Comparison of e‐cigarette use characteristics between exclusive e‐cigarette users and dual e‐cigarette and conventional cigarette users: an on‐line survey in France

Abstract

Background and Aims Completely substituting e‐cigarettes (EC) for combustible tobacco cigarettes reduces exposure to toxicants and carcinogens. However, a large proportion of EC users (dual users) continue to smoke conventional cigarettes. This study aimed to compare estimated nicotine intake and e‐cigarette use characteristics between exclusive EC users and dual users. Design Web‐based anonymous cross‐sectional survey. Setting France. Participants A total of 3189 adults, current users of electronic cigarettes (EC). Data collection between 4 October 2014 and 11 November 2014. Measurements Primary outcome: estimated nicotine intake per day (mg) from participants' reports. Secondary outcomes: duration, frequency of EC use and nicotine content of e‐liquids used/day. Dual use was defined as using at least one cigarette per day while also using EC. Findings A total of 2836 respondents reported exclusive EC use and 353 reported being dual users. Backward stepwise logistic regression showed that dual users had higher estimated combined daily nicotine intake from e‐liquids and cigarettes [estimate: 2.14, standard error (SE) = 0.26, adjusted odds ratio (aOR) = 8.48, 95% confidence interval (CI) = 5.11–14.09, P < 0.001], but lower daily nicotine intake from EC (estimate: –2.14, SE = 0.26, aOR = 0.12, CI = 0.07–0.196, P < 0.001) and reported fewer months of EC use (estimate: −0.31, SE = 0.14, aOR = 0.73, CI = 0.56–0.95, P = 0.022) compared with exclusive EC users. Conclusion Dual e‐cigarette users in France may have higher nicotine intake overall than exclusive e‐cigarette users, but they may take in less nicotine from their e‐cigarettes.

Dual use of e-cigarettes with conventional tobacco is associated with increased sleep latency in cross-sectional Study

“…Historically, conventional tobacco use is known to cause both cough and increased sleep latency 34 , 35 . Dual users have been found to have higher levels of nicotine exposure relative to use of either inhalant alone 10 , and the increased time to fall asleep may be directly due to the activating effects of nicotine in the central nervous system (CNS). It is also possible, however, that the higher incidence of cough may alone result in the longer sleep latency found in this cohort 36 .…”

“…As dual users reported the highest use of drugs such as cocaine and methamphetamine relative to all other groups, the gateway hypothesis may be a possible explanation 42 . Since dual users have been found to have higher levels of nicotine exposure 10 , it is possible that dual use may create an increased priming effect for drug use and increased facilitation of stimulant addiction compared to sole inhalant use of tobacco or e-cigarettes. Another explanation may be that dual users believe that other drugs are either less risky or more pleasurable than e-cigarettes and conventional tobacco.…”

“…We previously completed a small pilot study (274 participants) which suggested that women who smoked both conventional tobacco products and vaped e-cigarettes (dual users) had a significant decrease in their sleep quality 9 . Since dual users may intake greater quantities of nicotine than sole users of conventional tobacco or e-cigarettes 10 we hypothesized that nicotine may have been the driving factor in our 2019 findings of diminished sleep quality in women who were dual users 11 . Moreover, women are known to have different susceptibilities to tobacco in comparison to men 12 , such as greater nicotine withdrawal-related distress and a greater urge to smoke to relieve this stress, which can cause further sleep disruptions 13 .…”

Dual Use of E-Cigarettes with Conventional Tobacco is Associated with Increased Sleep Latency

“…Historically, conventional tobacco is well known to cause both cough and increased sleep latency (20,21). As dual users have been found to have higher levels of nicotine exposure relative to use of either inhalant alone (22), the increased time to fall asleep may be directly due to the activating effects of nicotine in the central nervous system (CNS). It is also possible that the higher incidence of bothersome cough may itself result in longer sleep latency.…”

Do the associations between the use of electronic cigarettes and smoking reduction or cessation attempt persist after several years of use? Longitudinal analyses in smokers of the CONSTANCES cohort

“…These battery-powered devices vaporize a glycerol and propylene glycol-based liquid with or without nicotine at various concentrations and different flavors and are believed to be less toxic than conventional cigarettes. Electronic cigarettes are now used more frequently than pharmacological treatments to quit smoking in some countries (Adkison, et al, 2013;Adriaens, Van Gucht, Declerck, & Baeyens, 2014;Berlin, Nalpas, Targhetta, & Perney, 2019;Etter, 2010;Hartmann-Boyce, Begh, & Aveyard, 2018). In adult smokers, the use of electronic cigarettes is associated with a decreased number of cigarettes consumed per day and an increased likelihood of cessation attempt at follow-up in both randomized controlled studies (Adriaens, et al, 2014;Bullen, et al, 2013; S. H. Lee, Ahn, & Cheong, 2019;O'Brien, Knight-West, Walker, Parag, & Bullen, 2015) and observational studies (Brose, Hitchman, Brown, West, & McNeill, 2015;Etter & Bullen, 2014;Gomajee, et al, 2019), with a duration of follow-up ranging from 6 to 24 months.…”