Vapes have become the most popular and effective smoking cessation tools in the United States, a recent study indicates. Most US adults who want to quit smoking are now choosing nicotine products like vapes to help them—and succeeding—despite years of negative media and official messaging.
The study, published in the Internal and Emergency Medicine journal in January, looked at “US adults who self-reported having stopped smoking cigarettes for 6 months or longer in the last year and the methods they used, or who did not stop smoking but tried in the last year.”
The researchers analyzed publicly available data from the National Health Interview Survey (NHIS), a cross-sectional survey of the US adult population.
Dr. Raymond Niaura, a psychologist and professor of social and behavioral sciences at New York University’s School of Global Public Health, co-authored the research. He noted that it’s one of several studies looking at US smoking cessation methods over the years, but that its use of 2022 data (the latest publicly available from NHIS) enabled it to present a more up-to-date picture.
In 2022 “an estimated 2.9 million US adults had stopped smoking in the last year.” Of these, 53.9 percent used nicotine products—and 40.8 percent used vapes.
“We found that smokers report more use of nicotine replacement products and e-cigarettes compared to prior reports,” he told Filter. “Because this is a nationally representative study, we can make stronger inferences about what is occurring at the population level of adult US smokers.”
In 2022 “an estimated 2.9 million US adults had stopped smoking in the last year,” the study states. Of these, 53.9 percent were estimated to have used nicotine products—and 40.8 percent used vapes, often in combination with other methods. For 26 percent of adults who quit smoking, vapes were the only method used.
Prescription drugs were used by 8.1 percent, while 6.3 percent used non-nicotine, non-prescription methods. The remainder quit unaided.
Evidence of increasingly successful use of vapes for this purpose is clearly very welcome, even if uptake might have been higher still in a different climate. In the United Kingdom, for example, which has (at least until recently) been more welcoming to vapes, evidence indicates that an outright majority of people quitting cigarettes use vapes to do so.
Dr. Brad Rodu is a professor of medicine at the University of Louisville in Kentucky. He wasn’t involved in the new study, but conducted some similar research in 2013-14. He said the new study represents definitive population-level evidence, using data from the federal government, of vapes’ harm reduction success.
“In a rational world, the evidence should be sufficient for broad Food and Drug Administration approval of vapor PMTAs.”
“The findings from national surveys are very compelling,” Rodu told Filter, “and in a rational world, the evidence should be sufficient for broad Food and Drug Administration approval of vapor PMTAs.”
That speaks to one of the reasons US vape uptake has been slower than it might. The FDA has been notoriously reluctant to authorize an effective, attractive range of vaping products under its Premarket Tobacco Product Applications process, resulting in a landscape where most US vape use is of unauthorized products—and sending an unhelpfully ambiguous public message.
There’s some room for optimism, however, in the wake of the FDA’s recent authorization of Zyn nicotine pouches and as tobacco harm reduction advocates await the outcome of the Supreme Court Triton case on flavored vapes. Niaura said he believes the FDA is beginning to better understand vapes’ value.
“Studies such as ours, hopefully, will help the FDA recognize that e-cigarettes and other reduced-harm tobacco products can be a positive element in helping smokers quit,” he said. “Perhaps they will be encouraged to accelerate their review of applications and authorize more reduced-harm products for sale.”
“Compared to those who tried but didn’t stop smoking, those who stopped were more likely to be younger, degree-educated, and to use e-cigarettes.”
Besides the question of regulators’ next moves, another note of caution is that the good news the study represents applies unequally. Most of the people who quit smoking, according to the data, were white, better-educated (so probably wealthier), identified as straight and were not depressed.
“Compared to those who tried but didn’t stop smoking, those who successfully stopped were more likely to be younger, degree-educated, and to use e-cigarettes to stop smoking,” the study states.
Niaura said this reinforces the established reality that marginalized people with many stressors in their lives—including people on lower incomes, LGBTQ+ people, Indigenous people, prisoners and people with mental health conditions—are both more likely to smoke and often find it harder to quit. Older people who smoke also seem less likely to try vaping.
“Our study just adds further confirmation,” he said, highlighting that there are certain groups of people smoking cessation efforts should especially focus on. “This means figuring out how best to provide the means and methods to quit smoking, including medications, nicotine replacement therapies and e-cigarettes.”
“The main takeaway for me is that we should pay attention to what people are doing and why they are doing it,” he added. “National surveys only give us a high-level peek at behaviors. We need to know more about why smokers are trying e-cigarettes (and other methods).”
This is particularly important in the context of “widespread misinformation” on vapes,” Niaura continued. “We need to know why people were motivated to try e-cigarettes, for example, whether they were successful or not and why, and whether there are ways we can improve their quitting experiences and boost success rates.”
Photograph by Lindsay Fox via Flickr/Creative Commons 2.0
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