Smokers who switch to e-cigarettes are now more likely to stop smoking regular cigarettes,
according to a new paper published by Oxford University Press in Nicotine & Tobacco
Research. In the past, smokers who began vaping mostly continued smoking.
Electronic nicotine delivery systems first emerged on the U.S. market in 2007. The first
e-cigarettes resembled conventional cigarettes (in appearance) and used fixed low-voltage
batteries. Beginning in 2016, manufacturers introduced e-liquids containing nicotine salt
formulations. These new e-cigarettes became widely available. These nicotine salts are
lower in pH than freebase formulations, which allow manufacturers to increase nicotine
concentration while avoiding harshness and bitterness.
Past population-level research provided conflicting findings on whether vaping helps
people who smoke combustible cigarettes to quit smoking. Some research suggests improved
cigarette quitting-related outcomes with e-cigarette use, while other research suggests
the opposite. Inconsistent findings may be due to differences in the samples and measures
considered, differences in the analytic approaches of researchers used, the rapidly
changing product environment, or policy contexts.
The researchers here examined differences in real-world trends in population-level
cigarette discontinuation rates from 2013 to 2021, comparing U.S. adults who smoked
combustible cigarettes and used e-cigarettes with U.S. adults who smoked combustible
cigarettes and did not use e-cigarettes.
Using data from among adults (ages 21+) in the Population Assessment of Tobacco and Health
(PATH) Study, a national longitudinal study of tobacco use from people from all over the
United States, the researchers found that between 2013 and 2016, rates of discontinuing
cigarette smoking among adults in the U.S. population were statistically indistinguishable
between those who used e-cigarettes and those who did not. Cigarette discontinuation rates
were 15.5 percent for those who used e-cigarettes and 15.6 percent for those who did not.
But the quit rates changed in subsequent years; the researchers here found that between
2018 and 2021 only 20 percent of smokers who did not use e-cigarettes stopped smoking
combustible cigarettes, but some 30.9 percent of smokers who used e-cigarettes stopped
smoking combustible cigarettes.
The paper notes that the full study period spanned a time in the United States when the
e-cigarette marketplace was expanding; salt-based nicotine formulations gained market
share in 2016 and vaping products became available with increased nicotine yields over
time. This was also a period in which state and federal governments restricted tobacco in
various ways, including increasing the tobacco-purchase age to 21 and restricting flavored
e-cigarettes.
“Our findings here suggest that the times have changed when it comes to vaping and
smoking cessation for adults in the U.S.,” said study first author, Karin Kasza, an
assistant professor of oncology in the Department of Health Behavior at Roswell Park
Comprehensive Cancer Center in Buffalo, New York, in a statement.
“While our study doesn’t give the answers as to why vaping is associated with cigarette
quitting in the population today when it wasn’t associated with quitting years ago,
design changes leading to e-cigarettes that deliver nicotine more effectively should be
investigated. This work underscores the importance of using the most recent data to inform
public health decisions.”
