Smokers who did not intend to stop but nonetheless began vaping drastically increased their likelihood of quitting cigarettes, according to a new study. The paper, published at the end of December 2021 in JAMA Network Open, a journal run by the American Medical Association, found that the quitting odds of such smokers who started vaping daily were multiple times better compared to those who never used e-cigarettes.
Nearly 20 co-authors—including Dr. Kenneth Michael Cummings, a professor of psychiatry and behavioral sciences at the Medical University of South Carolina; Dr. Andrew Anesetti-Rothermel, a health scientist at the Food and Drug Administration (FDA); and Dr. Heather Kimmel, a health scientist administrator at the National Institutes of Health (NIH)—focused on a select group of 1,600 individuals who did not set out to quit smoking. Their data was culled from the Population Assessment of Tobacco and Health (PATH) Study, a national longitudinal study of tobacco use spearheaded by the FDA and NIH. Specifically, the researchers used four “waves of data,” in which participants were evaluated in three pairs of interviews between October 2014 and November 2019.
“These findings are paradigm-shifting, because the data suggest that vaping may actually help people who are not actively trying to quit smoking.”
Just 6 percent of daily smokers quit smoking cigarettes entirely, but those who decided to vape daily instead saw their success rate dramatically go up: Twenty-eight percent of those smokers, in the end, quit when they began vaping every day.
“These findings are paradigm-shifting, because the data suggest that vaping may actually help people who are not actively trying to quit smoking,” Dr. Andrew Hyland, the chair of health behavior at Roswell Park Comprehensive Cancer Center and the scientific lead on the PATH study, said in a press statement. “Most other studies focus exclusively on people who are actively trying to quit smoking, but this study suggests that we may be missing effects of e-cigarettes by not considering this group of smokers with limited intention to stop smoking—a group that is often at the highest risk for poor health outcomes from cigarette smoking.”
The conclusions come on the heels of two studies in 2020, which employed data from the PATH study and gained traction when they suggested that vaping was not necessarily helping adults quit smoking—and may have just been prolonging their nicotine dependence. In the fall, the University of California San Diego issued a press release that highlighted these two peer-reviewed articles.
The first appeared in The American Journal of Epidemiology in late July and analyzed 2,535 daily and non-daily smokers who attempted to quit smoking from 2015 to 2016; 17 percent used e-cigarettes to do so, and 13 percent eventually reported not smoking for at least 12 months. The second, which ran a few months later in PLOS One, a peer-reviewed scientific journal put out by the Public Library of Science, showed similar results: Of 2,770 daily smokers who reported trying to quit cigarettes, 23.5 percent used e-cigarettes to do so from 2014 to 2015; the next year, 9.6 percent of e-cigarette users had not smoked in the past 12 months, as well as 9.5 percent who did not use vaping products, and 10.2 percent who used neither vapes nor a pharmaceutical aid. (Meaning vaping as a smoking cessation tool seemed indistinguishable from other methods.)
Those studies were limited, though, in the sense that they only looked at smokers who expressed a desire to quit and focused on a pretty short time frame. Nonetheless, tobacco harm reduction antagonists like Dr. Stanton Glantz, the founding director of the University of California San Francisco’s Center for Tobacco Control Research, trumpeted the conclusions as evidence that vapes were not appropriate smoking cessation tools.
But Glantz ignored another study, published in Nicotine & Tobacco Research around the same time, which did not restrict the sample to people who said they made a quit attempt. It also looked at a trajectory throughout the years. The authors found that people who said that they used e-cigarettes over a longer period of time were significantly more likely to quit combustible cigarettes.
It is important to understand these distinctions, because the JAMA Network Open study now goes a step further, homing in specifically on the data of individuals who stated that they never had any real goal of giving up smoking and yet, for whatever reason, eventually picked up vaping anyway. Although the authors did not identify why a particular person initially began vaping without aiming to quit cigarettes, they explicitly call for future research to be conducted on this subset of former smokers—perhaps into the reasons people incidentally give vaping a go in the first place.
Together with the PLOS One study, the JAMA Open Network study reveals a clear logic: You don’t have to try vapes with the idea of quitting cigarettes; it can just occur, unintended.
“The lesson is we need to open our eyes and our minds to what people are actually doing.”
“To me, the message here is that if we think of these products within the framework of a smoking cessation medication, then we’re really narrowing the scope of our inquiry,” Dr. Raymond Niaura, the interim chair of New York University’s Department of Epidemiology and a co-author on the JAMA Network Open study, told Filter. “If you think of them as consumer products, where people go back and forth and they try them—and not even because they’re interested in quitting, but something happens along the way, these people end up migrating off cigarettes. The lesson is we need to open our eyes and our minds to what people are actually doing.”
There’s an implication that medical-only vaping models, such as in Australia, will not be as effective as they could be, because they treat e-cigarettes only as tools to quit smoking instead of consumer products—or substitute goods, where any person has the easy ability to replace deadly combustible cigarettes with vapes out of sheer curiosity. In the United Kingdom, the government allows its citizens to access e-cigarettes through both consumer and medical channels.
The new findings are also all the more striking in the context of the United States’ relative demonization of vapes. The Centers of Disease Control and Prevention (CDC), for example, has still not actively corrected the falsehood that nicotine vaping products had anything to do with the vaping-linked illnesses, “EVALI,” that cropped up around the country in 2019. And the FDA has authorized a single, outdated vape and just two “tobacco”-flavored cartridges under its “appropriate for the protection of public health” standard—a threshold that has mainly come to be understood as a given product’s likelihood to help adult smokers transition to the safer alternative while not introducing nicotine to a new generation of users.
“To limit the marketplace to a handful of products,” Niaura said, “is detrimental to public health.”