John P. Pierce, Ph.D., Professor Emeritus, Moores UCSD Cancer Center speaks about Does switching to e-Cigarettes Prevent Relapse?
Points to Remember –
Is switching to e-cigarettes linked to a lower risk of relapsing into cigarette smoking?
Findings:
In this cohort research of a representative sample of US people, 9.4% of those who smoked cigarettes 1 year later were recent former smokers. Switching to any tobacco product, including e-cigarettes, was linked to an 8.5 percent increase in relapse to smoking over the next year, which was similar to the rise reported in people who moved to conventional tobacco products.
Meaning:
In adults in the United States, switching to e-cigarettes is not linked to reduced cigarette smoking relapse.
Summary –
Despite the fact that e-cigarettes have not been certified as a cessation aid, many smokers believe that they will assist them in effectively quitting cigarettes.
The goal of this study was to see if those who had recently stopped smoking and transitioned to e-cigarettes or another tobacco product were less likely to relapse than those who had stayed tobacco-free.
Design, Setting, and Participants:
This cohort study looked at a nationally representative sample of US households that took part in four waves of the Population Assessment of Tobacco and Health Study (from 2013 to 2017), each with three yearly surveys. Individuals who smoked at baseline had recently quit at the first follow-up and completed the second follow-up survey were all eligible.
Exposures:
Use of e-cigarettes or other tobacco products after stopping smoking for the first time at follow-up 1.
Main Outcomes and Measures:
Weighted percentage of participants who have been abstinent for more than 12 months at the follow-up 2.
Results:
Of the 13 604 participants who smoked cigarettes at the start of the study, 9.4% (95 percent confidence interval: 8.7%-10.0 percent) had recently quit smoking (mean age, 41.9; 95 percent CI, 39.7-46.6 years; 641 [43.2 percent ] women) 22.8 percent (95 percent confidence interval: 19.7 percent -26.0 percent) had shifted to e-cigarettes, with 17.6 percent (95 percent confidence interval: 14.8 percent -20.5 percent) using them on a daily basis. A total of 37.1 percent (95 percent CI, 33.7 percent -40.4 percent ) used a non-cigarette tobacco product, whereas 62.9 percent (95 percent CI, 59.6 percent -66.3 percent ) did not. Switching to e-cigarettes was most common among those in the top tertile of tobacco dependence (31.3 percent; 95 percent CI, 25.0 percent -37.7%), non-Hispanic White (26.4 percent; 95 percent CI, 22.3 percent -30.4 percent), and those with higher incomes ($35 000, 27.5 percent; 95 percent CI, 22.5 percent -32.4 percent vs. $35 000, 19.3 percent; 95 percent CI, 16.3 percent At the second follow-up, the unadjusted relapse rates among those who switched to different cigarette products were similar (for any tobacco product: successfully quit, 41.5 percent; 95 percent CI, 36.2 percent -46.9 percent; relapsed with significant requit, 17.0 percent; 95 percent CI, 12.4 percent -21.6 percent; currently smoking, 36.2 percent; 95 percent CI, 30.9 percent -41.4 percent ). When relevant confounders were taken into account, switching to any tobacco product was linked to a higher rate of relapse than staying tobacco-free (adjusted risk difference, 8.5 percent; 95 percent CI, 0.3 percent -16.6 percent ). The number of people who switched to e-cigarettes, whether they did so on a daily basis or not, was not substantial. While smokers who transitioned to e-cigarettes were more likely to relapse, they also looked to be more likely to stop and be abstinent for three months at follow-up 2. (17.0 percent; 95 percent CI, 12.4 percent -21.6 percent vs 10.4 percent; 95 percent CI, 8.0 percent -12.9 percent ).
Conclusions and Implications:
The premise that switching to e-cigarettes will prevent relapse to cigarette smoking is not supported by this large, nationally representative study from the United States.