New Study of Trajectory of E-Cigarette Use Suggests a Pattern of Decreasing Cigarette and Nicotine Addiction

In one of the first studies to examine the trajectory of electronic cigarette use over time, Lechner and colleagues have shown that extended duration of electronic cigarette use is associated with reductions in cigarette use and in the strength of nicotine used during vaping.

(See: Lechner et al. Effects of duration of electronic cigarette use. Nicotine and Tobacco Research. Published online May 13, 2014. doi: 10.1093/ntr/ntu061.)

The methods of the study were as follows: "Individuals were recruited at e-cigarette retail locations in a large metropolitan city in the midwestern portion of the United States in July 2013. A total of 159 participants completed a brief 29-item self-report measure that assessed behaviors and perceptions of use."

The results were reported as follows: "Increased duration of e-cigarette use was associated with fewer cigarettes smoked per day and differing patterns of dependence to e-cigarettes contingent upon smoking history. Additionally, increased duration of e-cigarette use was associated with increased frequency of use; however, this finding became nonsignificant when current tobacco cigarette use was accounted for, suggesting that individuals may increase e-cigarette use frequency as they decrease cigarette use. Overall, e-cigarette users tended to decrease the strength of nicotine in their e-cigarette products regardless of duration of use."

The Rest of the Story

There are three major findings -- all preliminary -- from this study.

First, in contrast to what Stan Glantz is arguing, dual use does not appear to be an "adverse consequence" of e-cigarette experimentation. Instead, it appears to be a positive effect that results in a substantial reduction in cigarette consumption among smokers who would almost certainly not have quit smoking altogether in the absence of electronic cigarettes.

Second, in dual users, the total amount of nicotine intake declines. The increase in electronic cigarette use over time is accompanied by a concomitant decline in cigarette smoking. Thus, overall nicotine declines.

Third, e-cigarette users tend to decrease the strength of nicotine in their products, leading one to believe that overall levels of addiction to nicotine decline compared to their baseline smoking status.

Combined with previous evidence, these results suggest that the natural history of electronic cigarette use over time is characterized, in general, by:

a. Substantial reductions in cigarette use;
b. Reduction in daily nicotine intake; and
c. Movement to a lower level of overall nicotine addiction.

The bottom line: it appears that the use of electronic cigarettes has tremendous health benefits not only for those who quit smoking, but also for those who become dual users. While it may take longer for these individuals to eventually get off of nicotine altogether, it appears that the switch to e-cigarettes yields a much lower level of nicotine addiction, making it easier, not harder, to subsequently cease using nicotine if they so desire.

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, there are now two studies which actually examine the trajectory of electronic cigarette and conventional cigarette use among a cohort of e-cigarette users. We are able to empirically 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.

The results from these two studies 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 decreased nicotine addiction, and perhaps ultimately to smoking cessation.

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.

The rest of the story is that dual use is not necessarily a bad thing. In fact, it may for some be a gateway to smoking cessation.