How Does Smoking and Nicotine Dependence Change After Onset of Vaping? A Retrospective Analysis of Dual Users

Abstract

Introduction Although some smokers switch to exclusive use of electronic cigarettes (e-cigarettes), others become dual users of combustible cigarettes and e-cigarettes. Little is known about how the onset of vaping affects the use of and dependence on combustible cigarettes or total nicotine use and dependence, which may influence health-related and cessation outcomes. Using self-report data of current combustible and e-cigarette use and retrospective recall of pre-vaping smoking in a sample of dual users, the aims of this study were (1) to compare pre- and post-vaping number of cigarettes per day and combustible cigarette dependence; (2) to compare pre- and post-vaping total nicotine use frequency (number of vaping sessions and cigarettes smoked per day), and total nicotine dependence; and (3) to examine predictors of nicotine dependence. Methods We used baseline data from a smoking cessation trial with 2896 dual users. Nicotine use frequency and the Heaviness of Smoking Index were used as measures of nicotine use and dependence, respectively. Results Participants decreased cigarettes/day from pre- (M = 19.24, SD = 9.01) to post-vaping (M = 11.15, SD = 8.02, p < .0001) and combustible cigarette dependence declined from pre- (M = 3.55, SD = 1.51) to post-vaping (M = 2.11, SD = 1.60, p < .0001). Total daily nicotine use frequency increased after initiating vaping (M = 19.25, SD = 9.01 vs. M = 29.46, SD = 8.61; p < .0001), as did total nicotine dependence (M = 3.55, SD = 1.51 vs. M = 4.68, SD = 1.38; p < .0001). Hierarchical regression analyses indicated that variables associated with greater overall nicotine dependence included: younger age, lower education, more years smoking, higher pre-vaping nicotine dependence, using e-cigarettes more days per month, more puffs per vaping session, higher e-liquid nicotine concentration, and longer vaping history. Conclusions Dual use leads to a reduction in the number of combustible cigarettes, but total nicotine use and dependence increases. Implications In dual users, a reduction in smoking following onset of vaping may offer some harm reduction via reduction in cigarette intake. However, the increase in total nicotine use and dependence could affect the ability to quit either or both products.

Type of e-liquid vaped, poly-nicotine use and nicotine dependence symptoms in young adult e-cigarette users: a descriptive study

“…Mirroring the prevalence in Canada and consistent with extant studies [1,4,38], 19% of young adults in this study had used e-cigarettes in the past year, including relatively more males than females. Also concordant with previous reports [1,4,24,25], most e-cigarette users smoked conventional cigarettes and two-thirds reported ND symptoms, with the proportion increasing to 80% among those who vaped nicotine-containing eliquid exclusively. Only one-quarter of cigarette users had used e-cigarettes to quit in the past year.…”

“…A US report using nationally representative data found that only 13% of young adult lifetime e-cigarette users reported using e-cigarettes as a cessation aid and these individuals were less likely to report cessation in the pastyear [56]. It is possible that, because of nicotine in ecigarettes (even in e-cigarettes labelled nicotine-free [53]), young adults who try to quit using nicotinecontaining e-cigarettes in fact contribute to or increase their ND level [25] leaving them craving nicotine. Polytobacco users in general, are more likely to report ND symptoms than cigarette-only smokers [25,57].…”

“…It is possible that, because of nicotine in ecigarettes (even in e-cigarettes labelled nicotine-free [53]), young adults who try to quit using nicotinecontaining e-cigarettes in fact contribute to or increase their ND level [25] leaving them craving nicotine. Polytobacco users in general, are more likely to report ND symptoms than cigarette-only smokers [25,57]. One hypothesis posits that e-cigarette users could decrease the number of cigarettes smoked because e-cigarettes deliver nicotine at similar rates, making them as or more satisfying than traditional nicotine replacement therapies, but contributing more to ND and sustained smoking [25].…”

“…We add poly-nicotine use (i.e., use of multiple nicotine-containing substances concurrently) to this list. Poly-nicotine use is common in young people [1,4,24,25]; it is estimated that only 1.4% of U.S. adults are sole e-cigarette users [26].…”

Usage of Electronic Cigarette and its Effects on Health

“…35 Martinez ve ark.nın yaptığı retrospektif bir analizde, geleneksel sigara kullanımı ve E-sigaranın birlikte kullanımının (ikili kullanım) zamanla geleneksel sigara kullanımını azalttığı, ancak toplam nikotin kullanımı ve bağımlılığı artırdığı bulunmuştur. 66 Kulik ve ark.nın 2018 yılında, 28 Avrupa Birliği ülkesi ile Büyük Britanya'da yaptıkları kesitsel bir araştırmada, ikili kullanıcıların sadece geleneksel sigara kullanıcılarına göre, günlük olarak önemli ölçüde daha fazla sigara kullandığı rapor edilmiştir. 67 Literatürde bildirilen çalışma so-nuçları dikkate alındığında; E-sigaraların içerdiği nikotin nedeni ile bağımlılığı sürdüreceği ve dolayısı ile geleneksel sigara kullananlarda sigarayı bırakmayı zorlaştıracağı, hiç kullanmayanlarda ise kademeli olarak geleneksel sigara kullanımına yol açacağı bildirilmektedir.…”