Some studies have suggested switching to e-cigarettes could help smokers stay away from regular cigarettes, which generally contain more harmful chemicals when burned. But new research shows the opposite effect.
People who quit smoking and switched to another form of tobacco use, including e-cigarettes, were more likely to relapse to regular cigarettes a year later than those who quit altogether by 8.5 percentage points, according to data from the Population Assessment of Tobacco and Health study conducted by the National Institute on Drug Abuse and the U.S. Food and Drug Administration Center for Tobacco Products.
Researchers followed 13,604 smokers identified between 2013 and 2015 for two years in which participants completed surveys about their use of 12 different tobacco products, such as cigars, pipes and hookah.
The study was published Oct. 19 in the journal JAMA Network Open.
“This is the first study to take a deep look at whether switching to a less harmful nicotine source can be maintained over time without relapsing to cigarette smoking,” study first author Dr. John Pierce, a professor emeritus in the department of family medicine and public health at the University of California San Diego, said in a news release.
“If switching to e-cigarettes was a viable way to quit cigarette smoking, then those who switched to e-cigarettes should have much lower relapse rates to cigarette smoking,” Pierce said. “We found no evidence of this.”
Among people who quit using all tobacco products, 50% were successful at staying away from regular cigarettes by the second follow-up with researchers a year later.
However, fewer people (41.5%) who initially quit then switched to another method such as e-cigarettes were able to refrain from returning to regular cigarettes. These adults were more likely to be white and have higher incomes and tobacco dependence, the researchers found.
They were also more likely to view e-cigarettes as a healthier alternative to regular cigarettes.
E-cigarettes are still relatively new, so scientists are continuing to learn more about any long-term health effects they may cause, the Centers for Disease Control and Prevention says.
They do contain fewer harmful chemicals than regular cigarettes, but the CDC notes e-cigarette aerosols can carry cancer-causing chemicals and “tiny particles that reach deep into the lungs.” E-cigarettes also contain nicotine, which is highly addictive.
Newer models of e-cigarettes use nicotine salts that allow higher levels of the substance to be inhaled with less throat irritation. Experts say the feature could increase nicotine dependence in some people and lead others, particularly teens and young adults, to try smoking for the first time.
Vitamin E acetate — a specific additive in some e-cigarettes, mostly those that carry the psychoactive ingredient in marijuana called THC — “is strongly linked” to outbreaks of “e-cigarette, or vaping, product use-associated lung injury,” or EVALI, which peaked in September 2019.
The additive typically does not harm people when consumed as a vitamin supplement or rubbed on skin, but it can disrupt lung function when inhaled, the CDC says.
Researchers of the new study say a third follow-up survey is needed to better understand if switching from regular to e-cigarettes and back again is a “pattern of chronic quitting and relapsing to cigarette smoking, or whether it is part of progress toward successful quitting.”