The variable journey from smoking to vaping
Persistence may be the key when quitting smoking using an electronic nicotine delivery system (ENDS), commonly known as vaping, a University of Otago study found.
Researchers found people attempting to switch from cigarettes to ENDS reported highly varied smoking and ENDS use. They recommend people persist in their attempts to transition away from smoking, even if their progress feels slow and uncertain.
Lead author Associate Professor Tamlin Conner, of the Department of Psychology, says, although people may plan to use ENDS exclusively instead of cigarettes, making the switch is not always straightforward.
"We found that dual use of ENDS and cigarettes was very common, suggesting that people tested but had difficulty successfully substituting ENDS for smoking," she says.
For the study, published this month in International Journal of Environmental Research and Public Health, the researchers recruited 45 people who wanted to quit smoking, gave each participant an ENDS device, and prompted participants to report their ENDS use and smoking each day for up to 20 weeks using a smartphone survey.
The researchers examined how participants' patterns of smoking and ENDS use changed over this extended period. The daily diary survey was part of a wider mixed qualitative and quantitative study of smoking to ENDS transitions funded by the Royal Society of New Zealand Marsden Fund to Principal Investigator Professor Janet Hoek and her collaborators.
Aided by innovative data visualizations created by co-authors Dr. Jimmy Zeng and Vicky He, the research team found considerable variety in how people used their ENDS.
The most common behavior pattern was dual use of cigarettes and ENDS, then exclusive ENDS use and back to dual use. A smaller group reported moving from dual use to exclusive smoking, and often back to dual use. Another small group reported moving between abstinence and different ENDS use and smoking behaviors.
"Not any one person's journey to quit smoking is the same. Some people take up exclusive vaping relatively quickly in several weeks, others take longer from 12—20 weeks, or do not transition at all and continue smoking. People who wish to switch to exclusive vaping should view this variability as typical and should persevere in their efforts to switch," Associate Professor Conner says.
Professor Hoek believes this variability has implications for smoking cessation programs.
"Classifying behaviors using point-prevalence categories, like achieving 'smoke free' status after 12 weeks, may be simplistic, especially during the early stages of an ENDS-assisted quit attempt. Cessation support programs involving ENDS may need to run for longer than the conventional 12-weeks to ensure people have access to support during what could be an extended period of movement between smoking and ENDS use," she explains.
Associate Professor Conner also wanted to remind people that ENDS are not a risk-free alternative to smoking cigarettes.
"Although vaping can assist some people in quitting cigarettes, people should regard their use as a transition phase and aim to quit vaping when they think their risk of relapse back to smoking is very low."