Vaping Helps Smokers Quit — Even When They Don't Plan To

Mounting evidence shows that e-cigarette use (vaping) can help smokers give up combustible tobacco for good, even if they have no intention to quit. According to a just-published study of 1,600 people in JAMA Open Network, daily smokers who used e-cigarettes every day were eight times more likely to quit cigarettes than smokers who didn't try vaping. The researchers utilized four waves of data collected between 2014 and 2019 as part of the Population Assessment of Tobacco and Health (PATH) study. Participants were asked in each of the waves whether they currently smoked, used any nicotine-containing e-cigarette and if they planned to quit cigarettes or tobacco at any point.

Participants who used e-cigarettes daily had a “discontinuation rate” of 28 percent compared to 5.8 percent among those who didn't vape every day. Even smokers who didn't quit entirely reduced their cigarette consumption. Among those who used e-cigarettes daily, 45.5 percent gave up daily cigarette smoking, compared with 9.9 percent of participants who didn't vape. However, “nondaily e-cigarette use was not associated with cigarette discontinuation or daily cigarette discontinuation,” the study authors reported. Their conclusion:

In this cohort study, daily e-cigarette use was associated with greater odds of cigarette discontinuation among smokers who initially had no plans to ever quit smoking. These findings support the consideration of smokers who are not planning to quit when evaluating the risk-benefit potential of e-cigarettes for smoking cessation in the population.

The standard epidemiological limitations apply. The researchers had no way to show that vaping actually caused the change in quit intentions. It could be that smokers who wanted to quit saw vaping as the best way forward, though I don't think this is the case for reasons we'll discuss below. The study's sample size was also relatively small, so it would be inappropriate to draw definite conclusions about the effects of vaping from this paper alone. Nonetheless, the results comport with previous research and validate anecdotal reports from former smokers.

An incentive to quit

Earlier research has found that smokers who want to quit can do so by using e-cigarettes. But this paper is significant because it bolsters a smaller body of literature showing that vaping actually motivates some smokers to make a quit attempt. “Indeed, an experimental study among smokers not planning to quit found use of e-cigarettes to be associated with increased plans to quit,” the researchers wrote. They cited this 2017 paper in support of their observation, but here's another study from just last month that reached the same conclusion. As we reported on December 22:

"While quit rates were relatively low, nobody in the study was actually trying to give up tobacco. Nonetheless, 'we noticed that the number of those receiving the high nicotine-delivery ENDS who abstained from cigarettes gradually increased,' lead author Jonathan Foulds, professor of public health sciences at Penn State College of Medicine, explained. This group also went longer without smoking cigarettes than anyone else in the study."

Why would smokers be willing to make a quit attempt after trying e-cigarettes? The most convincing explanation is that vaping nicotine allows them to continue the rituals they positively associate with smoking, like lighting up first thing in the morning with a cup of coffee.

I used to start my Saturdays with a pack of Camel Lights, a pot of coffee, and whatever book I was reading at the time. Before I started vaping, few things in life were more pleasant than that smoke-filled morning ritual, and behavioral cues of this sort represent a massive hurdle for many recovering addicts. Vaping may be such a powerful intervention because it allows smokers to continue these rituals while greatly reducing their exposure to the harmful chemicals in cigarette smoke.

The realization that you can make a healthier choice without disturbing your routine is likely a significant incentive to give up cigarettes. Observational studies won't confirm that suspicion with much confidence on their own. But taken in concert with anecdotal reports from smokers who have or are trying to quit with the help of e-cigarettes, research of this kind leads us to a very encouraging conclusion: vaping may save the lives of smokers who have no desire to drop their deadly habit.