Introduction: E-cigarettes are widely used by people who smoke, but observational evidence on longer-term smoking and vaping status remains mixed. Binary smoking-cessation outcomes can obscure whether smoking cessation is accompanied by continued vaping or whether smoking and vaping persist together. This study examined whether baseline e-cigarette-use frequency was associated with smoking and regular-vaping status four years later among adult cigarette smokers. Methods: Longitudinal data from 2,291 adult cigarette smokers in the UK Household Longitudinal Study were analysed, using Wave 10 (2018–2019) as baseline and Wave 14 (2022–2023) as follow-up. Baseline e-cigarette use was categorised as never, occasional, or regular (at least weekly). At follow-up, participants were classified as smoking without regular vaping, regular vaping without smoking, smoking with regular vaping, or neither smoking nor regular vaping. Multinomial logistic regression estimated relative risk ratios (RRRs) and 95% confidence intervals (CIs), adjusting for demographic, behavioural, and health-related covariates. Sensitivity analyses assessed alternative vaping definitions, restriction to participants reporting at least one cigarette per day at baseline, and inverse-probability weighting for differential analytic inclusion. Analyses were conducted in 2026. Results: At follow-up, 40.0% of baseline regular e-cigarette users were smoking without regular vaping, compared with 65.9% of baseline smokers who had never used e-cigarettes. With smoking without regular vaping as the reference outcome, regular users had higher relative risks of regular vaping without smoking (adjusted RRR 6.87, 95% CI 4.45–10.59; p<0.001) and smoking with regular vaping (adjusted RRR 10.61, 95% CI 6.61–17.03; p<0.001); the relative risk of neither smoking nor regular vaping did not differ from that among never users (adjusted RRR 0.86, 95% CI 0.55–1.34; p=0.509). Estimates were materially similar across sensitivity analyses, including inverse-probability-weighted models. Conclusions: Four years later, smokers who regularly used e-cigarettes at baseline were more likely to have stopped smoking while continuing to vape regularly, but were also more likely to continue smoking while vaping regularly. They were not more likely to have stopped smoking without regular vaping. These findings highlight the potential for e-cigarettes to replace combustible cigarettes for some smokers, while persistent dual use and uncertainty about the long-term effects of vaping remain important considerations.
Regular e-cigarette use and subsequent smoking cessation pathways: Evidence from a 4-year population-based cohort of current smokers.
Adebisi Y. U.;Cantone G. G.;TOMASELLI V.;Polosa R.
2026-01-01
Abstract
Introduction: E-cigarettes are widely used by people who smoke, but observational evidence on longer-term smoking and vaping status remains mixed. Binary smoking-cessation outcomes can obscure whether smoking cessation is accompanied by continued vaping or whether smoking and vaping persist together. This study examined whether baseline e-cigarette-use frequency was associated with smoking and regular-vaping status four years later among adult cigarette smokers. Methods: Longitudinal data from 2,291 adult cigarette smokers in the UK Household Longitudinal Study were analysed, using Wave 10 (2018–2019) as baseline and Wave 14 (2022–2023) as follow-up. Baseline e-cigarette use was categorised as never, occasional, or regular (at least weekly). At follow-up, participants were classified as smoking without regular vaping, regular vaping without smoking, smoking with regular vaping, or neither smoking nor regular vaping. Multinomial logistic regression estimated relative risk ratios (RRRs) and 95% confidence intervals (CIs), adjusting for demographic, behavioural, and health-related covariates. Sensitivity analyses assessed alternative vaping definitions, restriction to participants reporting at least one cigarette per day at baseline, and inverse-probability weighting for differential analytic inclusion. Analyses were conducted in 2026. Results: At follow-up, 40.0% of baseline regular e-cigarette users were smoking without regular vaping, compared with 65.9% of baseline smokers who had never used e-cigarettes. With smoking without regular vaping as the reference outcome, regular users had higher relative risks of regular vaping without smoking (adjusted RRR 6.87, 95% CI 4.45–10.59; p<0.001) and smoking with regular vaping (adjusted RRR 10.61, 95% CI 6.61–17.03; p<0.001); the relative risk of neither smoking nor regular vaping did not differ from that among never users (adjusted RRR 0.86, 95% CI 0.55–1.34; p=0.509). Estimates were materially similar across sensitivity analyses, including inverse-probability-weighted models. Conclusions: Four years later, smokers who regularly used e-cigarettes at baseline were more likely to have stopped smoking while continuing to vape regularly, but were also more likely to continue smoking while vaping regularly. They were not more likely to have stopped smoking without regular vaping. These findings highlight the potential for e-cigarettes to replace combustible cigarettes for some smokers, while persistent dual use and uncertainty about the long-term effects of vaping remain important considerations.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
