People who use both vapes and cigarettes are less likely to quit compared to those who smoke or vape exclusively, according to a new study. Over time, many of these ‘dual users’ are likely to revert back to smoking cigarettes, undermining the notion that vaping can be a viable alternative for quitting smoking.
The new study, led by Josef Hamoud from the University Medical Center Göttingen in Germany, has revealed that adopting vaping while still smoking rarely leads to cessation. The researchers argue that their results imply that starting to vape while continuing to smoke is likely ineffective in aiding individuals to quit smoking.
The research, conducted by scholars from Germany, the USA, and Denmark, was led by Josef Hamoud from the University Medical Center Göttingen, Germany.
This study is a systematic review and meta-analysis, meaning that the researchers assessed all available studies regarding individuals who use both vapes and cigarettes and compiled the data into a single study.
“Vaping has become widespread among adolescents and adults worldwide. Given the extensive marketing of vapes as healthier alternatives to conventional smoking, they have gained popularity among people trying to quit smoking. Some people are using them in addition to their conventional cigarettes, classifying them as dual users,” Mr Hamoud said. “There is still a lot we don’t know about the long-term health effects of vaping. However, credible studies have already delivered concerning results indicating that dual use might be even more harmful than conventional smoking.”
This comprehensive review consolidates findings from 16 individual studies examining the behaviors of dual users—those who both smoke cigarettes and vape—and their paths over time regarding quitting, transitioning to exclusive vaping, returning to smoking, or persisting in dual use.
The analysis includes data from up to 9,337 individuals, of which 2,432 are identified as dual users. When researchers evaluated dual users against those who either solely smoked cigarettes or solely vaped, they discovered that dual users had a lower likelihood of achieving total cessation.
Over time, the analysis indicated that a significant number of dual users reverted back to traditional cigarette smoking. The statistics are striking; only 3% of dual users quit completely within four to eight months, rising to just 5% by eight to 16 months. By 16 to 24 months, this figure climbs to 13%, and after 24 to 48 months, it reaches 24%.
In a compelling analysis of user behavior over time, it was found that 30% of dual users transitioned to cigarette use only within the first four to eight months. This trend continued to escalate significantly, with 47% making the switch between eight and 16 months, 58% between 16 and 24 months, and still a notable 55% after 24 to 48 months.
When we combine those who continued to use both vapes and cigarettes with those who shifted entirely to smoking, the overall proportion of cigarette users fluctuated between a striking 90% and 63%. The study also highlights that in the medium term (eight to 16 months), 38% of dual users were still utilizing both vapes and cigarettes.
“This cannot be considered a simple ‘transitional state,’ but rather a risk for prolonged double exposure,” Mr. Hamoud said.
He continued: “Given these findings, we believe that dual use might prove to be a major hindrance in achieving smoking abstinence, and this practice should not be recommended for treating nicotine addiction. In addition, while long-term health effects of vapes need to be studied further, the double exposure to large amounts of nicotine and toxicants from both conventional cigarettes and vapes is a great concern for public health.”
According to the researchers, the combination of multiple studies, each employing a slightly varied methodology, made it impossible to classify the different forms of dual use, such as individuals who primarily smoke but occasionally use vape products.
Mr Hamoud added: “While it may have been argued that heavy smokers might benefit from dual use by reducing their daily cigarette consumption, the high nicotine content of vapes adds to the risk of continued nicotine addiction. Future studies must further stratify dual-use groups to investigate the health implications over time.”
“We know that vaping is commonplace and that many people use e-cigarettes as well as cigarettes, often in the hopes of cutting down on smoking or quitting the habit. This large study examined all existing evidence on dual users, and it showed that, for most people, this is not a stepping stone to quitting,” said Dr. Filippos Filippidis, Chair of the European Respiratory Society Tobacco Control Committee, a reader in public health at Imperial College London, UK, and was not involved in the research.
“Nicotine in vapes is highly addictive, so we need to do all we can to discourage non-smokers from starting to vape. E-cigarettes may have a role in smoking cessation for some people, but we need to make sure appropriate support is freely available to help people quit, as it’s clear that many end up being dual users, which can actually undermine smoking cessation attempts.”
Journal reference:
- Josef Hamoud, Reiner Hanewinkel, Stefan Andreas. A Systematic Review Investigating the Impact of Dual Use of E-Cigarettes and Conventional Cigarettes on Smoking Cessation. ERJ Open Research, 2024; DOI: 10.1183/23120541.00902-2024
