E-cigarettes No Guarantee Against Relapse for Smokers

Oct. 22, 2021 — Former smokers who use e-cigarettes are just as likely to light back up, compared to those using other nicotine alternatives, new evidence reveals.

A recent study showed that people who quit cigarette smoking and then started using electronic cigarettes were just as likely to return to traditional tobacco cigarettes as people who switched to nicotine gum and other products.

Quitting tobacco completely was the most effective strategy. Overall, use of e-cigarettes or another tobacco product was associated with an 8.5% greater chance that a recent quitter would smoke again, compared to people who went “cold turkey.”

The study was published Oct. 19 in JAMA Network Open.

Interestingly, the findings come the week after the FDA announced its first e-cigarette authorization for three Vuse tobacco-flavored vaping products. Data from manufacturer R.J. Reynolds showed the products “could benefit addicted adult smokers who switch to these products — either completely or with a significant reduction in cigarette consumption — by reducing their exposure to harmful chemicals,” the FDA said in a news release.

Electronic Cessation?

“We were very surprised by the FDA’s permission to allow some e-cigarettes to be marketed to help smokers quit,” said John P. Pierce, PhD, lead author of the smoking relapse study.

The current paper asks a different question about e-cigarettes, compared to two previous studies by Pierce and colleagues. A December 2020 study evaluated e-cigarettes as a long-term aid to quit smoking. Another study, in September 2020, compared the use of e-cigarettes, other aids, and quitting tobacco cold turkey.

But “none of our work has been able to find a benefit to using e-cigarettes for cessation,” said Pierce, a professor emeritus in the Department of Family Medicine and Public Health at the University of California, San Diego.

So the researchers decided to test if people who already quit smoking were more likely to go back to smoking within 1 year — to relapse — if they switched to e-cigarettes, a product like nicotine patches, or just quit altogether.

Almost 1 in 4 Quitters Switched to e-Cigarettes

Pierce and colleagues studied 13,604 cigarette smokers from the U.S. Population Assessment of Tobacco and Health study. At the first annual follow-up, 9.4% had recently quit.

Among that group of 1,228 recent quitters, 37% switched to a non-cigarette tobacco product, including 23% who switched to e-cigarettes. The remaining 63% stayed tobacco-free. Non-Hispanic whites, people who were most tobacco-dependent, and those with an annual income greater than $35,000 were more likely to switch to e-cigarettes.

To complicate matters, some people both smoke cigarettes and use e-cigarettes where smoking is not allowed. But that doesn’t count as the “harm reduction” aim of switching to a supposedly safer product, Pierce and colleagues say.

“The potential for harm reduction with e-cigarettes requires that those attempting to quit successfully switch completely away from cigarettes and not become dual-product users.”

A ‘Hotly Debated’ Topic

Meanwhile, the controversy of e-cigarettes as a way to quit smoking continues.

The question “continues to be hotly debated,” Terry F. Pechacek, PhD, writes in a commentary published with the study.

“These new results add to the growing body of evidence from randomized trials and observational studies examining the effect of switching to e-cigarettes on smoking cessation,” says Pechacek, a professor of health management and policy at Georgia State University in Atlanta.

The study, he says, “provides additional evidence suggesting that switching to e-cigarettes in a real world setting could result in higher relapse rates back to smoking.”