E-cigarette use linked to increased risk of smoking relapse among those who quit cigarettes and nicotine
Findings from one study suggested that clinicians treating patients who formerly smoked and who have successfully quit all nicotine products should discourage use of electronic nicotine delivery systems, the authors concluded.
In patients who formerly smoked and who have successfully quit smoking without continuing to use nicotine, later use of electronic nicotine delivery systems (ENDS) may increase the risk of smoking relapse, a study found.
Researchers used data from the Population Assessment of Tobacco and Health (PATH) Study, a longitudinal study that evaluated smoking-related behaviors in a nationally representative cohort of individuals with four periodic evaluations over time from December 2013 to March 2018, to assess the association of ENDS use with cigarette smoking relapse among adult patients in the U.S. who formerly smoked cigarettes and used no tobacco products at the beginning of the study. Participants were separated into recent former smokers (last smoked within the past 12 months) and long-term former smokers (last smoked more than 12 months previously). The main outcome was self-reported current (every day or some days) use of cigarettes at follow-up interviews. Results were published on June 5 by JAMA Network Open.
Overall, 51.8% of participants were women, 65.0% were older than age 50 years, and 79.5% were of non-Hispanic white ethnicity. Among 304 patients in the recent group, those who used ENDS had an increased risk of cigarette smoking relapse compared with those who did not (adjusted hazard ratio [HR], 1.63; 95% CI, 1.04 to 2.53). Among 1,554 patients in the long-term group, the adjusted hazard ratio for smoking relapse was 3.79 (95% CI, 1.75 to 8.20) for those who used ENDS compared with those who did not. Similarly, use of other tobacco products (e.g., cigars, pipe tobacco, hookah, snus tobacco, other smokeless tobacco, and dissolvable tobacco) was associated with a significantly increased risk for cigarette smoking relapse among the recent group (adjusted HR, 1.97; 95% CI, 1.27 to 3.05) and the long-term group (adjusted HR, 3.82; 95% CI, 1.91 to 7.66).
One limitation of the study was that it did not assess the associations between cigarette smoking relapse and different ENDS devices, different e-liquid nicotine levels, or frequency of ENDS use, the study authors noted. They added that the PATH Study protocol was to conduct follow-up interviews with each participant near the first anniversary of his or her participation in the previous wave, and more frequent follow-up times would have increased the granularity of the data.
“For the many clinicians treating former smokers who have successfully quit all nicotine products, the implications are that use of ENDS products should be discouraged, just as use of all other tobacco products is discouraged,” the study authors concluded.
Still, too little is known about the effects of e-cigarettes to make definitive judgments, noted an editorial accompanying the study and two others on the same subject in JAMA Network Open. While the studies add to other evidence suggesting that e-cigarettes will not be the ultimate answer to the smoking pandemic, e-cigarettes could, along with other strategies, play a role in the effort to mitigate the harms of smoking, the editorialists said.
“We should all remember (including the authors of this Editorial), as we write and make pronouncements about e-cigarettes, that as the tide of our ignorance ebbs, we will someday have a much more accurate appraisal of their harms and benefits,” they wrote.