Changes in Use Patterns Over 1 Year Among Smokers and Dual Users of Combustible and Electronic Cigarettes

Abstract

Background Dual use of combustible and electronic cigarettes (e-cigarettes) is a growing use pattern; more than half of e-cigarette users are dual users. However, little is known regarding the course of dual use; for example, the likelihood of discontinuation of either combustible or e-cigarettes or both. Methods Adult daily smokers and dual users (daily smokers who also vaped at least once per week) who did not intend to quit use of either product in the next 30 days participated in a longitudinal, observational study (N = 322, 51.2% women, 62.7% white, mean age = 42.27 [SD = 14.05]). At baseline, participants completed demographics and smoking and vaping history assessments. They also reported daily cigarette and e-cigarette use via timeline follow-back assessment and provided a breath sample for carbon monoxide assay at 4-month intervals for 1 year. Results Of those who completed the year 1 follow-up, 1.9% baseline smokers and 8.0% dual users achieved biochemically confirmed seven-day point-prevalence abstinence from combustible cigarettes (χ2 = 4.57, p = .03). Of initial dual users, by 1 year 43.9% were smoking only, 48.8% continued dual use, 5.9% were vaping only, and 1.4% abstained from both products. Among baseline smokers, 92.3% continued as exclusive smokers. Baseline dual users who continued e-cigarette use were more likely to be white and report higher baseline e-cigarette dependence. Conclusions In this community sample, the majority of dual users transitioned to exclusive smoking. A higher percentage of dual users quit smoking than smokers, but attrition and baseline differences between the groups compromise strong conclusions. Sustained e-cigarette use was related to baseline e-cigarette dependence. Implications This research suggests that dual use of combustible and e-cigarettes is not a sustained pattern for the majority of dual users, but it is more likely to be a continued pattern if the user is more dependent on e-cigarettes. There was evidence that dual users were more likely to quit smoking than exclusive smokers, but this may be due to factors other than their dual use.

Are Heated Tobacco Product Users Less Likely to Quit than Cigarette Smokers? Findings from THINK (Tobacco and Health IN Korea) Study

“…Poly-users have higher nicotine dependence, and it is difficult for them to achieve smoking cessation despite having higher motivation and attempts to quit smoking than cigarette smokers. Piper et al showed that about half of dual users with CCs and e-cigarettes failed to quit smoking and continued to use both products, and only 5.9% switched from CCs to e-cigarettes completely and 1.4% abstained from both products after 1 year in a real-world setting [ 24 ]. Similar to previous results, the data from the Ministry of Health and Welfare in South Korea showed that 42.2% of cigarette smokers, 85.8% of e-cigarette users, and 86.6% of HTP users were dual or triple users of CCs, e-cigarettes, and/or HTPs [ 25 ].…”

E-Cigarette Use and Adult Cigarette Smoking Cessation: A Meta-Analysis

“…Manzoli et al 55 Gomajee et al 14 Jackson et al 47 Ekanem et al 36 Kalkhoran et al 49 ; daily EC use Kulik et al 52 Al−Delaimy et al 25 Brose et al 32 Giovenco and Delnevo 13 ; daily EC use Sweet et al 63 Sutfin et al 62 Piper et al 58 Cross−sectional Chiang et al 33 Pasquereau et al 56 Gmel et al 40 Christensen et al 34 Biener and Hargraves 23 ; less than daily EC use El−Khoury Lesueur et al 37 Kalkhoran et al 50 ; no chronic medical condition Bowler et al 31…”

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

“…6,7 Almost half of dual users continue both smoking and vaping when followed up for a year, and 44% return to exclusive smoking. 8,9 Therefore, although dual users are interested in quitting smoking and are more likely to make quit attempts than smokers who do not vape, 10 they still have difficulty achieving smoking abstinence. Many dual users report a reduction in smoking after the onset of vaping; yet even low rates of smoking are associated with poor health outcomes and increased mortality.…”