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More frequent use of e-cigarettes was associated with higher rates of quitting traditional, combustible cigarettes, a national cohort study revealed.

Daily vapers quit smoking more than twice as much as non-daily vapers (12.8% vs 6.1%; adjusted OR 2.26, 95% CI 1.34-3.81) and attempted it three times more often (aOR 3.12, 95% CI 2.42-4.02), reported Karin A. Kasza, PhD, of the Roswell Park Comprehensive Cancer Center in Buffalo, New York, and coauthors.

Cigarette discontinuation among e-cigarette users rose in recent years, more than doubling to 12% in 2019-2021 as compared with 5.3% from 2014-2016 (aOR 2.75, 95% CI 1.13-6.67), according to the study published in .

"Our findings suggest that e-cigarette public health decisions should be based on data from e-cigarettes marketed in recent years that have evolved outside the regulated market and that randomized clinical trials are warranted using these products," the group wrote.

Notably, mint and menthol flavors were associated with higher overall cigarette discontinuation rates compared to tobacco-flavored products, at 9.2% versus 4.7% (aOR 2.63, 95% CI 1.32-5.27). E-cigarette flavors have been a contentious issue, with regulators and public health advocacy organizations arguing that these increase appeal to youth and promote addiction to nicotine, though the FDA last month allowed marketing of the first such products.

The new study findings follow on the heels of a from the Substance Abuse and Mental Health Services Administration (SAMHSA) showing growing numbers of e-cigarette users. Last year, 9.4% of individuals ages 12 years and above reported vaping nicotine within the previous month, up from 8.3% in 2022.

In that same vein, 5.9 million people began vaping, bringing the total use of tobacco products among those 12 and older to 64.4 million. Cigarette use was reported among 38.7 million. More people began vaping in 2023 than initiated alcohol or illicit substances.

E-cigarettes have been gaining attention for their possible use as a smoking cessation aid, with clinical trials indicating that they outperform standard counseling measures and might be comparable to varenicline (Chantix), widely considered the top smoking cessation medication.

U.S. Surgeon General Vivek Murthy, MD, MBA, also highlighted that vaping "could be a major form of harm reduction for adults," although "not zero risk," but expressed strong concern over youth vaping.

Kasza's group also pointed to dual use of cigarettes and e-cigarettes, which has increased over time and usually involves smoking cigarettes more frequently than using e-cigarettes. "Individuals who dual use remain exposed to cigarette smoking toxicants, making complete rather than partial substitution of cigarettes with e-cigarettes important for risk reduction," they wrote. "Indeed, healthcare clinicians are now encouraged to discuss e-cigarettes as a cessation tool with patients who smoke cigarettes and have already tried FDA-approved cessation medications."

The study featured 1,985 participants; 49.4% were male and the average age was 40. The patient population was 80.7% white, 11.4% Black, 9.2% Hispanic, and 8% of another race.

Data were taken from the nationally representative Population Assessment of Tobacco and Health Study (PATH), which assessed participants through audio-based, computer-assisted self-interviews in English or Spanish. Interviews were conducted in "waves" -- October 2014 to October 2015, October 2015 to October 2016, December 2016 to January 2018, and December 2018 to November 2019. The last wave analyzed took place during the COVID-19 pandemic in March to November 2021 and was administered via audio computer-assisted self-interviews and telephone interviews.

Participants were asked about how frequently they used e-cigarettes and, for those who reported use, what flavor they typically used. Questions also asked for information regarding the use of rechargeable devices and associated cartridges. Participants also reported their attempts to quit smoking within the previous year, their daily cigarette use, and the cigarette flavors smoked.

Individuals included from the PATH study were 21 years and older daily cigarette smokers and reported any use of e-cigarettes within the previous 30 days.

Cessation rates for adults trying to quit smoking were 35.6% in 2019-2021 and 16.6% in 2014-2016 (aOR 3.32, 95% CI 1.36-8.10). In this model, no differences in cigarette cessation were observed based on the type or flavor of e-cigarette device used at baseline.

Adjusted analyses revealed that the type of e-cigarette device used played no role in the rates of cigarette discontinuation.

Researchers noted that they were unable to assess any association between e-cigarette nicotine formulation and cigarette cessation outcomes. Another potential limitation was that the study only included adult participants who reported smoking within the previous 30 days, limiting information about younger smokers and former smokers.

"Relatedly, frequent e-cigarette use may be an indicator of the process of quitting rather than an independent factor associated with quitting," the group wrote. "Such a distinction is important to consider from policy and practice standpoints, where promoting daily use of e-cigarettes may not be effective in encouraging quitting if daily use is part of the process of quitting."

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