//BTH #5 – Vaping use high among recent ex-smokers

Behind the Headlines is a regular feature taking a slightly deeper dive into a piece of recent media coverage of NGP research.

This edition’s story:

“Vaping use high among recent quitters but rare among those who gave up longer ago”

Former smokers “who quit tobacco within the last five years are likely to use e-cigarettes, while vaping is rare among those who quit more than a decade ago,” reported the BMJ via news service  EurekAlert on February 3, 2020.

“Today’s smokers who want to quit are using e-cigarettes as an aid, whereas in the past, quitters had to rely on other smoking cessation aids,” it added.

The article summarised a study published in the journal Tobacco Control, which examined the duration of smoking cessation and its association with EVPs (electronic vapour products), an as-yet little explored topic in tobacco harm reduction research.

Compared to cigarettes, EVPs are relatively new products – with many former smokers having stopped smoking before EVPs became widely available. The study authors surmised the duration of cessation can therefore influence the impact EVP’s have on smokers’ transition away from cigarettes.

How was the research conducted?

The authors – Farsalinos et al. – analysed data from the 2017 Eurobarometer, a cross-sectional survey which interviewed 13,057 people (6904 current and 6153 former smokers) from 28 EU member states about their tobacco and EVP use.

What did the study find?

• “Dual daily use is low in current smokers: current daily EVP use was reported in 2.4% of current smokers, suggesting daily dual use is low in this population.”
• Daily EVP use was “rare” among former smokers who had quit >10 years (0.2%).
• Daily EVP use was more frequently reported in former smokers who had stopped smoking recently (≤2 years: 12.9% and 3–5 years 9.0%).
• The authors concluded that “current daily [EVP] use was strongly associated with recent (≤5 years) smoking cessation in the EU in 2017”. Simultaneously, “former daily e-cigarette use was also associated with recent (≤2 years) smoking cessation”.
• The study suggested that generally smokers’ move away from cigarettes using EVPs, and eventually, stop using the devices altogether.
• The authors also reported that “compared with never use, current daily [EVP] use was associated with being a former smoker” of ≤2 and 3–5 years.
• The authors state that daily EVP use was negatively associated with being a former smoker of 5–10 and >10 years. This suggests that daily [EVP] use is more common amongst people who recently stopped smoking and less prevalent among those who gave up longer ago.

Our take on the research…

This specific study certainly supports the harm reduction potential of EVP compared to combustible tobacco, demonstrating adult smokers interested in quitting smoking are increasingly doing so via EVPs.

The study also addresses gaps in the existing literature, examining the relationship between cessation duration and EVP use. We recommend future research builds on these findings, perhaps considering the relationship cessation duration has with both EVPs and other cessation aids, like nicotine replacement therapies.

Doing so will continue to add to the comprehensive existing evidence base – including our own research – (link to A Closer Look page?) which suggests NGPs like vapes can play a crucial role in adult smokers’ journey away from cigarettes.

Did the study have any limitations?

• The study is cross-sectional, as the data was collected at one specific point rather than continually.

Cross-sectional data is unable to establish temporality, meaning it can’t determine the order between EVP uptake and smoking cessation. For example, did an individual use an EVP and then stop smoking, or did they stop smoking then start using an EVP? Owing to this methodology, while the authors can report an association, they cannot conclude causation.

• The researchers do not biochemically verify product use.

Instead, the study uses self-reported data which is open to recall bias. Participants can’t always remember their behaviours accurately. This means their answers could be subject to recall bias.

• The survey did not account for smoking cessation motivation.

Those who moved away from cigarettes might have more motivation to do so compared to current smokers. The survey didn’t assess these potential differences in mental drive.

• The use of smoking cessation aids was not assessed.

Smokers could have moved away from cigarettes using an EVP in combination with cessation aids, such as Nicotine Replacement Therapies (NRTs), but the authors haven’t mentioned whether this was considered in the research. To improve the study, it would be useful to know if EVPs were used in combination with NRTs, and if they were, to compare the effectiveness of each product type.

• The survey doesn’t consider any potential cases of smoking relapse.

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