Is dual use of nicotine products and cigarettes associated with smoking reduction and cessation behaviours? A prospective study in England

Abstract

ObjectivesTo investigate associations of dual use of e-cigarettes and cigarettes with subsequent quitting activity (smoking reduction, quit attempts and use of evidence-based cessation aids). To overcome potential confounding by factors associated with use of pharmacological support, we selected dual use of over-the-counter nicotine replacement therapy (OTC NRT) and cigarettes as a behavioural control.DesignProspective cohort study with 6-month follow-up.SettingEngland, 2014–2016.Participants413 current smokers participating in the Smoking Toolkit Study, a representative survey of adults in England, who reported current use of e-cigarettes or OTC NRT and provided data at 6-month follow-up.Main outcome measuresThe exposure was dual use of e-cigarettes or OTC NRT at baseline. Outcomes were change in cigarette consumption, quit attempts and use of evidence-based cessation aids during quit attempts over 6-month follow-up. Relevant sociodemographic and smoking characteristics were included as covariates.ResultsAfter adjustment for covariates, dual e-cigarette users smoked two fewer cigarettes per day at follow-up than at baseline compared with dual OTC NRT users (B=2.01, 95% CI −3.62; −0.39, p=0.015). While dual e-cigarette users had 18% lower odds than dual OTC NRT users to make a quit attempt at follow-up (risk ratio (RR) 0.82, 95% CI 0.67 to 1.00, p=0.049), the groups did not differ in use of cessation aids (RR 1.06, 95% CI 0.93 to 1.21, p=0.388).ConclusionsDual use of e-cigarettes is associated with a greater reduction in cigarette consumption than dual use of OTC NRT. It may discourage a small proportion of users from making a quit attempt compared with dual OTC NRT use but it does not appear to undermine use of evidence-based cessation aids.

Use of e-Cigarettes and Attendance at Stop Smoking Services: A Population Survey in England

“…Our findings align with some aforementioned studies that have not found e-cigarette use to be associated with depressed uptake of behavioural support [ 26 , 27 ]. Conversely, an English study found in an unplanned analysis that dual users of tobacco/e-cigarettes were significantly less likely than dual users of tobacco/NRT to specifically use behavioural support or prescription medication, though the two groups did not differ in their overall use of evidence-based cessation aids [ 25 ]. This mixed evidence base could result from differences in study designs, since Beard et al employed a prospective cohort design [ 25 ].…”

“…Similarly, research has only recently begun to explore whether vaping amongst smokers may be specifically affecting behavioural support uptake, with mixed findings. A recent UK prospective study suggested that, amongst smokers making a “serious quit attempt”, use of e-cigarettes was associated with reduced likelihood of specifically using behavioural support or prescription medication [ 25 ]. Although conclusions that can be drawn from cross-sectional or ecological research are more limited, available studies have found different results.…”

Longitudinal transition outcomes among adult dual users of e-cigarettes and cigarettes with the intention to quit in the United States: PATH Study (2013–2018)

“…We included in our models a range of variables measured at Wave 1 identified in the literature ( Jackson et al, 2020 ) as potential confounders in the association between dual use (of e-cigarettes and cigarettes) and cessation. Sociodemographic covariates included age [18–24 (reference), 25–34, 35–44, 44–54, 55 + ]; sex [male and female (reference)], race/ethnicity [Non-Hispanic White (reference), Non-Hispanic Black, Non-Hispanic Other and Hispanic]; education [high school or less (reference), some college and bachelor’s degree or higher]; income [< $25,000 (reference), $25,000-$49,999, ≥$50,000 and not reported]; census region [Northwest (reference), Midwest, South, and West].…”

Protocol for expansion of an existing national monthly survey of smoking behaviour and alcohol use in England to Scotland and Wales: The Smoking and Alcohol Toolkit Study

“…For binary outcome data we will use as binary and multivariable binary logistic (for odds ratios) or log-binomial (for relative risks) regression. These methods have been employed in numerous STS studies to analyse associations between self-reported abstinence and use of different smoking cessation aids 32 , 33 . Where the outcomes are ordinal or have more than two levels we will use ordinal or multinomial logistic regression, respectively.…”