Research published in JAMA Network Open indicates that most adults in the United States who use e-cigarettes would like to stop, and that former smokers – who most likely took up vaping to help quit smoking – have the strongest motivation to cease vaping too, writes John Gever, Managing Editor of MedPage Today.
Federal survey data indicated that while most adults who reported using e-cigarettes indicated that they would like to stop, but ratings of the strength of intention varied by their past histories with tobacco and, in general, were not especially high.
Among 1,988 self-identified e-cigarette users in wave 4 (conducted 2016-2018) of the Population Assessment of Tobacco and Health (PATH) survey, 1,194 (60.1%) said they planned to quit, according to Dr Amanda M Palmer of the Medical University of South Carolina in Charleston, and colleagues.
But respondents' mean “level of interest in quitting”, which they ranked on a 10-point scale (with 10 the strongest), was just 3.9 overall (95% CI 3.8-4.1), Palmer's group reported in a JAMA Network Open research letter.
Moreover, says the MedPage Today story published on 2 April 2021, plans to quit and strength of intention were most pronounced in e-cigarette users who had quit conventional smoking, and less so in those who had never smoked or were currently both vaping and smoking regular cigarettes:
- Never smokers: 55.4% wanting to quit, mean 3.8 strength of intention
- Former smokers: 66.1%, 4.2, respectively
- Dual users: 59.0%, 3.8, respectively
These differences were not statistically significant, however.
Respondents' demographics were as expected for e-cigarette users, with men and people younger than 35 predominating.
The PATH survey also asked participants about the number of previous quit attempts in the past year, and those data showed a different trend. Never smokers reported the most recent quit attempts – mean 3.0 – compared to 2.5 for former smokers and 2.1 for dual users.
Palmer and colleagues said the overall finding supported the idea that former smokers – who most likely took up vaping as a smoking-cessation tool – would have the strongest motivation to quit e-cigarettes too.
"Results suggest that dual users and never smokers are somewhat less inclined to consider stopping e-cigarettes, which may be related to health and/or risk perceptions of vaping," the researchers added, continues John Gever for MedPage Today.
Overall, Palmer and colleagues saw "an urgent need for development of interventions to help individuals quit vaping, regardless of their cigarette smoking status."
The group noted an important limitation to the analysis, aside from the expected biases from self-reported data: respondents' "anticipated timeframe for discontinuing e-cigarettes is unknown",
Study details
Research Letter – Interest in Quitting e-Cigarettes Among Adult e-Cigarette Users With and Without Cigarette Smoking History
Amanda M Palmer, Tracy T Smith, Georges J Nahhas et al, Alana M Rojewski, Brandon T Sanford, Matthew J Carpenter and Benjamin A Toll
Author Affiliations: Medical University of South Carolina in Charleston, United States.
Published in JAMA Network Open o 2 April 2021
Introduction
Approximately 2.8% to 3.2% of US adults are current e-cigarette users, with a majority being current cigarette smokers or former cigarette smokers.
The most common use for e-cigarettes is to quit smoking, but e-cigarette use may continue even after discontinuation of combustible cigarettes. Furthermore, those who initiate e-cigarettes to quit smoking may not be successful, leading to dual use of both tobacco cigarettes and e-cigarettes, which increases potential health harms.
Previous studies have shown that people who use e-cigarettes, also called vaping, are interested in quitting. No published randomised clinical trials for e-cigarette discontinuation exist, and evidence on how to aid e-cigarette users in stopping is limited.
It is important to understand interest in quitting among e-cigarette users, including dual users. The purpose of this study was to provide the most up-to-date estimate of interest in e-cigarette discontinuation among US adults.
Methods
Data were collected as a part of the Population Assessment of Tobacco and Health (PATH) Wave 4 adult cohort (December 2016 – January 2018), a comprehensive, publicly available longitudinal US survey approved by the Westat institutional review board.
Participants provided written informed consent. This survey study follows the American Association for Public Opinion Research (AAPOR) reporting guideline.
Outcomes of interest included: (1) those who attempted to quit e-cigarettes in the past 12 months, (2) those who plan to eventually quit e-cigarettes, and (3) level of interest in quitting (measured by a scale of 1 to 10, with higher scores indicating a higher interest in quitting).
Those who endorsed a quit attempt were asked how many attempts had been made in the past 12 months. Balanced repeated replication weighting procedures were used for analyses, completed on SAS version 9.4 (SAS Institute) from October to November 2020. χ2 tests examined differences in prevalence for dichotomous outcomes, and t tests examined continuous outcomes with a 2-tailed significance threshold of P < .05.
Results
Of the 30,191 adults who completed the survey, 1,988 (6.5%) were identified as established e-cigarette users (every day or some days for more than 30 days.
Among the analysed sample of 1,988 e-cigarette users, 1,332 (59%) were male, 1384 (75%) were non-Hispanic White, 1,189 (59%) had income less than $50 000 (representing lower levels of median income and educational attainment), and most were aged 44 years or younger (aged 18-24 years: 128 participants [17.9%; 95% CI, 14.8%-21.0%]; aged 25-34 years: 75 participants [14.1%; 95% CI, 9.7%-18.5%]; aged 35-44 years: 42 participants [12.3%; 95% CI, 8.4%-16.2%]).
Of the established e-cigarette users, dual users were identified as concurrent established cigarette smokers who smoked every day or some days for more than 30 days (1,053 participants [53.56%]); former cigarette smokers, as those who had quit smoking more than 30 days ago (540 participants [31.0%]); and never cigarette smokers, as those who denied smoking (371 participants [14.5%]).
Within the full sample, 302 participants (15.2%) endorsed having made a past-year quit attempt and 1208 participants (60.7%) endorsed future plans to quit e-cigarettes.
Dual users, former smokers, and never smokers differed in rates of attempting to quit in the past 12 months and plans to quit in the future.
Never smokers endorsed the highest rates of past quit attempts (69 never smokers [20.9%]; 95% CI, 15.2%-26.6% vs 177 dual users [15.3%]; 95% CI, 12.8%-17.8% vs 52 former cigarette smokers [7.9%]; 95% CI, 5.2%-10.7%; P < .001), whereas former smokers represented the highest proportion of participants planning to quit (357 former cigarette smokers [66.1%]; 95% CI, 60.4%-71.8% vs 624 dual users [59.0%]; 95% CI, 55.2%-62.8% vs 213 never cigarette smokers [55.4%]; 95% CI, 49.2%-61.6%; P = .02).
Although the differences were not statistically significant, former cigarette smokers rated higher interest in quitting compared with other groups (former cigarette smokers’ mean [95% CI] level of interest in quitting: 4.2 [3.9-4.4] vs dual users: 3.8 [3.6-4.0]; P = .06; and vs never cigarette smokers: 3.8 [3.4-4.1]; P = .09).
Of those who tried to quit, no group differences were found regarding number of quit attempts.
Discussion
A majority of e-cigarette users expressed interest in eventually quitting vaping. Not surprisingly, since e-cigarette use is often initiated to quit cigarettes, former cigarette smokers had the highest levels of intention to quit and interest in quitting vaping.
Results suggest that dual users and never smokers are somewhat less inclined to consider stopping e-cigarettes, which may be related to health and/or risk perceptions of vaping. These groups also endorsed higher rates of failed attempts to quit vaping, suggesting difficulties in stopping use.
A limitation of the present analysis is that the anticipated timeframe for discontinuing e-cigarettes is unknown.
There is an urgent need for development of interventions to help individuals quit vaping, regardless of their cigarette smoking status. Future research should also continue to monitor characteristics of e-cigarette users interested in quitting.
Medpage Today story – Many E-Cig Users Want to Quit (Open access)
SEE ALSO FROM MEDICALBRIEF’S ARCHIVES
WHO versus Public Health England over e-cigarettes
The health pros and cons of e-cigarettes – Evidence ambivalence
Australian GPs willing to prescribe e-cigarettes to help patients quit
JAMA editorial: Research strengthens case for e-cigarettes for smoking cessation
Oxford review: E-cigarettes versus traditional nicotine replacement therapies