New Study Shows that Among Committed Electronic Cigarette Users, Dual Use is a Gateway to Smoking Cessation

One of the main criticisms of electronic cigarettes leveled by its opponents in the tobacco control movement is that there are many dual users of e-cigarettes and tobacco cigarettes and that this has adverse public health consequences.

For example, Stan Glantz argued against electronic cigarettes in a Scientific American article, claiming that: "We’ve found very high levels of dual use [traditional cigarettes along with e-cigarette use]. Very few people have switched away from cigarettes or managed to use them as a bridge to eventually go off cigarettes."

While Dr. Glantz's statement that few people have switched away from cigarettes or used e-cigarettes as a bridge to eventually go off cigarettes was not science-based, but pure speculation, this week a study was published which actually examines the trajectory of electronic cigarette and conventional cigarette use among a cohort of e-cigarette users. For the first time, we are able to examine Glantz's dual use argument and his claim that very few smokers are using e-cigarettes as a bridge to eventually go off cigarettes.

(See: Etter J-F, Bullen C. A longitudinal study of electronic cigarette users. Addictive Behaviors (2013), doi: 10.1016/j.addbeh.2013.10.028.)

The study examined a cohort of 477 electronic cigarette users who were recruited from e-cigarette and smoking cessation web sites. The cohort was followed for one year, at which time e-cigarette and conventional cigarette use was assessed.

The authors report that among ex-smokers at baseline who had quit smoking using electronic cigarettes and were vaping daily, only 6% relapsed to smoking at 1 year follow-up.

The authors also report that among current smokers at baseline who were vaping daily (i.e., dual users), 46% had quit smoking at 1 year follow-up.

The article concludes that: "Most e-cigarette users were former smokers, who used e-cigarettes much like nicotine medications, to assist quitting, but with a longer duration of use. During the course of one year, use of e-cigarettes was remarkably stable in this group, even in those who had recently started to vape. Among vapers, very few ex-smokers relapsed to smoking, even among recent quitters. Dual users of e-cigarettes and conventional cigarettes reduced their cigarette consumption after they started to vape, and about half had stopped smoking at 1-year follow-up."

The Rest of the Story

It is first essential to point out that these results are not generalizable to the overall population. This is a select group of electronic cigarette users who were particularly committed to these products. The results apply to a select group of users who were vaping daily.

Nevertheless, the results do demonstrate that in contrast to the claims of many anti-smoking advocates, dual use of electronic cigarettes and conventional cigarettes does not necessarily have adverse public health consequences. Instead, it appears that for many smokers, dual use serves as a gateway to smoking cessation.

These results should not be used to make claims about the overall effectiveness of e-cigarettes in the population (for example, we cannot infer that 46% of all dual users will quit smoking). And clearly, research is necessary to estimate the corresponding percentages of changes in smoking behavior among a cohort of smokers that is representative of the overall population.

However, the results of this study suggest that anti-smoking advocates such as Dr. Glantz are wrong in asserting that very few smokers "have switched away from cigarettes or managed to use them as a bridge to eventually go off cigarettes." Instead, there appears to be a large number of smokers who have indeed switched completely from smoking to vaping, and there also appears to be a large number of smokers who have successfully used electronic cigarettes as a bridge to complete smoking cessation.

Dual use is not necessarily a bad thing. In fact, it may for some be a gateway to smoking cessation.