E-cigarettes don't help smokers stay off cigarettes, despite U.S. Centers for Disease Control and Prevention guidance suggesting they can be an effective path to quitting, a report published Tuesday with research from UC San Diego found.
The CDC has previously suggested that smokers who are unable to quit smoking may benefit by switching to vaping e-cigarettes if they switch completely and are able to avoid relapsing to cigarette smoking.
In a report published in Tuesday's online issue of JAMA Network Open, an analysis by the Herbert Wertheim School of Public Health and Human Longevity Science at UCSD and UCSD Moores Cancer Center reports that e-cigarette use — even on a daily basis — did not help smokers successfully stay off cigarettes.
"Our findings suggest that individuals who quit smoking and switched to e-cigarettes or other tobacco products actually increased their risk of a relapse back to smoking over the next year by 8.5 percentage points compared to those who quit using all tobacco products," said first author John Pierce, professor at the Wertheim School of Public Health and Moores Cancer Center. "Quitting is the most important thing a smoker can do to improve their health, but the evidence indicates that switching to e-cigarettes made it less likely, not more likely, to stay off of cigarettes."
Researchers used data from the Population Assessment of Tobacco and Health study, undertaken by the National Institute on Drug Abuse and the FDA Center for Tobacco Products under contract with Westat. The team identified 13,604 smokers between 2013 and 2015 who were followed over two sequential annual surveys to explore changes in use of 12 tobacco products.
At the first annual follow-up, 9.4% of the established smokers had quit. Now considered "former smokers," 62.9% of these individuals remained tobacco-free, while 37.1% had switched to another form of tobacco use. Of the recent smokers who switched to another product, 22.8% used e-cigarettes, with 17.6% of switchers using e-cigarettes daily.
Recent former smokers who switched to e-cigarettes were more likely to be non-Hispanic white, have higher incomes, have higher tobacco dependence scores and view e-cigarettes as less harmful than traditional cigarettes.
"Our goal in this study was to assess whether recent former smokers who had switched to e-cigarettes or another tobacco product were less likely to relapse to cigarette smoking compared to those who remained tobacco free," said senior author Karen Messer, professor and chief of the division of biostatistics at the Wertheim School of Public Health.
At the second annual follow-up, the authors compared the former smokers who were tobacco-free to those who had switched to e-cigarettes or other tobacco products. Individuals who switched to any other form of tobacco use, including e-cigarettes, were 8.5% more likely to relapse compared to former smokers who had quit all tobacco.
Among recent former smokers who abstained from all tobacco products, 50% were 12 or more months off cigarettes at the second follow-up and were considered to have successfully quit smoking; this compared to 41.5% of recent former smokers who switched to any other form of tobacco use, including e-cigarettes.
While people who switched were more likely to relapse to smoking, they were also more likely to attempt to quit again and be off cigarettes for at least three months at the second follow-up. A further follow-up survey is needed to identify whether this is evidence of a pattern of chronic quitting and relapsing to cigarette smoking, or whether it is part of progress toward successful quitting, the researchers said.
"This is the first study to take a deep look at whether switching to a less harmful nicotine source can be maintained over time without relapsing to cigarette smoking," Pierce said. "If switching to e-cigarettes was a viable way to quit cigarette smoking, then those who switched to e-cigarettes should have much lower relapse rates to cigarette smoking. We found no evidence of this."
