Evidence that e-cig use patterns associated with quitting smoking: daily users quit more; everyone else quits less

August 20, 2017

Stanton A. Glantz, PhD

The new paper by Daniel Giovenco and Christine Delnevo, “Prevalence of population smoking cessation by electronic cigarette use status in a national sample of recent smokers,” contributes to the emerging picture that intensive users of e-cigarettes are more likely to have stopped smoking while incidental users quit less.
The cross-sectional study (snapshot in time) uses the 2014 and 2015 National Health Interview Survey (NHIS) to examine the association between e-cigarette use and being a former smoker.  The found that daily e-cigarette users were about 3 times more likely to be former cigarette smokers than non-e-cigarette users.  (The e-cigarette advocates have been making a big deal about this finding.)
At the same time, they found that non-daily e-cigarette users were about 3 times less likely to be former smokers, i.e. e-cigarette use was associated with significantly less quitting.  (The e-cigarette advocates didn’t mention this result.)  This distinction is important because non-daily users comprise about 2/3 of all current e-cigarette users in the study.
This paper is consistent with several other papers that have shown more quitting cigarettes among intensive e-cigarette users and less quitting among non-intensive users, which is the dominant use pattern.
Here is the abstract:
INTRODUCTION:  Amid decreasing rates of cigarette smoking and a rise in e-cigarette use, there is a need to understand population patterns of use to inform tobacco control efforts and evaluate whether e-cigarettes may play a role in tobacco harm reduction.
METHODS:  This study merged data from the 2014 and 2015 National Health Interview Survey (NHIS) and restricted the sample to recent smokers [i.e., current smokers and former smokers who quit in 2010 or later (n=15,532)]. Log-binomial regression estimated adjusted prevalence ratios (aPR) for being quit by e-cigarette use status (i.e., daily, some day, former trier, never). All analyses controlled for factors traditionally correlated with smoking cessation.
RESULTS:  A quarter of the sample (25.2%) were former smokers. The prevalence of being quit was significantly higher among daily e-cigarette users compared to those who had never used e-cigarettes [52.2% vs. 28.2%, aPR: 3.15 (2.66, 3.73)]. Those who used e-cigarettes on some days were least likely to be former smokers (12.1%). These relationships held even after accounting for making a quit attempt and use of other tobacco products.
CONCLUSIONS:  Among those with a recent history of smoking, daily e-cigarette use was the strongest correlate of being quit at the time of the survey, suggesting that some smokers may have quit with frequent e-cigarette use or are using the products regularly to prevent smoking relapse. However, the low prevalence of cessation among infrequent e-cigarette users highlights the need to better understand this subgroup, including the individual factors and/or product characteristics that may inhibit cessation.
The full citation is:  Giovenco DP, Delnevo CD.  Prevalence of population smoking cessation by electronic cigarette use status in a national sample of recent smokers.  Addict Behav. 2017 Aug 3;76:129-134. doi: 10.1016/j.addbeh.2017.08.002. [Epub ahead of print]

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