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Combustible cigarette smokers are now more likely to quit if they start on e-cigarettes, a trend not seen a decade ago, according to longitudinal data from adults in the Population Assessment of Tobacco and Health (PATH) study.

Between 2016-2017 and 2018-2019, 20.1% of adult smokers who used electronic nicotine delivery systems discontinued cigarette smoking at follow-up compared with 16.5% of those who did not use e-cigarettes (P<0.05), reported Karin Kasza, PhD, of Roswell Park Comprehensive Cancer Center in Buffalo, New York, and co-authors.

This trend continued between 2018-2019 to 2021, with 30.9% of those who used e-cigarettes discontinuing cigarette smoking at follow-up compared with 20% of those who did not use e-cigarettes (P<0.001), they detailed in .

Of note, between 2013 and 2016, rates of discontinuing cigarette smoking among U.S. adults were almost identical between those who used e-cigarettes, at 15.5%, and those who did not, at 15.6%.

"Our findings here suggest that the times have changed when it comes to vaping and smoking cessation for adults in the U.S.," said Kasza in a . "While our study doesn't give the answers as to why vaping is associated with cigarette quitting in the population today when it wasn't associated with quitting years ago, design changes leading to e-cigarettes that deliver nicotine more effectively should be investigated. This work underscores the importance of using the most recent data to inform public health decisions."

The researchers explained that in the nearly 20 years since electronic nicotine delivery system products entered the market, there have been varied results regarding the role they play in quitting smoking. These findings follow a recent randomized trial that showed e-cigarettes helped people better stick to smoking cessation.

"Our full study period spanned a time in the United States when the ENDS [electronic nicotine delivery systems] marketplace was expanding; salt-based nicotine formulations gained market share in 2016 and ENDS products became available with increased nicotine yields over time, prevalence of ENDS use and frequent ENDS use was increasing, and various tobacco control actions were taken at state and federal levels," the group wrote.

"Inconsistent findings may be due in part to differences in the samples and measures considered, differences in analytic approaches used, and/or may be because of the rapidly changing product environment or differing policy contexts," they added.

Joan Burnham, MSN, RN, an oncology nurse navigator at Houston Methodist Sugar Land Hospital in Texas, told MedPage Today via email that one factor that may contribute to e-cigarettes working as a smoking cessation tool is the nicotine concentration of those devices, which may be higher than those of regular cigarettes.

"The difficulty in quitting smoking is related to the nicotine addiction that people have to go through when quitting," she said. "If you are getting a higher level of nicotine from the ENDS, the withdrawal and nicotine craving is completely alleviated."

Farrah Kheradmand, MD, of Baylor College of Medicine in Houston, stressed that replacing one type of nicotine with another can still be dangerous.

She told MedPage Today that some research indicates high relapse rates among those who switch from smoking to a form of nicotine replacement, and that the urge to smoke will likely remain, as "using nicotine in an electronic cigarette is a sure sign of nicotine dependency."

"Therefore, all in all, I would not see these data as encouraging or suggestive that electronic cigarettes enable adults to quit smoking. They are replacing nicotine usage from one type to another, which will not result in true smoking cessation," she said.

For this study, Kasza and team used data on adults ages 21 and up from waves 1-6 (2013-2021) of the PATH study. Median age was 41, 54% were men, 64.6% were white, 15.1% were Black, and 13.5% were Hispanic. Some level of college or an associate's degree was the most common education level, at 33.4%, followed by high school graduates at 27.3%, less than a high school/general equivalency diploma at 25.5%, and a Bachelor's degree or more at 13.4%.

Participants completed audio computer-assisted self-interviews that were provided to them in either English or Spanish. Since wave 6 overlapped with the onset of the COVID-19 pandemic, interview data were obtained via both audio computer-assisted self-interviews and telephone interviews.

The researchers noted that limitations to the study included the fact that data on e-cigarette use were not tracked between baseline and follow-up waves and subgroup analyses for different patient populations were not conducted. Furthermore, the reasons why people stopped smoking regular cigarettes were not identified.

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