Former smokers who quit tobacco within the last five years are likely to use e-cigarettes, while vaping is rare among those who quit more than a decade ago, reveal the findings of research published online in the journal Tobacco Control.
The authors say their findings suggest that today's smokers who want to quit are using e-cigarettes as an aid whereas in the past quitters had to rely on other smoking cessation aids, so few long-standing quitters have tried e-cigarettes.
And it appears that smokers find e-cigarettes a useful and effective quitting aid, as current users of e-cigarettes are more likely to be recent quitters than non-users, and some successful quitters then stop using e-cigarettes.
As e-cigarettes are consumer products and are generally used without medical supervision or support, there have been concerns that vaping may become an adjunct or replacement for smoking tobacco products. Numerous studies have tried to determine whether e-cigarettes help smokers quit, but they have produced conflicting results.
To gain a better understanding of e-cigarette use by current and former smokers, researchers accessed data on 13,057 people (6904 current and 6153 former smokers) from 28 member states who were interviewed face-to-face about their tobacco and e-cigarette use for a special 2017 Eurobarometer cross-sectional survey.
Eurobarometer surveys are performed regularly at the request of the European Commission to measure population attitudes on different issues in EU member states.
Current daily e-cigarette use was reported by 2.4% of current and 3.3% of former smokers interviewed, while former daily use was reported by 5.6% and 1.9% respectively.
A previous Eurobarometer survey in 2014 suggested that use of e-cigarettes was inhibiting rather than assisting in smoking cessation, as it found that compared with no current or previous e-cigarette use, daily e-cigarette use was negatively associated with being a former smoker. However, unlike the 2017 survey, the 2014 survey did not take into account when interviewees had quit smoking.
In the 2017 survey, more than half of all former smokers had quit more than 10 years ago and current daily e-cigarette use was rare among this group, at only 0.2%.
Among former smokers, e-cigarette use was most prevalent in those who had quit in the last two years (12.9%) followed by those who had quit between three and five years ago (9%).
E-cigarettes also appeared to be helping smokers quit successfully, as current regular e-cigarette use was associated with being a recent quitter. Compared with interviewees who had never used e-cigarettes, current e-cigarette users were almost five times more likely to have quit smoking within the last two years and over three times more likely to have quit smoking between three and five years ago.
Former daily e-cigarette use was associated with quitting smoking within the last two years which suggested that some successful quitters were then also giving up e-cigarettes.
However, current daily e-cigarette use was negatively associated with being a former smoker who quit more than five years ago, and the authors acknowledge that some former and current smokers who use or have used e-cigarettes do not see them as a quitting aid.
This is an observational study, so can't establish cause. Limitations of the study include that interviewees self-reported their use of e-cigarettes, smoking status and time since quitting. Also no data were gathered on participants' motivation to quit, the types of e-cigarette devices they used, or whether any additional smoking cessation methods were employed, all of which may have impacted on quitting success.
The authors conclude that current daily e-cigarette use was strongly associated with recent (5 or fewer years) smoking cessation in the study of current and former smokers in EU member states.
"Former daily e-cigarette use was positively associated with smoking cessation of 2 or fewer years indicating that some smokers may have quit with e-cigarettes and then quit e-cigarette use too," they write.
"Duration of smoking cessation was a major determinant in understanding the complex interaction between smoking and e-cigarette use," they add, "and this parameter may be important in examining the impact of e-cigarettes in future population studies."
Peer reviewed? Yes
Evidence type: Observational
Subject: EU citizens