicotine devices

  • Related Article: E-Cigarettes vs. Nicotine Inhalers
  • “In conclusion, during this brief trial, the e-cigarette was found to be more acceptable, provided more satisfaction and rewards, and had higher perceived benefit than the nicotine inhaler. These findings may explain why the e-cigarette has become popular among smokers while the inhaler has not achieved the same favorability. Based on this difference, e-cigarettes could have the potential to become “tobacco cigarette substitutes,” owing to their high acceptance and perceived effectiveness. While toxicants have been identified in e-cigarettes, they are present at orders of magnitude lower than tobacco cigarettes. As such, e-cigarettes may hold value as a harm reduction strategy among those unwilling or unable to quit. However, given the large variation in the market with respect to brands, more data are needed to demonstrate their efficacy and safety, and to allow physicians to more appropriately inform their patients about these products.”
  • PDF Version

2014: Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study

  • Conclusion: “Among smokers who have attempted to stop without professional support, those who use e-cigarettes are more likely to report continued abstinence than those who used a licensed NRT product bought over-the-counter or no aid to cessation. This difference persists after adjusting for a range of smoker characteristics such as nicotine dependence.”
  • PDF Version

2013: Electronic cigarettes for smoking cessation: a randomised controlled trial

  • 657 people were randomised (289 to nicotine e-cigarettes, 295 to patches, and 73 to placebo e-cigarettes) and were included in the intention-to-treat analysis.
  • At 6 months, verified abstinence was 7·3% (21 of 289) with nicotine e-cigarettes, 5·8% (17 of 295) with patches, and 4·1% (three of 73) with placebo e-cigarettes
  • PDF Version

2013: Electronic cigarettes and vaping: a new challenge in clinical medicine and public health. A literature review

  • When compared to the harmful effects of smoking, these studies suggest that vaping could be used as a possible “harm reduction” tool. There is evidence supporting e-cigarettes as an aide for smoking cessation, at least as successful as currently available FDA-approved NRTs.


Importance of Nicotine Levels

2022: Effect of Electronic Nicotine Delivery Systems on Cigarette Abstinence in Smokers With No Plans to Quit: Exploratory Analysis of a Randomized Placebo-Controlled Trial

  • When smokers seeking to reduce smoking tried ENDS, few quit smoking in the short term. However, if smokers continued to use an ENDS with cigarette-like nicotine delivery, a greater proportion completely switched to ENDS, as compared with placebo or a cigarette substitute.

2021: A Single-Arm, Open-Label, Pilot, and Feasibility Study of a High Nicotine Strength E-Cigarette Intervention for Smoking Cessation or Reduction for People With Schizophrenia Spectrum Disorders Who Smoke Cigarettes

  • A high strength nicotine e-cigarette has the potential to help people with schizophrenia spectrum disorders to quit or reduce smoking.
  • PDF Version

2021: Differences in Switching Away From Smoking Among Adult Smokers Using JUUL Products in Regions With Different Maximum Nicotine Concentrations: North America and the United Kingdom

  • In this longitudinal study of N.Am. and UK smokers who purchased JUUL, switch rates were higher in the N.Am. users, where smokers were using higher nicotine concentrations. The results were robust to multiple adjustments for differences between the two nicotine concentration policy regions across different statistical approaches, including PSM on relevant observable characteristics. These results have implications for regulatory policy, as the availability of ENDS with nicotine concentrations greater than 20 mg/mL may facilitate switching away from cigarette among adult smokers.

2021: Changes in dependence, withdrawal, and craving among adult smokers who switch to nicotine salt pod-based e-cigarettes

  • Smokers who switch to nicotine salt pod system e-cigarettes maintain their nicotine levels and transfer their dependence, suggesting that nicotine salt pod system e-cigarettes have a similar reinforcement potential to cigarettes and facilitate switching.

2021: Effect of Electronic Nicotine Delivery Systems on Cigarette Abstinence in Smokers with no Plans to Quit: Exploratory Analysis of a Randomized Placebo-Controlled Trial

  • Preprint
  • When smokers seeking to reduce smoking tried ENDS, few quit smoking in the short term. However, if smokers continued to use an ENDS with cigarette-like nicotine delivery, a greater proportion completely switched to ENDS, as compared with placebo or a cigarette substitute.
  • The extent to which use of electronic nicotine delivery systems (ENDS) for smoking reduction leads to cigarette abstinence in smokers with no plans to quit smoking was unclear. This randomized trial found that ENDS with nicotine delivery approaching that of a cigarette are more effective in helping ambivalent smokers to quit cigarette smoking.

2020: Reported patterns of vaping to support long-term abstinence from smoking: a cross-sectional survey of a convenience sample of vapers

  • Those who start on a low self-reported nicotine e-liquid concentration (strength) will be more likely to relapse to tobacco smoking than those starting on a higher nicotine e-liquid, after controlling for cigarettes per day (CPD) before cessation.

2019: Young adult dual combusted cigarette and e-cigarette users’ anticipated responses to hypothetical e-cigarette market restrictions

  • Hypothetical regulations resulted in reported intentions to reduce EC (e-cigarette) use and increase CC (combustible cigarette) use; the greatest impact was found for restrictions regarding e-liquid nicotine content, followed by flavor
  • This work provides preliminary evidence that restrictive regulations regarding key EC characteristics may increase intentions to increase CC use among young adult dual EC and CC users.
  • PDF Version

2018: Advice From Former-Smoking E-Cigarette Users to Current Smokers on How to Use E-Cigarettes as Part of an Attempt to Quit Smoking

  • This study describes the advice that former-smokers who used e-cigarettes to quit smoking would offer to smokers who are considering using an e-cigarette to support an attempt to quit smoking. Vapers advised smokers to find the right combination of device, flavors and nicotine strength, continue to smoke and vape for a while if they wished, not be deterred by past failed attempts to quit smoking, and expect health to improve after they have switched to vaping. Encouraging smokers to interact with vaping peers in vape shops and in online vaping-dedicated discussion forums may help significantly more smokers switch to vaping.
  • PDF Version

2014: Characteristics, Perceived Side Effects and Benefits of Electronic Cigarette Use: A Worldwide Survey of More than 19,000 Consumers

  • The main results of this survey indicate that ECs may be an effective substitute for smoking even in highly dependent subjects who are heavy smokers. Significant benefits are experienced by these people in physiologic functions and in some disease conditions, with former smokers (those who completely substituted smoking with EC use) being more likely to report such beneficial effects.
  • Both former and current smokers initiated EC use with high nicotine-containing liquids. More than one-fifth of the population initiated use with more than 20 mg/mL nicotine concentration, with higher prevalence in former smokers, supporting the hypothesis that nicotine plays an important role in the success of ECs as smoking substitutes. This can be attributed to the lower nicotine absorption from EC use compared to smoking. Such repeated observations should be taken into consideration by the regulatory authorities.
  • The most important reasons for participants to initiate ECs were to reduce or completely quit smoking and to reduce exposure of family members to second-hand smoking. It seems that these subjects are well-informed about the adverse health effects of smoking and are willing to try an alternative product which they consider less harmful.
  • In conclusion, in this large sample of dedicated EC users, it seems that ECs are used as long-term substitutes to smoking. They can be effective even in subjects who are highly dependent on smoking and are heavy smokers. Mild temporary side-effects and significant benefits are reported by this population. Motivation for using ECs comes from their expected less harmful potential compared to smoking.
  • PDF Version

2013: Evaluating Nicotine Levels Selection and Patterns of Electronic Cigarette use in a Group of “Vapers” Who Had Achieved Complete Substitution of Smoking

  • Nicotine levels appear to play an important role in achieving and maintaining smoking cessation in the group of motivated subjects studied. High nicotine-containing liquids were used while few mild and temporary side effects were reported. Proposals about regulation should consider the pragmatic use patterns of ECs, especially in consumers who have completely substituted smoking.
  • 42% of participants reported quitting smoking during the first month of EC use.
  • Liquids with nicotine concentration >15 mg/mL were used by 74% of users at initiation of EC use, while 16.2% had to increase the initial nicotine levels in order to achieve complete smoking abstinence.
  • 64.9% reported that from the time of smoking cessation to the time of the interview (8 months median duration of EC use) they reduced the nicotine concentration they were consuming.
  • PDF Version


Flavors/Flavours

2023 (Article): Smokers who get e-cigarette flavour advice more likely to quit, report finds

  • Smokers who get help picking the flavour of e-cigarette they will use and receive supportive text messages are much more likely to quit, research has found.

See Also: ENDS - Flavors and Nicotine - Banning Flavors - Opposition

2023: Randomized trial assessing the effect of the JUUL system on switching away from cigarettes and smoking reduction among U.S. adults who smoke cigarettes

  • Use of JUUL products may support complete switching away from cigarettes, including among those not ready to quit smoking. Results suggest a preference for nontobacco-flavored ENDS among adults who smoke, although smoking outcomes did not differ by flavor.

2022: Associations between e-cigarette use and e-cigarette flavors with cigarette smoking quit attempts and quit success: Evidence from a US large, nationally representative 2018-2019 survey

  • E-cigarette use is positively associated with both making a quit attempt and quit success, and those using flavored e-cigarettes are more likely to successfully quit smoking, with no statistically significant differences between the use of menthol or mint-flavored e-cigarettes versus the use of other nontobacco flavored products.

2022: Association of device type, flavours and vaping behaviour with tobacco product transitions among adult electronic cigarette users in the USA

  • Non-tobacco flavours, daily vaping and modifiable e-cigarette devices may help some smokers abstain from cigarette smoking via transitioning to exclusive e-cigarette use, but are also associated with ongoing exclusive e-cigarette use.

2022: Impact of existing and potential e-cigarette flavor restrictions on e-cigarette use among young adult e-cigarette users in 6 US metropolitan areas

  • Results from this study highlight heterogeneity in young adult e-cigarette users’ reactions to existing flavored e-cigarette sales restrictions and hypothetical restrictions. Some reduced e-cigarette use, but many reported intentions to continue e-cigarette use, by using tank-based e-cigarettes, available flavors, or flavors accessed through alternative sources. More concerning, some switched to cigarettes. Similarly, in response to future restrictions of all flavored e-liquids, young adult e-cigarette users largely indicated that they would either quit vaping – the ideal scenario – or switch to cigarettes – the least desirable scenario. Another major concern highlighted was access to flavored e-cigarettes despite restrictions (e.g., online, across state lines). Collectively, findings suggest that implications of flavored e-cigarette sales restrictions are complex, with the potential for both reductions in e-cigarette use and unintended consequences among young adults, including continued use of flavored e-cigarettes or switching to cigarettes, and retail and consumer circumvention of restrictions.

2022: Responses to potential nicotine vaping product flavor restrictions among regular vapers using non-tobacco flavors: Findings from the 2020 ITC Smoking and Vaping Survey in Canada, England and the United States

  • Predicted behavioral responses were: 28.8% would continue vaping an available flavor, 28.3% would find a way to get their banned flavor(s), 17.1% would stop vaping and smoke instead, 12.9% said that they would stop vaping and not smoke, and 12.9% do not know what they would do.

2021: How Does the Use of Flavored Nicotine Vaping Products Relate to Progression Toward Quitting Smoking? Findings From the 2016 and 2018 ITC 4CV Surveys

  • Use of fruit and other sweet flavored e-liquids is positively related to smokers’ transition away from cigarettes.

2020: Associations of Flavored e-Cigarette Uptake With Subsequent Smoking Initiation and Cessation

  • Adults who began vaping nontobacco-flavored e-cigarettes were more likely to quit smoking than those who vaped tobacco flavors.
  • Banning flavors altogether may be too blunt an instrument for the current problem (youth use of vapor products).
  • PDF Version

2020: Reported patterns of vaping to support long-term abstinence from smoking: a cross-sectional survey of a convenience sample of vapers

  • Qualitative research suggests e-cigarettes can meet many of the needs of ex-smokers by substituting physical, psychological, social, cultural and identity-related aspects of tobacco addiction.
  • According to a time-series analysis of data from the Smoking Toolkit study, in which repeated cross-sectional surveys are conducted with a representative sample of households in England, increasing prevalence of e-cigarette use in current smokers was predictive of higher success rates of quit attempts.
  • Most participants were self-reported long-term abstinent smokers (86.3%).
  • Those who start on a low self-reported nicotine e-liquid concentration (strength) will be more likely to relapse to tobacco smoking than those starting on a higher nicotine e-liquid, after controlling for cigarettes per day (CPD) before cessation.
  • Results suggest a change in flavor choices over the course of vaping initiation and uptake. There was a reduction in the proportion of people using a tobacco flavor, and increase in the proportion using a fruit/sweet/food flavor, from initial to current flavor choice
  • According to the 2017 ASH-A survey, among current users, fruit flavors were the most popular.
  • PDF Version

2020: Patterns of e-cigarette use and subsequent cigarette smoking cessation over two years (2013/2014 to 2015/2016) in the Population Assessment of Tobacco and Health (PATH) Study

  • Smoking cessation was more likely among frequent e-cigarette users, users of e-cigarettes in last quit attempt, and users of flavored and rechargeable devices.
  • In this study, the proportion of US adults who incorrectly perceived e-cigarettes as equal to, or more, harmful than cigarettes increased steadily regardless of smoking or vaping status. Current adult smokers appear to be poorly informed about the relative risks of e-cigarettes yet have potentially the most to gain from transitioning to these products. The findings of this study emphasise the urgent need to accurately communicate the reduced relative risk of e-cigarettes compared to continued cigarette smoking and clearly differentiate absolute and relative harms.
  • The lack of accurate and consistent messaging from both public health agencies and the media may be contributing to public, and more specifically adult smokers’, perceptions about the relative risk of nicotine when decoupled from combustion and tobacco smoke.
  • Confusion may potentially be discouraging adult smokers from using alternative, less hazardous products which may ultimately result in a missed opportunity to positively impact health at both an individual and population level.
  • PDF Version

2020: The impact of a comprehensive tobacco product flavor ban in San Francisco among young adults

  • Among the 18–24 age group, there was a significant increase in cigarette smoking.
  • Cigarette smoking increased among 25–34 years old.
  • Banning flavors in e-cigarettes can push some e-cigarette users to turn to cigarette smoking and could prompt some youth to initiate into smoking instead of e-cigarette use.
  • The proportions of e-cigarettes, cigarettes, and cigars obtained over the internet increased after the ban, and the proportions obtained from retailers outside of San Francisco also increased overall.
  • PDF Version

2019: The role of flavors in vaping initiation and satisfaction among U.S. adults

  • Most common reasons for vaping initiation were as an alternative to cigarettes (43.7%) and because respondents viewed e-cigarettes as less harmful than other tobacco products (31.2%). Flavor was the third most commonly reported reason.
  • Satisfaction among those who bought flavored e-liquid was higher than those who did not buy flavored e-liquid.
  • PDF Version

2019: Video: Can Flavors Help People Who Smoke Quit Smoking?

  • Minnesota Smoke-Free Alliance
  • Do flavors help adults quit smoking? Is there "right" flavored products and "wrong" flavored products? Do we have the right to tell people they have to quit smoking using a method we approve of? (English)

2019: Article: Flavors make vaping more palatable, help cigarette smokers kick the habit

  • Flavored e-cigarettes were not invented by “Big Tobacco,” nor are they an unscrupulous marketing plot from the thousands of small, independently owned vape companies in the United States to addict kids. Non-tobacco vape flavors are a user innovation.
  • Fruit, candy, bakery, mint, and beverage flavors were introduced to vaping in 2008 by pioneering users of the technology who were desperate to use e-cigarettes to replace smoking.
  • Flavors like cotton candy, bubble gum, and the many other examples opponents claim are obviously targeted to youth are in fact flavors someone trying to quit smoking wanted to vape and mixed themselves. These innovations in home-mixing resulted in the commercial market about to be banned today.
  • The preponderance of evidence indicates that non-tobacco flavors, including fruit, dessert, and candy, are essential to vaping as an effective way to quit smoking and avoid relapse.

2019: Young adult dual combusted cigarette and e-cigarette users’ anticipated responses to hypothetical e-cigarette market restrictions

  • Hypothetical regulations resulted in reported intentions to reduce EC (e-cigarette) use and increase CC (combustible cigarette) use; the greatest impact was found for restrictions regarding e-liquid nicotine content, followed by flavor
  • This work provides preliminary evidence that restrictive regulations regarding key EC characteristics may increase intentions to increase CC use among young adult dual EC and CC users.
  • PDF Version

2019: Changes in Flavor Preference in a Cohort of Long-Term Electronic Cigarette Users

  • It is also concerning that some established e-cigarette users believed that they would return to cigarette smoking if nontobacco e-cigarette flavors were banned. Thus, for adult e-cigarette users who use certain flavors to facilitate smoking cessation or reduction, banning all nontobacco flavors could precipitate relapse to smoking.
  • PDF Version

2018: Patterns of flavored e-cigarette use among adults vapers in the United States: an internet survey

  • Survey results submitted to the FDA
  • In conclusion, this cross-sectional study of a very large sample of adult US e-cigarette users, most of which were former smokers, identified the importance of non-tobacco flavors in e-cigarette use initiation and sustained use, and their contribution to smoking cessation and relapse prevention. *This information should be considered by regulators in order to avoid unintentional adverse effects of over-restrictive regulation on e-cigarette flavors.
  • PDF Version

2018: Advice From Former-Smoking E-Cigarette Users to Current Smokers on How to Use E-Cigarettes as Part of an Attempt to Quit Smoking

  • This study describes the advice that former-smokers who used e-cigarettes to quit smoking would offer to smokers who are considering using an e-cigarette to support an attempt to quit smoking. Vapers advised smokers to find the right combination of device, flavors and nicotine strength, continue to smoke and vape for a while if they wished, not be deterred by past failed attempts to quit smoking, and expect health to improve after they have switched to vaping. Encouraging smokers to interact with vaping peers in vape shops and in online vaping-dedicated discussion forums may help significantly more smokers switch to vaping.
  • PDF Version

2018: Motivation and main flavour of use, use with nicotine and dual use of electronic cigarettes in Barcelona, Spain: a cross-sectional study

  • The most prevalent motivation for using e-cigarettes was to reduce tobacco smoking 48%, followed by quitting smoking 39.2%, and to use e-cigarettes in places where tobacco smoking was prohibited 10.2%.

2018: Changing patterns of first e-cigarette flavor used and current flavors used by 20,836 adult frequent e-cigarette users in the USA

  • Adult frequent e-cigarette users in the USA who have completely switched from smoking cigarettes to using e-cigarettes are increasingly likely to have initiated e-cigarette use with non-tobacco flavors and to have transitioned from tobacco to non-tobacco flavors over time. Restricting access to non-tobacco e-cigarette flavors may discourage smokers from attempting to switch to e-cigarettes.
  • PDF Version

2018: Should flavours be banned in cigarettes and e-cigarettes? Evidence on adult smokers and recent quitters from a discrete choice experiment

  • A ban on flavoured e-cigarettes would likely increase the choice of cigarettes in smokers, the more harmful way of obtaining nicotine.
  • PDF Version

2017: Differences between Dual Users and Switchers Center around Vaping Behavior and Its Experiences Rather than Beliefs and Attitudes

  • To the extent that dual users substantially lower the number of cigarettes, they will reduce health risks from smoking. However, from a medical point of view, exclusive vaping is preferable to dual use;
  • Differences between dual users and switchers center around variables proximal to the vaping behavior and its experienced effects rather than hinging on more general vaping-related beliefs and attitudes.
  • After e-cig initiation, dual users decreased tobacco consumption by 82% and were low-to-moderately cigarette dependent.
  • The two groups (dual users and switchers) reported mostly using a flavor other than tobacco.
  • PDF Version

2016: Cigarette smoking and electronic cigarette vaping patterns as a function of e-cigarette flavourings

  • The findings suggest that adoption of e-cigarettes in smokers may influence smoking rates of people who smoke.
  • E-cigarette vaping rates are influenced by flavorings by people transistioning from smoking.
  • These findings have implications for the utility of e-cigarettes as a nicotine replacement device and for the regulation of e-cigarettes for harm reduction.
  • PDF Version

2015: Biochemically verified smoking cessation and vaping beliefs among vape store customers

  • Among vapor store customers in the USA who use ENDS to stop smoking, vaping longer, using newer-generation devices and using non-tobacco and non-menthol flavored e-liquid appear to be associated with higher rates of smoking cessation.

2015: The Impact of Flavor Descriptors on Nonsmoking Teens’ and Adult Smokers’ Interest in Electronic Cigarettes

  • Nonsmoking teens’ interest in e-cigarettes was very low.
  • Adult smokers’ interest was significantly higher overall and for each flavor.
  • Teen interest did not vary by flavor, but adult interest did.
  • Past-30-day adult e-cigarette users had the greatest interest in e-cigarettes, and their interest was most affected by flavor.
  • Nonsmoking teens who had never tried e-cigarettes had the lowest interest in flavors, followed by adults who had never tried e-cigarettes
  • PDF Version

2015: Preferred Flavors and Reasons for E-cigarette Use and Discontinued Use Among Never, Current, and Former Smokers

  • Never users had significantly lower prevalence of use of alcohol, marijuana, and other tobacco products (take less risks).
  • The most commonly reported reasons for e-cigarette use were “they might be less harmful than cigarettes” (77%); “they don’t smell” (77%); “they help people quit smoking” (66%); and “they cost less than other forms of tobacco” (62%); these reasons were more frequently endorsed by former smokers.
  • Among current e-cigarette users, the most commonly used flavor was fruit flavors (67%)
  • Over 90% of former cigarette smokers who were current e-cigarette users reported using e-cigarettes to quit smoking.
  • Over half of never smokers who are former e-cigarette users said they did not recently use e-cigarettes because they “just don’t think about it”, possibly indicating that addiction did not play a role in their use.
  • PDF Version

2015: Counseling in Vape Shops: A Survey of Vape Shop Managers in Switzerland

  • Vape-shop managers explain how they successfully switched from smoking to vaping and help customers individually find the right combination of device, e-liquid flavor, and nicotine concentration.

2013: Impact of Flavour Variability on Electronic Cigarette Use Experience: An Internet Survey

  • 4,618 participants were included in the analysis, with 4,515 reporting current smoking status (current vs. former smokers).
  • More than 90% were former smokers. The mean age was 40 years
  • At the time of participation, most commonly used flavors were fruits, followed by sweets.
  • Most participants (68.3%) were switching between flavours on a daily basis or within the day, with former smokers switching more frequently. More than half of the study sample mentioned that they like the variety of flavours and that the taste gets blunt from long-term use of the same flavour. The average score for importance of flavours variability in reducing or quitting smoking was 4 (“very important”). Finally, the majority of participants stated that restricting variability of flavours would make the EC experience less enjoyable while almost half of them answered that it would increase craving for tobacco cigarettes and would make reducing or completely substituting smoking less likely.
  • The results of this survey indicate that EC liquid flavourings play a major role in the overall experience of dedicated users and support the hypothesis that they are important contributors in reducing or eliminating smoking consumption.
  • PDF Version

2006: Tobacco Dependence: Global Public Health Potential for New Medications Development and Indications

  • The marketing of a mint-flavored form of nicotine gum in the United States increased the market for nicotine gum by more than 25% and contributed to increasing numbers of smokers finding a treatment that was acceptable and thereby successfully quitting smoking.
  • There is clearly a need for increased forms of nicotine delivery, possibly including those that more closely mimic the pharmacokinetics of cigarettes.


Vaping Frequency or Duration

2024: Concurrent E-cigarette Use While Enrolled in a Smoking Cessation Program: Associations between Frequency of use, Motives for Use and Smoking Cessation.

  • More evidence suggesting the intuitively obvious idea that more frequent and regular use of e-cigarettes is more likely to assist with smoking cessation than occasional or never-use.  The figures below are for prevalence 7-day point abstinence at 6 months.
  • Adjusted quit probabilities were significantly higher (both p<0.001) for frequent baseline e-cigarette users (31.6%; 95% CI = 29.3%, 33.8%) than for non-users (25.8%; 25.3%, 26.3%) or occasional users (24.2%; 22.5%, 26.0%).
  • Prior observational studies investigating e-cigarettes use for smoking cessation have found that occasional users have poorer outcomes than either frequent or non-users. Consistent with these studies, occasional users in our data also had poorer outcomes. However, after adjustment for variables associated with cessation success we found that cessation probabilities did not differ between occasional and non-users.
  • turralde K, Veldhuizen S, Selby P, Zawertailo L. Nicotine Tob Res. 2024 Jan 11:ntae006. doi: 10.1093/ntr/ntae006. Online ahead of print. PMID: 38206633

2022: Prospective Association between E-cigarette Use Frequency Patterns and Cigarette Smoking Abstinence among Adult Cigarette Smokers in the United States

  • In a US cohort of adult smokers, longitudinal patterns of vaping frequency appear to predict smoking abstinence, even after accounting for several sources of systematic error. Consistent daily vaping is associated with increased chances of cigarette smoking abstinence, while consistent non-daily vaping is associated with decreased chances of smoking abstinence.

2022: E-cigarette use and change in plans to quit cigarette smoking among adult smokers in the United States: Longitudinal findings from the PATH Study 2014–2019

  • We evaluated adult daily cigarette smokers initially not planning to ever quit.
  • Subsequent daily e-cigarette use was related to changing plans to quit smoking.

2022: Association of device type, flavours and vaping behaviour with tobacco product transitions among adult electronic cigarette users in the USA

  • Non-tobacco flavours, daily vaping and modifiable e-cigarette devices may help some smokers abstain from cigarette smoking via transitioning to exclusive e-cigarette use, but are also associated with ongoing exclusive e-cigarette use.

2021: Effect of Electronic Nicotine Delivery Systems on Cigarette Abstinence in Smokers with no Plans to Quit: Exploratory Analysis of a Randomized Placebo-Controlled Trial

  • Preprint
  • However, if smokers continued to use an ENDS with cigarette-like nicotine delivery, a greater proportion completely switched to ENDS, as compared with placebo or a cigarette substitute.

2021: Association of e-Cigarette Use With Discontinuation of Cigarette Smoking Among Adult Smokers Who Were Initially Never Planning to Quit

2021: Switching away from Cigarettes across 12 Months among Adult Smokers Purchasing the JUUL System

  • Rates of switching with JUUL increased over time. Over 50% of respondents reported complete switching away from cigarettes 12 months following purchase.

2021: Use of e-cigarettes (vapes) among adults in Great Britain

  • Nearly two thirds of current vapers are ex-smokers (64.6%)
  • As in previous years the main reason given by ex-smokers for vaping is to help them quit (36%) then to prevent relapse (20%).

2021: Reactions on Twitter towards Australia's proposed import restriction on nicotine vaping products: a thematic analysis

  • Approximately three-quarters of tweets that cited potential adverse consequences of the policy mentioned smoking relapse as their primary concern.

2020: Reported patterns of vaping to support long-term abstinence from smoking: a cross-sectional survey of a convenience sample of vapers

  • Qualitative research suggests e-cigarettes can meet many of the needs of ex-smokers by substituting physical, psychological, social, cultural and identity-related aspects of tobacco addiction.
  • Most participants were self-reported long-term abstinent smokers (86.3%).
  • PDF Version

2019: Electronic Cigarette Use and Cigarette Abstinence Over 2 Years Among U.S. Smokers in the Population Assessment of Tobacco and Health Study

  • In this nationally representative longitudinal cohort study of US adult cigarette smokers, daily e-cigarette use, compared to no e-cigarette use, was associated with a 77% increased odds of prolonged cigarette smoking abstinence over the subsequent 2 years.

2019: A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy

  • The 1-year abstinence rate was 18.0% in the e-cigarette group, as compared with 9.9% in the nicotine-replacement group. Among participants with 1-year abstinence, those in the e-cigarette group were more likely than those in the nicotine-replacement group to use their assigned product at 52 weeks.
  • PDF Version

2018: E-cigarette initiation and associated changes in smoking cessation and reduction: the Population Assessment of Tobacco and Health Study, 2013–2015

  • Daily e-cigarette initiators were more likely to have quit smoking cigarettes...

2017: The Relationship of E-Cigarette Use to Cigarette Quit Attempts and Cessation: Insights From a Large, Nationally Representative U.S. Survey

  • Consistent with randomized trials and those observational studies that measure frequency of e-cigarette use, both quit attempts and quit success were positively associated with increased frequency of e-cigarette use.

2017: Cohort study of electronic cigarette use: effectiveness and safety at 24 months

  • Of the e-cigarette users, 61.1% remained abstinent from tobacco (while 23.1% and 26.0% of tobacco-only smokers and dual users achieved tobacco abstinence).
  • PDF Version

2016: Patterns of Electronic Cigarette Use Among Adults in the United States

  • Although e-cigarette experimentation is most common among current cigarette smokers and young adults, daily use is highest among former smokers who quit in the past year (13.0%) and older adults. Compared to daily cigarette smokers, recently quit smokers were more than four times as likely to be daily users of e-cigarettes.
  • PDF Version

2016: Long-term e-cigarette use and smoking cessation: a longitudinal study with US population

  • Long-term use of e-cigarettes was associated with a higher rate of quitting smoking.
  • PDF Version

2015: Biochemically verified smoking cessation and vaping beliefs among vape store customers

  • Among vapor store customers in the USA who use ENDS to stop smoking, vaping longer, using newer-generation devices and using non-tobacco and non-menthol flavored e-liquid appear to be associated with higher rates of smoking cessation.

2015: A Longitudinal Study of Electronic Cigarette Use Among a Population-Based Sample of Adult Smokers: Association With Smoking Cessation and Motivation to Quit

  • Results: At follow-up, 23% were intensive users... Logistic regression controlling for demographics and tobacco dependence indicated that intensive users of e-cigarettes were 6 times more likely than non-users/triers to report that they quit smoking. Daily use of electronic cigarettes for at least 1 month is strongly associated with quitting smoking at follow-up.
  • PDF Version

2015: Associations Between E-Cigarette Type, Frequency of Use, and Quitting Smoking: Findings From a Longitudinal Online Panel Survey in Great Britain

  • Whether e-cigarette use is associated with quitting depends on type and frequency of use. Compared with respondents not using e-cigarettes, daily tank users were more likely, and non-daily cigalike users were less likely, to have quit. Tanks were more likely to be used by older respondents and respondents with lower education.
  • PDF Version


Weight Concerns

2018: Lack of Substantial Post-Cessation Weight Increase in Electronic Cigarettes Users

  • “Conclusion: Within the study limitations, EC use may help smokers attenuate cigarette consumption or remain abstinent, as well as reduce their post-cessation weight increase. The potential role of the e-vapour category for harm minimization in relation to tobacco and/or food abuse requires confirmation from larger prospective studies. Moreover, the observed lack of post-cessation weight gain in those who reduced substantially cigarette consumption by switching to ECs (i.e., dual users) is an interesting finding and calls for further research investigating the role of nicotine in weight control. Meanwhile, these preliminary findings should be communicated to smokers and particularly to weight-conscious smokers intending to quit.
  • By combining substantial reduction of smoking with prevention of post-cessation weight gain, EC-based interventions may promote an overall improvement in quality of life. Considering that the negative effects of weight increase could overshadow the health benefits of smoking abstinence, it is important to stimulate more research in this area.”

2018: E-cigarettes and Weight Loss—Product Design Innovation Insights From Industry Patents

  • E-cigarettes may be presented to cigarette users as a possible solution to support smoking cessation and address the fear of weight gain.

2017: Could Vaping be a New Weapon in the Battle of the Bulge?

  • Obesity is set to overtake tobacco smoking in many countries as the primary cause of several high-cost diseases. Tobacco smoking mitigates weight gain through nicotine’s effect on the brain and metabolism.
  • There have been some reports among vapers that vaping is helping to mitigate weight gain after stopping smoking and or vaping is helping them to control their weight. There are several potential mechanisms by which vaping, in addition to the direct effects of nicotine, could facilitate weight control, these include taste perception, physical mouthfeel, and sensation and behavioral replacement.

2011 Anti-inflammatory effects of nicotine in obesity and ulcerative colitis

  • Nicotine, the principal addictive constituent of tobacco, has been shown to suppress appetite and attenuates obesity in many studies, but the underlying mechanism is not clear.
  • Low-grade inflammation is a key feature of obesity and links obesity to insulin resistance, impaired glucose tolerance and even diabetes.
  • Overall, these findings suggest that nicotine and specific α7nAChR agonists may be beneficial in the prevention and treatment of obesity-induced inflammation and insulin resistance. However, there is also evidence that heavy smoking affects body fat distribution that is associated with central obesity and insulin resistance. Moreover, smoking appears to aggravate insulin resistance in persons with type 2 diabetes and to impair glycemic control.
  • Much work remains in terms of understanding the anti-inflammatory effects of nicotine in obesity-related inflammation and ulcerative colitis. However, it is now known that the α7nAChR plays a major role in the anti-inflammatory effects of nicotine and nicotine attenuates inflammation in both obesity and ulcerative colitis. Since the inflammatory response is an integral process in both obesity and ulcerative colitis, controlling the inflammatory response could ameliorate tissue damage.


Physical Health Challenges

2022: Tobacco Harm Reduction with Vaporised Nicotine (THRiVe): A Feasibility Trial of Nicotine Vaping Products for Smoking Cessation Among People Living with HIV

  • This study found that the provision of NVPs for 12 weeks was associated with 7-day point prevalence tobacco smoking abstinence among 35% of a sample of PLHIV who smoked tobacco daily. These findings suggest that NVPs represent a potentially feasible and effective short-to-medium term tobacco smoking cessation aid and/or tobacco harm reduction strategy among PLHIV.

2021: Switching away from Cigarette Smoking with JUUL: Populations of Special Interest

  • Substantial rates of complete switching were consistently achieved across all medico-socio-demographic subgroups 12 months following the purchase of the JSK. The potential benefits of switching with JUUL on smokers are likely to be experienced by a wide range of adult smokers.

2019: E-Cigarettes and Smoking Cessation in Smokers With Chronic Conditions

  • At a population level, e-cigarette use by smokers with chronic medical conditions is associated with more quitting activity and smoking abstinence.
  • PDF Version

2019: Electronic cigarette use among patients with cancer: Reasons for use, beliefs, and patient-provider communication

  • Patients with cancer who use e-cigarettes have positive attitudes toward these devices and use them to aid in smoking cessation.

2016: Patients with lung cancer: Are electronic cigarettes harmful or useful?

  • Based on current knowledge, for patients with lung or other forms of cancer who would otherwise continue to smoke, e-cigarettes offer an alternative way to quit smoking while they undergo medical treatment. The option to switch to e-cigarettes should be considered by healthcare practitioners with patients with cancer who would otherwise continue to smoke.


Mental/Behavioral Health Conditions

2023: Electronic Cigarettes: an Overlooked Tool to Alleviate Disparities in Tobacco Use Disorder Among People with Mental Health and Substance Use Disorders

  • Although not a panacea, electronic cigarettes may represent a powerful harm reduction tool amongst subpopulations traditionally left behind in conventional smoking cessation movements. The argument in favor of studies of electronic cigarettes as a smoking cessation, harm reduction intervention in people with BHC [Behavioral Health Conditions] is multi-faceted. People with BHC have higher levels of smoking burdens and nicotine addiction compared to the general population, and they quit at lower rates. Unlike NRT, the nicotine delivery from an electronic cigarette mimics the nicotine pharmacokinetics of tobacco cigarettes unaccompanied by high levels of toxicants and carcinogens.

2022: E-Cigarette Provision to Promote Switching in Cigarette Smokers With Serious Mental Illness—A Randomized Trial

  • This was the first prospective study to compare e-cigarette provision with assessments only to evaluate the appeal and impact of e-cigarettes on smoking behavior, carbon monoxide exposure, and nicotine dependence among smokers with SMI who had tried but were unable to quit and were not currently interested in cessation treatment. The finding that e-cigarette provision led to significant reductions in smoking and carbon monoxide without increasing nicotine dependence has implications for reducing harm not only among the millions of smokers with SMI [serious mental illness] who struggle to quit, but also for other vulnerable smokers who cannot achieve cessation.

2021: A Single-Arm, Open-Label, Pilot, and Feasibility Study of a High Nicotine Strength E-Cigarette Intervention for Smoking Cessation or Reduction for People With Schizophrenia Spectrum Disorders Who Smoke Cigarettes

  • An estimated 60%–90% of people with schizophrenia smoke, compared with 15%–24% of the general population, exacerbating the already high morbidity and mortality rates observed in this population.
  • Pilot Study - only 40 participants
  • Sixteen (40%) participants quit by the end of 12 weeks. For the whole sample, we observed an overall, sustained 50% reduction in smoking or smoking abstinence in 37/40 (92.5%) of participants and an overall 75% reduction in median cigarettes per day from 25 to six was observed by the end of the 12 weeks.
  • A high strength nicotine e-cigarette has the potential to help people with schizophrenia spectrum disorders to quit or reduce smoking.
  • PDF Version

2021: Switching away from Cigarette Smoking with JUUL: Populations of Special Interest

  • Substantial rates of complete switching were consistently achieved across all medico-socio-demographic subgroups 12 months following the purchase of the JSK. The potential benefits of switching with JUUL on smokers are likely to be experienced by a wide range of adult smokers.

2019: Electronic Cigarette Use During a Randomized Trial of Interventions for Smoking Cessation Among Medicaid Beneficiaries with Mental Illness

  • Spontaneous e-cigarette use during cessation treatment was common among smokers with mental illness and was not associated with positive or negative treatment outcomes. The high rate of naturalistic e-cigarette use in this group suggests that e-cigarettes are an appealing strategy to obtain nicotine during cessation treatment that could be harnessed as a smoking cessation tool or for harm reduction.


Pregnancy or Nursing

See Also: ENDS Pregnancy

2022: Can electronic cigarettes help pregnant smokers quit, and are they as safe to use in pregnancy as nicotine replacement treatments?

  • ECs might help women who smoke while pregnant to stop smoking. Their use during pregnancy appears to be as safe as the use of NRT and may reduce the risk of having a low‐birth‐weight baby compared to the use of NRT. In countries where stop‐smoking advice includes, among other treatment options, a recommendation to switch to ECs, such a recommendation can be extended also to pregnant smokers.

2022: Electronic cigarettes versus nicotine patches for smoking cessation in pregnancy: a randomized controlled trial

2022: The Royal College of Midwives - Position Statement

  • Nicotine Replacement Therapy is safe in pregnancy and should be provided in line with evidence-based protocols to women and their partners, to maximise its use as a quitting aid
  • E-cigarettes contain some toxins, but at far lower levels than found in tobacco smoke. If a pregnant woman who has been smoking chooses to use an e-cigarette (vaping) and it helps her to quit smoking and stay smokefree, she should be supported to do so.
  • If a woman has switched completely to vaping and is not smoking at all, she should be recorded as a non-smoker.
  • Based on the available evidence on e-cigarette safety, there is no reason to believe that use of an e-cigarette has any adverse effect on breastfeeding. ‘Vaping’ should continue if it is helpful to quitting smoking and staying smokefree.

2020: Addressing and Overcoming Barriers to E-Cigarette Use for Smoking Cessation in Pregnancy: A Qualitative Study

  • This study has described the solutions women employ to overcome potential or experienced barriers to vaping during pregnancy. Women vaped to help them reduce or stop smoking with the intention of improving their own and their baby’s health and wellbeing; by focusing on these reasons, women felt motivated and determined. Our findings have been incorporated into the TDF model, which can be used to inform e-cigarette interventions and support women who have not been able to quit smoking through traditional forms of support and would otherwise smoke.

2020: Factors influencing the uptake and use of nicotine replacement therapy and e-cigarettes in pregnant women who smoke: a qualitative evidence synthesis

  • Consistent messages from health professionals, based on high-quality evidence and clearly explaining the safety of NRT and e-cigarettes compared to smoking in pregnancy, could help women use NRT and e-cigarettes more consistently/as recommended. This may improve their attitudes towards NRT or e-cigarettes, increase their willingness to use these in their attempt to quit, and subsequently encourage them to stay smoke-free.

2020: Potential effects of using non-combustible tobacco and nicotine products during pregnancy: a systematic review

  • The use of smoke-free nicotine products almost certainly has less effect than smoking on pregnancy outcomes (most of which are negative, but there are some positive effects), but any use of nicotine is probably worse for the fetus than none... This review demonstrates that the evidence does not support denying pregnant women the use of smoke-free products if the alternative is that she would continue to smoke.

2019: The Effect of E-Cigarette Taxes on Pre-pregnancy and Prenatal Smoking

  • We show that e-cigarette taxes increase pre-pregnancy smoking, increase prenatal smoking, and lower smoking cessation during pregnancy. These findings imply that e-cigarettes and traditional cigarettes are substitutes among pregnant women.
  • PDF Version

2019: E-cigarette minimum legal sale age laws and traditional cigarette use among rural pregnant teenagers

  • This paper suggests that increases in teen prenatal cigarette smoking may be an unintended consequence of ENDS MLSAs among rural teens. Increases in prenatal smoking were entirely accounted for by pre-pregnancy smokers, suggesting that the mechanism through which ENDS MLSAs affected prenatal smoking was by reducing smoking cessation rather than by causing new initiation of cigarette smoking during pregnancy.

2015: E-cigarettes and pregnancy. Is a closer look appropriate?

  • Pregnancy is a special situation where there is a limited window to reduce the risk of harm to the fetus, and it may be that e-cigarettes have a role where other interventions have been unsuccessful. The available data suggest that ecigarettes have a risk profile very similar to that of currently available forms of NRT, but that trial participants are more likely to use them because of the similarities to conventional smoking. The best evidence we have is that NRT is safer than continued smoking, certainly for women who smoke more than five cigarettes a day in pregnancy.


Taxes

See also: ENDS Taxes to learn more about taxing vapor products.

2023: Intended and unintended effects of e-cigarette taxes on youth tobacco use

  • We find that ENDS taxes reduce youth ENDS consumption, with estimated ENDS tax elasticities of -0.06 to -0.21. However, we estimate sizable positive cigarette cross-tax effects, suggesting economic substitution between cigarettes and ENDS for youth. These substitution effects are particularly large for frequent cigarette smoking. We conclude that the unintended effects of ENDS taxation may considerably undercut or even outweigh any public health gains.

2022: Young adult responses to taxes on cigarettes and electronic nicotine delivery systems

  • In the United States, higher ENDS tax rates are associated with decreased ENDS use but increased cigarette smoking among 18‐ to 25‐year‐olds, with associations reversed for cigarette taxes.

2021: Estimating the Impact of Tobacco Parity and Harm Reduction Tax Proposals Using the Experimental Tobacco Marketplace

  • These findings support tobacco taxation as a robust tool for suppressing purchasing and suggest that differential taxation in proportion to product risk would be an effective way to incentivize smokers to switch from smoked to unsmoked products.

2021: Intended and Unintended Effects of E-cigarette Taxes on Youth Tobacco Use

  • Currently, Congress is considering doubling the cigarette excise tax (to $2.01 per pack) and setting the ENDS tax to parity with the new cigarette tax (Durbin 2021). This tax, if adopted, would imply a roughly $2.01 tax per 0.7 fluid mL of nicotine, assuming a Juul pod is equivalent to a pack of cigarettes (Truth Initiative 2019), or $2.87 per fluid mL. Our MTF results suggest that this would reduce youth current ENDS use by 5.5 pp but raise current cigarette use by 3.7 pp, assuming that the cigarette tax portion of the bill has no effect as suggested by the small, statistically insignificant cigarette tax effects estimated in this paper, and other recent studies (Hansen, Sabia, and Rees 2017). The YRBSS results meanwhile suggest much larger reductions in youth current ENDS use, but a sizable increase in youth current cigarette use of 2.3 pp. If ENDS are substantially safer products as suggested by several major government-commissioned reviews (McNeill et al. 2018; National Academies of Sciences, Engineering, and Medicine 2018; UK Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment 2020), our results suggest that the proposed bill may harm youth health in the United States
  • PDF Version

2021 (Op-Ed): To Increase Smoking Rates Among Young Adults, Keep Hiking Vape Taxes

  • Of eight states that had e-cigarette taxes prior to 2019, seven saw an increase in proportions of young adult smokers after their state e-cigarette tax went into effect. California had a 34 percent increase in people aged 18-24 who smoked after the passage of an e-cigarette tax. Deleware's increase was 48.6 percent. Pennsylvania passed a 40% wholesale tax on vapor products, which closed 1/3 of the vape shops in that state and increased smoking in the 18-24 year old age group by 19 percent. Kansas, Louisiana, Minnesota and West Virginia also say increases in smoking in young adults after passing taxes on vapor products.

2021 (Revision): The Effects of E-Cigarette Taxes on E-Cigarette Prices and Tobacco Product Sales: Evidence from Retail Panel Data

  • Our results suggest that e-cigarettes are elastic goods and their use substantially reduces cigarette sales. *Here, a 1% increase in cigarette taxes reduces cigarette sales while a 1% increase in e-cigarette taxes increases cigarette sales.

2020: The Effects of E-Cigarette Taxes on E-Cigarette Prices and Tobacco Product Sales: Evidence from Retail Panel Data

2020: Tobacco harm reduction in the 21st century

  • Increasing taxes on reduced-risk products could function to deter smokers from switching to them.
  • To reduce smoking and to save millions of lives, tobacco harm reduction in the form of cigarette substitution with low-risk products appears to be a promising path.

2020: The ethics of tobacco harm reduction: An analysis of e-cigarette availability from the perspectives of utilitarianism, bioethics, and public health ethics

  • E-cigarette availability (ECA) can also advance justice by providing a harm reduction alternative for disadvantaged groups that disproportionately bear the devastating consequences of smoking. Policies of differential taxation of cigarettes and e-cigarettes can facilitate adoption of less harmful alternatives by those economically disadvantaged.

2019: E-Cigarettes and Adult Smoking: Evidence from Minnesota

  • We provide some of the first evidence on how e-cigarette taxes impact adult smokers, exploiting the large tax increase in Minnesota. That state was the first to impose a tax on e-cigarettes by extending the definition of tobacco products to include e-cigarettes. This tax, which is 95% of the wholesale price, provides a plausibly exogenous deterrent to e-cigarette use.
  • Our results suggest that in the sample period about 32,400 additional adult smokers would have quit smoking in Minnesota in the absence of the tax. If this tax were imposed on a national level about 1.8 million smokers would be deterred from quitting in a ten year period. The taxation of e-cigarettes at the same rate as cigarettes could deter more than 2.75 million smokers nationally from quitting in the same period.
  • PDF Version

2019 The Effect of E-Cigarette Taxes on Pre-pregnancy and Prenatal Smoking

  • We show that e-cigarette taxes increase pre-pregnancy smoking, increase prenatal smoking, and lower smoking cessation during pregnancy. These findings imply that e-cigarettes and traditional cigarettes are substitutes among pregnant women.
  • PDF Version

2019: The Effects Of Traditional Cigarette And E-Cigarette Taxes On Adult Tobacco Product Use

  • We find evidence that adults are more likely to use e-cigarettes when traditional cigarette taxes rise.
  • Traditional cigarette taxes appear to be less effective – in terms of reducing smoking – when a locality has also adopted an e-cigarette tax.
  • This finding suggests that the combination of a traditional cigarette tax hike and e-cigarette tax prevents smokers for either quitting or switching to a less harmful product, both actions would improve smoker health by minimizing exposure to carcinogens and other toxins contained in traditional cigarettes.
  • Our research contributes further evidence from differences-in-differences methods that regulating e-cigarettes have the unintended consequence of raising traditional cigarette use; while neither product is harmless, the clinical literature strongly suggests that e-cigarettes are the less harmful product. These results suggest caution in regulating e-cigarettes because they may increase smoking of traditional cigarettes.


Combining Alternative Nicotine Products With Other Quit Smoking Strategies

2023: Varenicline for smoking cessation in individuals who smoke cigarettes and use electronic cigarettes: a double-blind, randomised, placebo-controlled phase 3 trial

  • Our findings indicate that inclusion of varenicline in a cessation programme for adults who smoke and use e-cigarettes with an intention to quit smoking could result in smoking abstinence without serious adverse events. In the absence of evidence from other smoking cessation methods, it could be useful to suggest the use of varenicline in cessation programmes specifically designed to help dual users stop smoking.
  • Caponnetto P, Spicuzza L, Campagna D, Ahluwalia JS, Russell C, Maglia M, Riela PM, Longo CF, Caci G, Quattropani MC, Signorelli MS, Polosa R. Varenicline for smoking cessation in individuals who smoke cigarettes and use electronic cigarettes: a double-blind, randomised, placebo-controlled phase 3 trial. EClinicalMedicine. 2023 Nov 21;66:102316. doi: 10.1016/j.eclinm.2023.102316. PMID: 38192585; PMCID: PMC10772233.

2023: Smoking reduction using electronic nicotine delivery systems in combination with nicotine skin patches

  • A critically important design component of this study was that it was not a smoking cessation treatment study, and hence smoking abstinence was not the primary outcome. Accordingly, no smoking cessation counseling was provided and smokers who expressed a desire to receive treatment for nicotine dependence were excluded from the study. Thus, the study was not expected to lead to high smoking abstinence rates but was instead designed to differentiate the pharmacologic impact of nicotine vs. no nicotine (in ENDS or patch) on smoking behavior.
  • ...there was a strong correlation between ENDS use and decrease in self-reported cigarette consumption in week 8 (end of treatment), but only in nicotine ENDS condition...
  • Smoking abstinence at week 8 was also related to ENDS use in the nicotine ENDS condition only; participants who were abstinent from smoking used more nicotine pods than non-abstinent participants
  • The main finding of this study was that the use of nicotine vs. no nicotine in ENDS was associated with a large and statistically significant reduction in expired air CO, an objective biomarker of smoking.

2023: E-cigarette support for smoking cessation: Identifying the effectiveness of intervention components in an on-line randomized optimization experiment

  • Text-message support with tailored advice on flavour is a promising intervention combination for smokers using an e-cigarette in a quit attempt.
  • Article: Smokers who get e-cigarette flavour advice more likely to quit, report finds
    • Smokers who get help picking the flavour of e-cigarette they will use and receive supportive text messages are much more likely to quit, research has found.

2021: Electronic cigarettes in standard smoking cessation treatment by tobacco counselors in Flanders: E-cigarette users show similar if not higher quit rates as those using commonly recommended smoking cessation aids

  • One third of the total sample was biochemically verified smoking abstinent 7 months after quit date, with e-cigarette users (40%) having significantly higher chances to be smoking abstinent than NRT users (23%).
  • PDF Version

2020: Highlights of Studies in Cardiovascular Disease Prevention Presented at the 2020 American College of Cardiology Annual Scientific Session

  • In E3, nicotine e-cigarettes plus counseling was superior to counseling alone for smoking cessation. Non-nicotine e-cigarettes plus counseling was also more effective compared with counseling alone though its effects on cessation were modest. This trial demonstrates the efficacy of e-cigarettes as a tool for smoking cessation compared with counseling alone.
  • PDF Version

2019: Nicotine patches used in combination with e-cigarettes (with and without nicotine) for smoking cessation: a pragmatic, randomised trial

  • In summary, when looking at continuous abstinence from smoking, provision of patches plus a nicotine e-cigarette resulted in three to seven more smokers per 100 quitting long-term (depending on the analyses done) than with patches plus a nicotine-free e-cigarette. The smaller than anticipated sample size meant the study was not sensitive enough to pick up a definitive finding for the second comparison, although analyses suggest combination nicotine therapy—ie, use of a slow release nicotine patch, together with a faster-acting oral nicotine product (in this case a nicotine e-cigarette)—could result in five to ten more smokers per 100 quitting long-term than with monotherapy (ie, nicotine patches alone). Our findings are consistent with the current findings of the Cochrane review of e-cigarettes for smoking cessation and contribute to the growing body of evidence from randomised trials on the efficacy, effectiveness and safety of e-cigarettes for smoking cessation.
  • PDF Version

2019: Multimodal Smoking Cessation in a Real-Life Setting: Combining Motivational Interviewing With Official Therapy and Reduced Risk Products

  • The use of different therapeutic strategies in clinical practice, including pharmacotherapy and nonstandard electronic nicotine delivery systems, such as an electronic cigarette, ensures a greater chance of cessation success and the possibility of tailoring interventions according to patients’ resources.


Vape Shop/Peer Support

2021: Vape Shop Employees: Do They Act as Smoking Cessation Counselors?

  • Most vape shop employees provide advice to customers who desire to quit cigarette smoking and initiate electronic cigarette use. Approximately 85% of employees had quit cigarettes by switching to e-cigarettes.

2019: A Comparison of E-Cigarette Use Patterns and Smoking Cessation Behavior among Vapers by Primary Place of Purchase

  • Among those smoking 12 months prior to the survey, smoking cessation rates were higher for vape shop and internet customers than for retail customers, even though retail customers were more likely to use FDA-approved smoking cessation aids.

2018 (Report): Working with vape shops

  • UK National Centre for Smoking Cessation and Training (NCSCT)
  • This guide covers:
    • How can vape shops support stop smoking services?
    • How can stop smoking services work with vape shops?
    • What does ‘reputable vape shop’ mean?
    • Can vape shops be trusted?
    • Are vape shops owned by or associated with the tobacco industry?

2018: Advice From Former-Smoking E-Cigarette Users to Current Smokers on How to Use E-Cigarettes as Part of an Attempt to Quit Smoking

  • This study describes the advice that former-smokers who used e-cigarettes to quit smoking would offer to smokers who are considering using an e-cigarette to support an attempt to quit smoking. Vapers advised smokers to find the right combination of device, flavors and nicotine strength, continue to smoke and vape for a while if they wished, not be deterred by past failed attempts to quit smoking, and expect health to improve after they have switched to vaping. Encouraging smokers to interact with vaping peers in vape shops and in online vaping-dedicated discussion forums may help significantly more smokers switch to vaping.
  • PDF Version

2018: A Qualitative Exploration of the Role of Vape Shop Environments in Supporting Smoking Abstinence

  • At an individual level, shops can provide a supportive environment. Shops also provided ongoing support to reduce risk of smoking lapse.
  • At an interpersonal level, shops can offer friendly personable service. For some vapers, shops also provided an opportunity for social interaction, acting as a community group.
  • At a structural level, shops provide a competitive environment, responding to legislative changes.
  • Furthermore, vape shops provide opportunity to those who do not wish to stop smoking to try vaping and perhaps eventually stop smoking.
  • Vape shops can provide effective behavioural support to quitters to maintain smoking abstinence. Health professionals could capitalise on this through partnership working with shops, to ensure best outcomes for clients wanting to use e-cigarettes to quit smoking.

2018: A qualitative assessment of business perspectives and tactics of tobacco and vape shop retailers in three communities in Orange County, CA, 2015–2016

  • Tobacco shops’ reasons for carrying e-cigarettes were business oriented... In comparison, vape shops opened because of the owner’s positive experiences with e-cigarettes and belief in the potential of e-cigarettes to help people quit or reduce smoking.

2018: Vape shops: who uses them and what do they do?

  • The majority of vape shop customers are vapers who have quit smoking. Shop staff play a central role in providing customers with product information, and many provide smoking cessation advice.

2016: A Qualitative Study of Vape Shop Operators' Perceptions of Risks and Benefits of E-Cigarette Use and Attitude Toward Their Potential Regulation by the US Food and Drug Administration, Florida, Georgia, South Carolina, or North Carolina, 2015

  • Most owners were former smokers and used ENDS to quit. Vape shop owners are in a unique position to serve as frontline consumer educators.
  • Vape shop owners perceived ENDS to be less harmful and more economical than conventional cigarettes and indicated that most of their customers used ENDS as a smoking cessation tool

2016: A Pilot Study of Retail ‘Vape Shops’ in the San Francisco Bay Area

  • The intensive engagement with customers over time provides social support for quitting and practical advice, both of which are elements of recommended smoking cessation counseling.

2016: A Dollars and “Sense” Exploration of Vape Shop Spending and E-cigarette Use

  • Across the US, vape shops have emerged to provide e-cigarette users access to products not usually available at gas stations or retail stores.
  • Mod use and intention to use e-cigs as a cessation device were significantly associated with vape shop spending.
  • Customers who spent more than $50/month used lower levels of nicotine (mg/ml) (p=0.003) but a greater quantity of e-liquid (ml/month).

2015: Biochemically verified smoking cessation and vaping beliefs among vape store customers

  • Among vapor store customers in the USA who use ENDS to stop smoking, vaping longer, using newer-generation devices and using non-tobacco and non-menthol flavored e-liquid appear to be associated with higher rates of smoking cessation.

2015: Quit and Smoking Reduction Rates in Vape Shop Consumers: A Prospective 12-Month Survey

  • Here we have shown for the first time that combining availability of appealing e-vapour products for smoking substitution with professional advice from vape shops staff it is possible to achieve high and stable success rates. By promoting healthier life-style changes in smokers, vape shops may become valuable allies in the fight against smoking.

2015: Counseling in Vape Shops: A Survey of Vape Shop Managers in Switzerland

  • Vape-shop managers explain how they successfully switched from smoking to vaping and help customers individually find the right combination of device, e-liquid flavor, and nicotine concentration.


Expansion/Contraction of the Alternative Nicotine Products Market vs Smoking

2023: Comparison of smoking prevalence in Canada before and after nicotine vaping product access using the SimSmoke model

  • Using a version of the SimSmoke model calibrated to the Canadian population, this study compares actual smoking trends from 2012-2020 with the counterfactual (i.e. what would have been expected in a world without e-cigarettes, as estimated by projecting pre-2012 trends):
    • Results: Comparing 2012-2020 survey data of post-NVP to SimSmoke projected smoking prevalence trends, one survey indicated an NVP-related relative reduction of 15% (15%) for males (females) age 15+, but 32% (52%) for those ages 15-24. The other survey indicated a 14% (19%) NVP-related smoking reduction for ages 18+, but 42% (53%) for persons ages 18-24. Much of the gain occurred since Canada relaxed NVP restrictions. NVP-related 2012-2020 smoking reductions yielded 100,000 smoking-attributable deaths averted from 2012 to 2060.
  • Levy DT, Cadham CJ, Yuan Z, Li Y, Gravely S, Cummings KM. Can J Public Health. 2023 Aug 4. doi: 10.17269/s41997-023-00792-3. Online ahead of print. PMID: 37540451

2022: Higher Sales of Electronic Nicotine Delivery Systems (ENDS) in the US Are Associated with Cigarette Sales Declines, according to a Trend Break Analysis

  • Higher ENDS sales were significantly associated with a greater cigarette shortfall: for every additional per-capita ENDS unit, cigarette sales were 1.4 packs-per-capita lower than expected... These findings support ENDS serving as a substitute for cigarettes (through potentially many mechanisms including cigarette price), causing cigarette consumption to decline. Since ENDS potentially pose a lower risk than cigarettes, this general substitution effect suggests that risk-proportionate tobacco regulation could mitigate the tobacco-related health burden.

2022: Population-level counterfactual trend modelling to examine the relationship between smoking prevalence and e-cigarette use among US adults

  • Population-level data suggest that smoking prevalence has dropped faster than expected, in ways correlated with increased e-cigarette use. This population movement has potential public health implications.

2022: PREPRINT: A decision aid for policymakers to estimate the impact of e-cigarette flavour restrictions on population smoking and e-cigarette use prevalence among youth versus smoking prevalence among adults

2022: Effect of flavored E-cigarette bans in the United States: What does the evidence show?

  • However, in this paper, we propose an evidence-based version of this model based on several years' worth of longitudinal and econometric research, which suggests that youth e-cigarette use has instead worked to replace a culture of youth smoking. From this analysis, we propose a re-evaluation of current policies surrounding e-cigarette sales so that declines in e-cigarette use will not come at the cost of increasing cigarette use among youth and adults.

2022: Impact of existing and potential e-cigarette flavor restrictions on e-cigarette use among young adult e-cigarette users in 6 US metropolitan areas

  • Results from this study highlight heterogeneity in young adult e-cigarette users’ reactions to existing flavored e-cigarette sales restrictions and hypothetical restrictions. Some reduced e-cigarette use, but many reported intentions to continue e-cigarette use, by using tank-based e-cigarettes, available flavors, or flavors accessed through alternative sources. More concerning, some switched to cigarettes. Similarly, in response to future restrictions of all flavored e-liquids, young adult e-cigarette users largely indicated that they would either quit vaping – the ideal scenario – or switch to cigarettes – the least desirable scenario. Another major concern highlighted was access to flavored e-cigarettes despite restrictions (e.g., online, across state lines). Collectively, findings suggest that implications of flavored e-cigarette sales restrictions are complex, with the potential for both reductions in e-cigarette use and unintended consequences among young adults, including continued use of flavored e-cigarettes or switching to cigarettes, and retail and consumer circumvention of restrictions.

2021: US Nicotine Vaping Product SimSmoke Simulation Model: The Effect of Vaping and Tobacco Control Policies on Smoking Prevalence and Smoking-Attributable Deaths

  • Our model results imply that historical and ongoing tobacco control policies in the US cannot fully explain the accelerated reductions in smoking prevalence in the time period when NVP use became more prevalent. These reductions were found mainly among those at younger ages who are more likely to use NVPs.

2021: Modeling the Population Health Impact of ENDS in the U.S.

  • The availability of ENDS in the US is projected to reduce smoking and prevent 2.5 million premature deaths by 2100 in the Modified Case. Sensitivity analyses show that a significant population health benefit occurs under all plausible scenarios.

2021: Modeling the public health impact of e-cigarettes on adolescents and adults

  • Using a simple model of competition between traditional cigarettes and e-cigarettes for users, we predict the change in smoking prevalence due to the introduction of vaping in the U.S. Vaping products appear to decrease the prevalence of smoking among both adult and adolescent populations. Because the long-term health risks of vaping are currently unknown, the public health cost and/or benefit of e-cigarette is less clear. However, as suggested by our model, it is possible that the introduction of e-cigarettes will have positive effects for both adult and youth populations depending on the relative health risk of smoking and vaping.

2021: A Difference-in-Differences Analysis of Youth Smoking and a Ban on Sales of Flavored Tobacco Products in San Francisco, California

  • San Francisco’s ban on flavored tobacco product sales was associated with increased smoking among minor high school students relative to other school districts. While the policy applied to all tobacco products, its outcome was likely greater for youths who vaped than those who smoked due to higher rates of flavored tobacco use among those who vaped. This raises concerns that reducing access to flavored electronic nicotine delivery systems may motivate youths who would otherwise vape to substitute smoking. Indeed, analyses of how minimum legal sales ages for electronic nicotine delivery systems are associated with youth smoking also suggest such substitution.

2021: Reactions to sales restrictions on flavored vape products or all vape products among young adults in the US

  • Young adult e-cigarette users indicate low support for e-cigarette sales restrictions (both for flavored products and complete restrictions). Moreover, if vape product sales were restricted to tobacco flavors, 39.1% of users reported being likely to continue using e-cigarettes but 33.2% were likely to switch to cigarettes. If vape product sales were entirely restricted, e-cigarette users were equally likely to switch to cigarettes versus not (~40%).
  • Free version of full study or PDF not available

2021: Vaping liquid flavour preferences, oral nicotine pouch and cannabis use: A survey of participants in the 2019 Oceania Vape Expo (version 1; peer review: awaiting peer review)

  • In the event of a ban on other flavours, 20% of the NZ residents said they would probably go back to smoking (see Table 3). A majority (57%) indicated they intended to circumvent the ban, by mixing their own liquids and/or buying from overseas or the black market. Only 29% indicated they would change their vaping consumption to comply with the ban, as is typically implicitly assumed will happen. Nine percent would try to stop vaping and 35% would buy only the legal products (which includes the 18% who were already buying only products that would not be banned).
  • PDF Version

2021: Reactions on Twitter towards Australia's proposed import restriction on nicotine vaping products: a thematic analysis

  • Approximately three-quarters of tweets that cited potential adverse consequences of the policy mentioned smoking relapse as their primary concern.

2020: The impact of a comprehensive tobacco product flavor ban in San Francisco among young adults

  • Among the 18–24 age group, there was a significant increase in cigarette smoking.
  • Cigarette smoking increased among 25–34 years old.
  • Banning flavors in e-cigarettes can push some e-cigarette users to turn to cigarette smoking and could prompt some youth to initiate into smoking instead of e-cigarette use.
  • The proportions of e-cigarettes, cigarettes, and cigars obtained over the internet increased after the ban, and the proportions obtained from retailers outside of San Francisco also increased overall.
  • PDF Version

2019: Changes in Flavor Preference in a Cohort of Long-Term Electronic Cigarette Users

  • Our results regarding anticipated reactions to FDA e-cigarette flavor regulation suggest complexities such that the benefits and risks of flavor ban need to be carefully evaluated.
  • A majority anticipated that they would personally attempt to circumvent potential FDA regulations of e-cigarettes by obtaining e-cigarette flavors from various illicit sources (e.g., Internet orders from foreign countries) or even self-making flavors.
  • The use of flavoring agents purchased from unregulated sources could lead to additional unanticipated toxicities.
  • It is also concerning that some established e-cigarette users believed that they would return to cigarette smoking if nontobacco e-cigarette flavors were banned. Thus, for adult e-cigarette users who use certain flavors to facilitate smoking cessation or reduction, banning all nontobacco flavors could precipitate relapse to smoking.
  • PDF Version

2019: Young adult dual combusted cigarette and e-cigarette users’ anticipated responses to hypothetical e-cigarette market restrictions

  • Hypothetical regulations resulted in reported intentions to reduce EC (e-cigarette) use and increase CC (combustible cigarette) use; the greatest impact was found for restrictions regarding e-liquid nicotine content, followed by flavor
  • This work provides preliminary evidence that restrictive regulations regarding key EC characteristics may increase intentions to increase CC use among young adult dual EC and CC users.
  • PDF Version

2018: Should flavours be banned in cigarettes and e-cigarettes? Evidence on adult smokers and recent quitters from a discrete choice experiment

  • A ban on flavoured e-cigarettes would likely increase the choice of cigarettes in smokers, the more harmful way of obtaining nicotine.
  • PDF Version


Dual/Poly Nicotine Product Use - Smoking Reduction - Part of Switching Process

2021: Patterns of E-Cigarette Use Among Primary Care Patients at an Urban Community Center

  • Among primary care patients at a community health center, e-cigarette use was reported by a sizeable portion of the sample. Overall, odds of use were higher in certain patient populations, and individuals who formally used cigarettes were more likely to report e-cigarette use than individuals who currently smoke, suggesting that e-cigarettes may be functioning as a cessation aid or a strategy to reduce conventional cigarette use.
  • Reasons for e-cigarette use included “to help me quit smoking cigarettes”, “to help me reduce the number of cigarettes I smoke”, and “so that I can e-smoke in places where cigarette smoking is not allowed."
  • The mean frequency of e-cigarette use was higher among those who formerly smoked cigarettes than among those who currently smoked (t = 6.45, p < 0.001) and patients who currently smoked had less than half the odds of daily e-cigarette use compared to those who formerly smoked (OR = 0.39, p < 0.001).

2021: Targeted smoking cessation for dual users of combustible and electronic cigarettes: a randomised controlled trial

  • A targeted self-help intervention with high potential for dissemination could be efficacious in promoting smoking cessation among dual users of combustible cigarettes and e-cigarettes.
  • PDF Version

2021: Predictors of smoking reduction among african american and latinx smokers in a randomized controlled trial of JUUL e-cigarettes

  • Minority smokers decreased cigarette consumption in a trial of e-cigarettes.
  • Smoking reduction was associated with a higher number of JUUL pods used.
  • Lower baseline cigarette dependence predicted greater smoking reduction.
  • Lower baseline cotinine predicted greater smoking reduction.

2021: Effect of Electronic Nicotine Delivery Systems on Cigarette Abstinence in Smokers with no Plans to Quit: Exploratory Analysis of a Randomized Placebo-Controlled Trial

  • Preprint
  • When smokers seeking to reduce smoking tried ENDS, few quit smoking in the short term. However, if smokers continued to use an ENDS with cigarette-like nicotine delivery, a greater proportion completely switched to ENDS, as compared with placebo or a cigarette substitute.
  • The extent to which use of electronic nicotine delivery systems (ENDS) for smoking reduction leads to cigarette abstinence in smokers with no plans to quit smoking was unclear. This randomized trial found that ENDS with nicotine delivery approaching that of a cigarette are more effective in helping ambivalent smokers to quit cigarette smoking.

2020: Using e-cigarettes for smoking cessation: evaluation of a pilot project in the North West of England

  • Of the 1022 participants who engaged with the pilot 614 were still engaged at 4 weeks, of whom 62% had quit smoking. Of those who still smoked tobacco at week 4, smoking had reduced from a baseline of 19.1 cigarettes/day to 8.7. Overall, 37% of those initially enrolled were confirmed to be using an e-cigarette on its own at follow-up. Successful quit was associated with occupation (unemployed, 33% vs intermediate, 47%) and residing in the less deprived quintiles of deprivation (50% vs 34% in the most deprived quintile.
  • E-cigarettes appear to be an effective nicotine replacement therapy
  • PDF Version

2019: Association Between Electronic Cigarette Use and Smoking Reduction in France

  • This cohort study found that, among daily smokers in France, regular (daily) electronic cigarette use is associated with a significantly higher decrease in the number of cigarettes smoked per day as well as an increase in smoking cessation attempts. However, among former smokers, electronic cigarette use is associated with an increase in the rate of smoking relapse.
  • PDF Version
  • NOTE: Article that covers above study - Adults who vape are more likely to quit cigarettes, study finds
    • “The study did find that the heightened risk of relapse disappeared in those who quit smoking more recently, which the researchers said may be due to improved e-cigarette technology.”
    • “For example, the study as a whole considered anybody who quit smoking from 2010 onward and found that, in that sample, vaping increased the risk of relapse. But when researchers only considered people who quit cigarettes as of 2013, former smokers were not more likely to relapse if they vaped.”
    • “The researchers noted in their study that "measures of plasma nicotine levels have shown that, compared with older models of [e-cigarettes], the new generation delivers higher levels of nicotine to the bloodstream," which may make them more satisfying.”
    • “Other "technical improvements in [e-cigarettes] over time," they said, may also explain why people who recently quit smoking and switched to e-cigarettes were less likely to relapse than those who quit earlier.”

2019: Vaping patterns, nicotine dependence and reasons for vaping among American Indian dual users of cigarettes and electronic cigarettes

  • The ten-item Penn State Dependence Index (PSDI) suggested greater dependence on smoking than vaping
  • The most common reasons for vaping were to reduce smoking (79%), enjoyment of flavors (78%), and ability to vape where smoking is not allowed (73%). Perceptions of less harm to others (69%) or to self were the next most common (65%). Fewer than half used ECs to reduce stress, for affordability, or because others used them.
  • PDF Version

2019: 2019 Perceived relative harm of using e-cigarettes predicts future product switching among US adult cigarette and e-cigarette dual users

  • Compared with those with other perceptions of e‐cigarette harm, dual users who perceived e‐cigarettes as less harmful than cigarettes were more likely to become exclusive e‐cigarette users 1 year later.
  • PDF Version

2018: Advice From Former-Smoking E-Cigarette Users to Current Smokers on How to Use E-Cigarettes as Part of an Attempt to Quit Smoking

  • This study describes the advice that former-smokers who used e-cigarettes to quit smoking would offer to smokers who are considering using an e-cigarette to support an attempt to quit smoking. Vapers advised smokers to find the right combination of device, flavors and nicotine strength, continue to smoke and vape for a while if they wished, not be deterred by past failed attempts to quit smoking, and expect health to improve after they have switched to vaping. Encouraging smokers to interact with vaping peers in vape shops and in online vaping-dedicated discussion forums may help significantly more smokers switch to vaping.
  • PDF Version

2018: E-cigarette initiation and associated changes in smoking cessation and reduction: the Population Assessment of Tobacco and Health Study, 2013–2015

  • Daily e-cigarette initiators were more likely to have quit smoking cigarettes or reduced use compared with non-users. However, less frequent e-cigarette use was not associated with cigarette cessation/reduction. These results suggest incorporating frequency of e-cigarette use is important for developing a more thorough understanding of the association between e-cigarette use and cigarette cessation.
  • PDF Version

2018: Motivation and main flavour of use, use with nicotine and dual use of electronic cigarettes in Barcelona, Spain: a cross-sectional study

  • The most prevalent motivation for using e-cigarettes was to reduce tobacco smoking 48%, followed by quitting smoking 39.2%, and to use e-cigarettes in places where tobacco smoking was prohibited 10.2%.

2017: Predicting Short-Term Uptake of Electronic Cigarettes: Effects of Nicotine, Subjective Effects, and Simulated Demand

  • Mean cigarettes per day decreased by 37% when e-cigarettes were available relative to baseline. Nicotine-containing cartridges were associated with greater use and craving reduction than 0 mg. Alleviation of withdrawal symptoms and taste and enjoyment factors predicted e-cigarette use.
  • PDF Versioin

2017: Cohort study of electronic cigarette use: effectiveness and safety at 24 months

  • Of the e-cigarette users, 61.1% remained abstinent from tobacco (while 23.1% and 26.0% of tobacco-only smokers and dual users achieved tobacco abstinence).
  • PDF Version

2017: Patterns of and reasons for electronic cigarette use in primary care patients

  • In descriptive analyses, compared to never e-cigarette users, ever e-cigarette users were younger, non-Hispanic white, more educated, more likely to be daily smokers, smoked more cigarettes per day, and smoked their first cigarette within 30 min of waking.
  • Among current e-cigarette users, 84% reported using e-cigarettes to quit cigarettes, to cut down on cigarettes, or because they believe they are less harmful than cigarettes. The least common reason for use was cost (48%). Among former e-cigarette users, 78% reported using e-cigarettes to quit cigarettes, to cut down on cigarettes, or because they believe they are less harmful than cigarettes, and the least common reason was also cost (30%).
  • PDF Version

2017: Differences between Dual Users and Switchers Center around Vaping Behavior and Its Experiences Rather than Beliefs and Attitudes

  • To the extent that dual users substantially lower the number of cigarettes, they will reduce health risks from smoking. However, from a medical point of view, exclusive vaping is preferable to dual use;
  • Differences between dual users and switchers center around variables proximal to the vaping behavior and its experienced effects rather than hinging on more general vaping-related beliefs and attitudes.
  • After e-cig initiation, dual users decreased tobacco consumption by 82% and were low-to-moderately cigarette dependent.
  • The two groups (dual users and switchers) reported mostly using a flavor other than tobacco.
  • PDF Version

2016: Long-term e-cigarette use and smoking cessation: a longitudinal study with US population

  • E-cigarettes have grown popular. The most common pattern is dual use with conventional cigarettes. Dual use has raised concerns that it might delay quitting of cigarette smoking. This study examined the relationship between long-term use of e-cigarettes and smoking cessation in a 2-year period.
  • Dual use of e-cigarettes and cigarettes was not associated with a lower smoking cessation rate.
  • Among those making a quit attempt, use of e-cigarettes as a cessation aid surpassed that of FDA-approved pharmacotherapy.
  • Long-term use of e-cigarettes was associated with a higher rate of quitting smoking.
  • PDF Version

2016: Association between electronic cigarette use and changes in quit attempts, success of quit attempts, use of smoking cessation pharmacotherapy, and use of stop smoking services in England: time series analysis of population trends

  • Changes in prevalence of e-cigarette use in England have been positively associated with the success rates of quit attempts. No clear association has been found between e-cigarette use and the rate of quit attempts or the use of other quitting aids, except for NRT obtained on prescription, where the association has been negative.
  • PDF Version

2016: Electronic cigarette use in the European Union: analysis of a representative sample of 27 460 Europeans from 28 countries

  • E‐cigarette use in the European Union appears to be largely confined to current or former smokers, while current use and nicotine use by people who have never smoked is rare. More than one‐third of current e‐cigarette users polled reported smoking cessation and reduction.
  • PDF Version

2016 Reductions in biomarkers of exposure, impacts on smoking urge and assessment of product use and tolerability in adult smokers following partial or complete substitution of cigarettes with electronic cigarettes

  • Subjects switching to e-cigarettes had significantly lower levels (29 %–95 %) of urinary BoEs after 5 days. Nicotine equivalents declined by 25 %–40 %.
  • Dual users who substituted half of their self-reported daily cigarette consumption with e-cigarettes experienced 7 %–38 % reductions, but had increases (1 %–20 %) in nicotine equivalents.
  • Blood nicotine biomarker levels were lower in the cessation (75 %–96 %) and e-cigarette use groups (11 %–83 %); dual users had no significant reductions.
  • All groups experienced significant decreases in exhaled CO (27 %–89 %). Exhaled NO increases (46 %–63 %) were observed in the cessation and e-cigarette use groups; dual users had minimal changes.
  • By Day 5, all groups had greater reductions in smoking urge compared to cessation. However, reductions were larger in the dual use group.
  • No serious adverse events were observed.
  • PDF Version

2015: E-Cigarettes and Smoking Cessation: Evidence from a Systematic Review and Meta-Analysis

  • “This systematic review and meta-analyses assessed the findings of six studies which reported smoking cessation after using e-cigarettes. We found an association between nicotine-enriched e-cigarette use and smoking cessation, suggesting that the devices may be an effective alternative smoking cessation method. We also found that use of e-cigarettes was also associated with a reduction in the number of cigarettes used, suggesting they may also have a role in tobacco harm reduction programs. To our knowledge, this is the most comprehensive evidence to date on this issue, and while there are a number of important implications for further research, these findings provide timely information to inform regulatory strategies.”
  • PDF Version


Facilitators and Barriers to Quitting Smoking or Remaining Abstinent

See Also: Nicotine - Misperceptions, Misinformation, or Disinformation

2021: Associations Between Nicotine Knowledge and Smoking Cessation Behaviors Among US Adults Who Smoke

  • This study provides longitudinal evidence that among adult smokers, misperceiving nicotine as a primary cause of smoking-related diseases may be associated with reduced cessation success and lower likelihood of using less harmful nicotine products. These misperceptions may therefore impede efforts to encourage smokers ready to quit to use evidence-based cessation support such as nicotine replacement during quit attempts and limit the success of policies designed to shift smokers to less harmful sources of nicotine.

2021: “It is the One Thing that has Worked”: facilitators and barriers to switching to nicotine salt pod system e-cigarettes among African American and Latinx people who smoke: a content analysis

  • The majority said they would continue using JUUL to replace cigarettes (83% African American; 94% Latinx) and that JUUL worked better than other methods to reduce cigarettes (72%).
  • PDF Version

2021: Effect of Massachusetts House Bill No. 4196 on electronic cigarette use: a mixed-methods study

  • ...messaging questioning the safety of e-cigarettes led to an increase in combustible cigarette use. This suggests the need for health authorities to reconsider how they communicate the relative risks of smoking and vaping.

2018: Socioeconomic and Racial/Ethnic Differences in E-Cigarette Uptake Among Cigarette Smokers: Longitudinal Analysis of the Population Assessment of Tobacco and Health (PATH) Study

  • Compared with non-Hispanic Whites, non-Hispanic Black, and Hispanics were less likely to become exclusive e-cigarette users
  • Low-income smokers were less likely than higher-income smokers to become exclusive e-cigarette users
  • Black, Hispanic, and low-income smokers were more likely to believe e-cigarettes are more harmful than cigarettes and to have positive tobacco-related social norms.
  • Results of this study show that the exclusive use of e-cigarettes is more prevalent in higher-income and White smokers. Our data suggest that higher-income and White smokers may be more likely to use e-cigarettes as a means to quit combustible cigarettes compared with low-income and racial/ethnic minority smokers. These findings suggest that sociodemographic differences in e-cigarette uptake and use patterns may contribute to widening disparities in cigarette smoking.
  • PDF Version

Long Term usage

2023: An 8-year longitudinal study of long-term, continuous users of electronic cigarettes. (2012-2016 to 2021 8 years is the average)

  • Etter JF. Addictive Behaviors, 149, February 2024, 107891
  • A rare look at long-term e-cigarette use (from 2012-2016 to 2021, averaging 8 years’ difference) and the shifts in use patterns:
    • Findings: Fewer people in 2021 (11%) than at baseline (33%) had smoked tobacco in the past 31 days. Participants switched from second-generation models at baseline (e.g. Ego) to box mods in 2021 (e.g. iStick), they used larger refill bottles, they used home-made e-liquids twice as often, they used tobacco flavours less often and the nicotine concentration in e-liquids decreased from 12 to 6 mg/L.
  • Given the concerns over the proliferation of products with high nicotine concentrations, it’s reassuring that people who use e-cigarettes long term tend to reduce their nicotine concentration over time. Likewise with indicators of dependence:
    • There was no change over time in the time to the first e-cigarette puff of the day, but an e-cigarette dependence score of 0-100 decreased from 75 to 60, the frequency and strength of urges to vape decreased (from 31% to 18% of the “strong” urges) and the proportion of people who said they would be likely to succeed if they tried to stop vaping increased.
  • Reasons for vaping also changed over time:
    • Compared to baseline, fewer people in 2021 reported vaping to cope with cravings or other smoking cessation symptoms, and fewer people reported vaping to quit smoking, to avoid relapse into smoking, or to reduce their tobacco consumption.
  • It makes sense that some of these motivations would decrease as people moved away from other tobacco products, but it is surprising to see that the reason of “avoiding relapse” was lower. If these reasons decreased, did other reasons increase? Yes, and they had to do with perceived addiction to e-cigarettes (from 49% to 62%), although endorsement of this was substantially lower than “vaping is less toxic than smoking tobacco” and simply “because I enjoy it” which nearly all participants endorsed.
  • Also notable is that at follow-up, 63% of participants said the flavors they used helped them quit or reduce their smoking, and 59% were afraid that they would start smoking again if they stopped using e-cigarettes.

Smoking Harm Reduction vs Nicotine Abstinence

2023: Nicotine - friend or foe? The complex interplay between its role in dependence, harm reduction and risk communication.

  • Clearly, no one wants to see a generation of nicotine-dependent youth, and more effective measures to limit access to nicotine, especially combustible nicotine, are needed. But when it comes to communicating research to the wider public, we must avoid conflating the relatively limited harm of nicotine dependence with its effects on maintaining tobacco addiction, and therefore well-established tobacco-related harm, not least because of the impact this has on risk perceptions of those most in need of nicotine-based treatment: Tobacco users.

2021: The Taxation of Nicotine in Canada: A Harm-Reduction Approach to the Profusion of New Products

  • A critical feature of tobacco use is that morbidity and mortality spring primarily from the combustion process associated with traditional cigarettes. Nicotine, a chemical found in tobacco, is addictive and may not be safe in extreme doses but it, by itself, is not the source of harm from tobacco/smoking. As a result, policymakers must take this into account when considering tax rates for nicotine/tobacco-based products. The harm-reduction approach taken in this Commentary recognizes that cigarettes kill and that if alternative nicotine systems are known with certainty to contain a small fraction of the toxins in cigarettes, this is sufficient to attempt to divert users away from the killer products toward the lower-risk ones, even with uncertainty surrounding the lifecycle health impacts of the latter.
  • Several identifiable social groups experience high rates of tobacco use: individuals with poor mental health, First Nations and Indigenous Communities (FNICs), the homeless and individuals who identify as LGBTQ+. For many in these communities, tobacco is both a comfort and a burden: nicotine provides the comfort while the toxins debilitate the body and the mind. The objective of reducing smoking must become more keenly focused upon who is still smoking and why. If nicotine alone provides minimal health damage and at the same time provides satisfaction to users, then the “war on tobacco” needs to separate out combustion-related tobacco toxins from nicotine. These high nicotine-use social groups also have lower average incomes than the population at large and, therefore, should not be denied access to less-expensive nicotine by limiting access to lowerpriced ANDS (Alternative Nicotine Delivery Systems).

2020: Tobacco harm reduction in the 21st century

  • Covers Snus and smokeless tobacco, Heat not burn, and e-cigarettes
  • In conclusion, to reduce smoking and to save millions of lives, tobacco harm reduction in the form of cigarette substitution with low-risk products appears to be a promising path. These products, although not completely risk-free, offer an alternative to quit or die. In consideration of the available evidence, advice to tobacco smokers should include trying substitute products. The obvious fact so often overlooked is that smoking is rewarding and people like to do it. Giving smokers an alternative with efficient nicotine delivery means that they might prefer one of these products over cigarettes.
  • PDF Version and PDF2

2011: Electronic cigarettes (e‐cigs): views of aficionados and clinical/public health Perspectives

  • The health risks from smoking are large and are known with certainty. Comparatively, the health risks from e‐cig use are likely much smaller (if any) and temporarily switching to e‐cigs will likely yield a large health benefit.
  • If the patient perceives that the e‐cig is helping them to stay off cigarettes and is not reporting any health problems likely attributable to the e‐cig, then the focus should be on staying smoke‐free rather than e‐cig free.
  • PDF Version

Military/Veterans

2023: Motives for using electronic nicotine delivery systems (ENDS) as a cessation tool are associated with tobacco abstinence at 1-year follow-up: A prospective investigation among young adults in the United States Air Force.

  • Researchers who are willing to push back on the mantra of giving primacy to "FDA authorised smoking cessation treatments" and going with evidence of public health impact as the basis for their conclusions.
  • Results: Smokers reporting ENDS use for cigarette cessation were more likely to be abstinent at one-year follow-up (Odds Ratio[OR] = 1.62, 95% CI: 1.06-2.49, P =.03) as well as quit using non-cigarette tobacco products (OR = 2.11, 95% CI: 1.65-2.70, P <.001) than those reporting ENDS use for alternative reasons.
  • Conclusions: Current tobacco users are recommended to use FDA-approved products for smoking cessation, such as nicotine replacement therapy. However, given the high prevalence of cigarette use among military populations, ENDS may provide a useful alternative harm reduction strategy for this high-risk population. 
  • Aycock CA, Wang XQ, Williams JB, Fahey MC, Talcott GW, Klesges RC, Little MA.Prev Med Rep. 2023 Sep 8;35:102399. doi: 10.1016/j.pmedr.2023.102399. eCollection 2023 Oct. PMID: 37712011
  • PDF Version

Jails & Prisons

Drug or Alcohol Treatment Facilities

Shareables

INNCO: Myth of the month: Ecigs and snus don’t help smokers quit

  • Each statement on this doc complies with the character limits on twitter. Feel free to copy/paste them into tweets.

Shareables from VAEP


Smoking Cessation Twitter Threads


Suggestions to Add to This Page