November 21, 2024

expert reaction to use of ecigs among ex-smokers in England, as published in BMC Medicine

A study published in BMC Medicine looks at the use of e-cigarettes among ex-smokers in England. 

Dr Jasmine Khouja, Senior Research Associate in the Tobacco and Alcohol Research Group, University of Bristol, said:

“This study uses information from the Smoking Toolkit Study to show that the number of people who have stopped smoking and vape instead has increased since 2013. This is good news for some, but potentially bad news for others. On one hand, the results indicate that people who use e-cigarettes to stop smoking are often using them for more than a year to help them stay smoke-free. On the other hand, there is a small proportion of people who gave up smoking 14 or more years ago and likely did not use e-cigarettes to help them stop smoking that have recently taken up vaping. These people could have been tempted to use nicotine again by new products like disposable vapes. However, after a pandemic and financial crisis in the UK, some of these people may have felt the urge to start smoking again and may have taken up vapes instead. There are lots of possible reasons for the increase and further research is needed to explore why these individuals might start vaping after being smoke-free for so long.”

Prof Caitlin Notley, Professor of Addiction Sciences at the University of East Anglia, said:

“This paper uses robust methods and pre-registered analysis of a major general population dataset on smoking, vaping and nicotine use in England. It shows that prevalence of vaping has increased substantially among adult ex-smokers over the past decade. This is likely to have been partly driven by increases in people using vapes as a smoking cessation aid and continuing to vape, but there was also evidence of increased uptake of vaping among those who had been abstinent from smoking for many years.

“The increased rates of vaping by ex-smokers and long-term ex-smokers may be partly attributable to disposable nicotine vapes. The study shows that more people used a vape in a quit attempt at the time disposable vapes became widely available and increased in popularity. This suggests that not only were young people experimenting with disposables, but adults were using them in quit attempts too. A product that we may wish to discourage young people using was, conversely, proving highly popular in adult smoking quit attempts. This paradox suggests that policy and regulation must carefully balance the desire to protect youth from using nicotine products with the urgent public health need to support adults smoking tobacco to quit smoking at the earliest opportunity.

“The reported increase in current vaping among recent ex-smokers suggests that vaping not only has supported people in their quit attempts, but is, for some, a continued behaviour and may be considered a relapse prevention tool. Of course, people may decide to quit vaping eventually and should be supported to do so, but we must not be too keen to promote vaping cessation which may risk tobacco smoking relapse for those that are not ready to fully quit using nicotine.

“Perhaps more surprisingly, the study also reports increased vaping amongst long term ex-smokers (of more than 14 years). This may be concerning to those who advocate for a society free from nicotine use. However, if we theorise about why this might be there are plausible explanations. From a behavioural perspective, past smoking may have strong associative ties to alcohol use or certain social situations. In those situations, a residual desire to smoke may be experienced, even by long term ex-smokers. It is perhaps encouraging that ex-smokers, given powerful behavioural and social cues to smoke, instead turned to nicotine vapes as a reduced harm alternative to tobacco.

“This study highlights that more research is needed to better understand the extent to which vaping either increases or reduces the risk of relapse to tobacco smoking (both among ex-smokers who vape continuously from the point of a successful quit attempt and among those who take up vaping after quitting smoking some time ago). Current UK policy focus is clearly on prevention and cessation, but preventing relapse is an important target that also impacts population health, and should not be forgotten.”

‘Prevalence and uptake of vaping among people who have quit smoking: a population study in England, 2013‑2024’ by name of Sarah E. Jackson et al. was published in BMC Medicine at 1am UK time on Thursday 21 November. 

DOI: https://doi.org/10.1186/s12916-024-03723-2

Declared interests

Caitlin Notley: “No conflicts of interest to declare.”

Jasmine Khouja: “I have no relevant declarations of interest.”