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

McNeill, Ann; Driezen, Pete; Hitchman, Sara C.; Cummings, K. Michael; Fong, Geoffrey T.; Borland, Ron

doi:10.1111/add.14722

Cited by 21 publications

(18 citation statements)

References 46 publications

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“…Few other studies have examined the role of NVPs in smoking relapse. One study found that vaping may be protective against relapse [ 14 ], but similar to our study, Brose et al [ 36 ] reported that there was no difference in relapse between exclusive daily vapers compared to those who were not vaping. However, they did find that ex-smokers who vaped infrequently had a higher probability of relapse, suggesting that this group of ex-smokers were not vaping enough to satisfy their cravings for nicotine.…”

Section: Discussionsupporting

confidence: 86%

“…However, some caution is required when interpreting population-based studies as NVP use is not randomized and there is reason to believe those vaping differ from those who are not. For example, concurrent users have been shown to be more dependent on nicotine than smokers who do not vape [ 14 , 15 ]. Further, baseline smokers who use NVPs could be viewed as “treatment failures” if they initiated NVP use to help them to stop smoking, but had not quit at the time of the follow-up survey.…”

Section: Introductionmentioning

confidence: 99%

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Changes in Smoking and Vaping over 18 Months among Smokers and Recent Ex-Smokers: Longitudinal Findings from the 2016 and 2018 ITC Four Country Smoking and Vaping Surveys

Gravely

Meng

Cummings

et al. 2020

IJERPH

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This descriptive study of smokers (smoked at least monthly) and recent ex-smokers (quit for ≤2 years) examined transitions over an 18 month period in their smoking and vaping behaviors. Data are from Waves 1 (W1: 2016) and 2 (W2: 2018) of the ITC Four Country Smoking and Vaping Survey, a cohort study of adult (≥18+) smokers, concurrent users (smoke and vape), and recent ex-smokers from Australia, Canada, England, and the United States (US). Respondents (N = 5016) were classified according to their smoking and vaping status, which resulted in eight subgroups: (1) exclusive daily smokers (2) exclusive non-daily smokers; (3–6) concurrent users (subdivided into four groups by each combination of daily/non-daily smoking and daily/non-daily vaping); (7) ex-smokers who vape; (8) ex-smokers not vaping. The analyses focused first on describing changes between groups from W1 to W2. Second, transition outcomes were assessed based on changes in smoking and vaping between W1 and W2. Transitions focused on smoking were: no change in smoking (continued smoking at the same frequency); decreased smoking; increased smoking; discontinued smoking; relapsed (ex-smokers at W1 who were smoking at W2). Transitions focused on vaping were: initiated vaping; switched from smoking to vaping. Overall, this study found that the vast majority of smokers were smoking 18 months later. Non-daily smokers were more likely than daily smokers to have discontinued smoking (p < 0.0001) and to have switched to exclusive vaping (p = 0.034). Exclusive non-daily smokers were more likely than exclusive daily smokers to have initiated vaping (p = 0.04). Among all W1 daily smokers, there were no differences in discontinued smoking between daily smokers who vaped (concurrent users) and exclusive daily smokers; however, concurrent users were more likely than exclusive daily smokers to have decreased to non-daily smoking (p < 0.001) or to have switched to vaping by W2 (p < 0.001). Among all W1 non-daily smokers, there were no significant differences in increased smoking or discontinued smoking between concurrent users or exclusive smokers. Most ex-smokers remained abstinent from smoking, and there was no difference in relapse back to smoking between those who vaped and those who did not.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Changes in Smoking and Vaping over 18 Months among Smokers and Recent Ex-Smokers: Longitudinal Findings from the 2016 and 2018 ITC Four Country Smoking and Vaping Surveys

Gravely

Meng

Cummings

et al. 2020

IJERPH

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“…Vaping and also use of NRT may be a marker of higher dependence on nicotine which is consistently associated with increased relapse [25]. This is supported by evidence that vapers were more likely than non-vapers to report higher cigarette dependence when they were smoking [26]. Infrequent use and thus nicotine consumption would not sufficiently protect against this increased risk of relapse.…”

Section: Discussionmentioning

confidence: 99%

Associations between vaping and relapse to smoking: preliminary findings from a longitudinal survey in the UK

et al. 2019

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Background: Most smokers attempting to quit relapse. There is little evidence whether the use of e-cigarettes ('vaping') increases or decreases relapse. This study aimed to assess 1) whether vaping predicted relapse among exsmokers, and 2) among ex-smokers who vaped, whether vaping characteristics predicted relapse. Methods: Longitudinal web-based survey of smokers, recent ex-smokers and vapers in the UK, baseline in May/ June 2016 (n = 3334), follow-up in September 2017 (n = 1720). Those abstinent from smoking ≥ 2 months at baseline and followed up were included. Aim 1: Relapse during follow-up was regressed onto baseline vaping status, age, gender, income, nicotine replacement therapy use and time quit smoking (n = 374). Aim 2: Relapse was regressed onto baseline vaping frequency, device type, nicotine strength and time quit smoking (n = 159). Results: Overall, 39.6% relapsed. Compared with never use (35.9%), past/ever (45.9%; adj OR = 1.13; 95% CI, 0.61-2.07) and daily vaping (34.5%; adj OR = 0.61; 95% CI, 0.61-1.89) had similar odds of relapse, for non-daily vaping evidence of increased relapse was inconclusive (65.0%; adj OR = 2.45; 95% CI, 0.85-7.08). Among vapers, non-daily vaping was associated with higher relapse than daily vaping ( adj OR = 3.88; 95% CI, 1.10-13.62). Compared with modular devices (18.9% relapse), tank models (45.6%; adj OR = 3.63; 95% CI, 1.33-9.95) were associated with increased relapse; evidence was unclear for disposable/cartridge refillable devices (41.9%; adj OR = 2.83; 95% CI, 0.90-8.95). Nicotine strength had no clear association with relapse.Conclusion: Relapse to smoking is likely to be more common among ex-smokers vaping infrequently or using less advanced devices. Research into the effects of vaping on relapse needs to consider vaping characteristics.

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“…Such socioeconomic patterning in e-cigarette use is important, considering that studies have shown that those who formerly smoked and now vape reported greater confidence in not smoking compared with those who do not vape. 16,24 This is contextualized by the absence of a trend in the use of nicotine replacement therapy, another widely available nicotine product, across the period. However, a 2019 randomized clinical trial that showed e-cigarettes to be almost twice as effective for smoking cessation at 1 year compared with nicotine replacement therapy 3 has indicated that, in the context of the trial, the devices may not confer extra protection against relapse.…”

Section: Jama Network Open | Substance Use and Addictionmentioning

confidence: 99%

Association of Socioeconomic Position With e-Cigarette Use Among Individuals Who Quit Smoking in England, 2014 to 2019

2020

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IMPORTANCE e-Cigarette use among individuals who quit smoking more than 1 ago in England is highest among those with lower socioeconomic position and may affect smoking-related health inequalities, depending on whether the devices protect against relapse to tobacco smoking. OBJECTIVES To assess trends in current e-cigarette use by socioeconomic position among individuals who have quit smoking for at least 1 year, to capture postcessation initiation among those who quit within the past year and did not use an e-cigarette in their most recent quit attempt (representing recent initiation), and to capture postcessation initiation among those who quit smoking before e-cigarettes became popular in 2011 (representing late initiation). DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of 34 442 adults (Ն16 years) who formerly smoked used data from the Smoking Toolkit Study (conducted 2014-2019), a nationally representative, monthly, repeated, cross-sectional, household survey of smoking and smoking cessation in England. Data analysis was conducted in December 2019. EXPOSURES Socioeconomic position based on occupation. MAIN OUTCOMES AND MEASURES Current self-reported e-cigarette use. RESULTS Weighted samples consisted of 19 297 individuals who had quit smoking for at least 1 year (mean [SD] age, 59.2 [17.0] years; 9024 [46.8%] women), 904 who quit in the past year and did not use an e-cigarette in their most recent quit attempt (mean [SD] age, 41.6 [17.1] years; 445 [49.3%] women), and 14 241 who quit before 2011 (mean [SD] age, 63.6 [14.6] years; 6619 [46.5%] women). Among those who had quit smoking fot at least 1 year, e-cigarette use increased from 3.3% (95% CI, 2.7%-4.0%) in 2014 to 10.4% (95% CI, 9.2%-11.6%) in 2019 among all socioeconomic groups. Use was more common among those with lower socioeconomic position than those with higher socioeconomic position (odds ratio, 1.59; 95% CI, 1.05-2.40; P = .03). Regarding postcessation initiation of e-cigarettes, among those who quit smoking in the past year and did not use an e-cigarette in their most recent quit attempt, 7.1% (95% CI, 5.9%-9.3%) initiated e-cigarette use after smoking cessation, and there was no clear trend over time or any difference according to socioeconomic position. Among those who quit before 2011, there was an overall increase in use of e-cigarettes (0.8% [95% CI, 0.5%-1.2%] in 2014 to 2.1% [95% CI, 1.4%-2.8%] in 2019), but there were no apparent differences in use across socioeconomic position. CONCLUSIONS AND RELEVANCE In this study, e-cigarette use increased among all participants from 2014 to 2019 but was highest among those with lower socioeconomic position. Continued monitoring of this socioeconomic patterning is important because if e-cigarettes do not confer the public health benefit of protection against relapse to smoking, then equity-negative disadvantages of long-term usage are more likely. Late, but not recent, postcessation initiation of e-cigarettes has (continued) Key Points Question Is socioeconomic position associated wi...

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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

Cited by 21 publications

References 46 publications

Changes in Smoking and Vaping over 18 Months among Smokers and Recent Ex-Smokers: Longitudinal Findings from the 2016 and 2018 ITC Four Country Smoking and Vaping Surveys

Changes in Smoking and Vaping over 18 Months among Smokers and Recent Ex-Smokers: Longitudinal Findings from the 2016 and 2018 ITC Four Country Smoking and Vaping Surveys

Associations between vaping and relapse to smoking: preliminary findings from a longitudinal survey in the UK

Association of Socioeconomic Position With e-Cigarette Use Among Individuals Who Quit Smoking in England, 2014 to 2019

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