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Another big well-done study shows e-cigarette use associated with more progression to smoking and less quitting
On January 11, 2016 Gerhard Gmel and colleagues published a very well done longitudinal study of the relationship between e-cigarette and cigarette use in 5128 Swiss male 20 year olds.
They recruited subjects when they were registering for military service (required of all 20 year old males in Switzerland) and followed them up a year later.
The authors measured smoking behavior at the beginning and the end and e-cig use at the end.
(Yes, I know our friends in England will criticize only measuring e-cigarette use at the end. The authors of the paper discuss this issue and we showed that when e-cig use is measured does not affect the results.)
- Nonsmokers at baseline who used ecigs were more likely to be smokers one year later than nonsmokers who did not use e-cigs
- Smokers at baseline who used e-cigs were less likely to have quit smoking a year later
Consistent with other studies, smokers who used e-cigs were making more quit attempts. So the marketing claim that e-cigs help people quit is being heard but the effect of using e-cigs is less, not more, quitting.
The authors analyzed daily and occasional smokers separately and found similar effects. They also controlled for level of nicotine dependence at baseline as well as several demographic variables. One of the interesting results is that including these covariates did not substantially affect the overall estimates of the effects of e-cig use, which is more evidence that all the details that e-cig advocates use to dismiss the accumulating evidence are not important.
The full paper, “E-cigarette use in young Swiss men: is vaping an effective way of reducing or quitting smoking?,” is available for free here.
Here is the abstract:
QUESTION UNDER STUDY: To test longitudinally differences in conventional cigarette use (cigarettes smoked, cessation, quit attempts) between vapers and nonvapers.
METHODS: Fifteen months follow-up of a sample of 5 128 20-year-old Swiss men. The onset of conventional cigarette (CC) use among nonsmokers, and smoking cessation, quit attempts, changes in the number of CCs smoked among smokers at baseline were compared between vapers and nonvapers at follow-up, adjusted for nicotine dependence.
RESULTS: Among baseline nonsmokers, vapers were more likely to start smoking at follow-up than nonvapers (odds ratio [OR] 6.02, 95% confidence interval [CI] 2.81, 12.88 for becoming occasional smokers, and OR = 12.69, 95% CI 4.00, 40.28 for becoming daily smokers). Vapers reported lower smoking cessation rates among occasional smokers at baseline (OR = 0.43 (0.19, 0.96); daily smokers: OR = 0.42 [0.15, 1.18]). Vapers compared with nonvapers were heavier CC users (62.53 vs 18.10 cigarettes per week, p <0.001) and had higher nicotine dependence levels (2.16 vs 0.75, p <0.001) at baseline. The number of CCs smoked increased between baseline and follow-up among occasional smokers (b = 6.06, 95% CI 4.44, 7.68) and decreased among daily smokers (b = –5.03, 95% CI –8.69, –1.38), but there were no differential changes between vapers and nonvapers. Vapers showed more quit attempts at follow-up compared with nonvapers for baseline occasional smokers (incidence rate ratio [IRR] 1.81, 95% CI 1.24, 2.64; daily smokers IRR 1.28, 95% CI 0.95, 1.73).
CONCLUSIONS: We found no beneficial effects of vaping at follow-up for either smoking cessation or smoking reduction.
My one quibble with the paper is that it does not just find “no beneficial effects.” It finds harm.
The full citation is: Gmel G, Baggio S, Mohler-Kuo M, Daeppen JB, Studer J. E-cigarette use in young Swiss men: is vaping an effective way of reducing or quitting smoking? Swiss Med Wkly. 2016 Jan 11;146:w14271. doi: 10.4414/smw.2016.14271. eCollection 2016. http://www.smw.ch/content/smw-2016-14271/