“This study is the first to point out that even if smokers may succeed in stopping smoking with the aid of electronic cigarettes, they still need to be monitored by doctors and health professionals to prevent a relapse in the long term,” said Ramchandar Gomajee, the paper’s lead author and a researcher at France’s Pierre Louis Institute of Epidemiology and Public Health.
The findings suggest that e-cigarette use may affect current and former smokers differently: helping people addicted to cigarettes kick the habit, perhaps, but also drawing some who had already quit back to smoking.
The study, published in the medical journal JAMA Internal Medicine, tracked more than 5,000 daily smokers for an average of two years in France. It found that smokers who vaped used fewer cigarettes per day and were more than one and a half times as likely to quit completely.
But researchers also looked at more than 2,000 former smokers and found that those who used e-cigarettes were more likely to relapse back to smoking. “Thus, while [e-cigarette] use can help persons reduce their smoking levels in the short term,” the researchers wrote, “there is no evidence that it is an efficacious smoking cessation aid in the long term.”
Newer e-cigarettes may reduce the risk of relapse
The study did find that the heightened risk of relapse disappeared in those who quit smoking more recently, which the researchers said may be due to improved e-cigarette technology.
For example, the study as a whole considered anybody who quit smoking from 2010 onward and found that, in that sample, vaping increased the risk of relapse. But when researchers only considered people who quit cigarettes as of 2013, former smokers were not more likely to relapse if they vaped.
The researchers noted in their study that “measures of plasma nicotine levels have shown that, compared with older models of [e-cigarettes], the new generation delivers higher levels of nicotine to the bloodstream,” which may make them more satisfying.
Other “technical improvements in [e-cigarettes] over time,” they said, may also explain why people who recently quit smoking and switched to e-cigarettes were less likely to relapse than those who quit earlier.
Gregory Conley, president of the American Vaping Association, said that e-cigarettes have undergone drastic changes in recent years. “Prior to technological advancements made around 2013, e-cigarette devices were difficult to use and only effective for the most dedicated of would-be quitters,” he said.
Devices used years earlier “bear no resemblance to current technology,” he said, “so using ancient data is not particularly helpful to understanding whether vaping products can help smokers quit today.”
The great vape debate
It’s unclear why vaping heightened the risk of relapse in some former smokers, but Gomajee noted that “[people] who are using electronic cigarettes are still addicted to nicotine.” If they have withdrawal symptoms but can’t vape, or if their vape isn’t satisfying, then “they are likely to smoke again,” he said.
Prior research has highlighted some of those same risks while also showing that e-cigarettes may be an effective tool to quit smoking.
The research comes at a time of intense scrutiny for e-cigarette companies.
To Dr. Robert Jackler, founder of the group Stanford Research into the Impact of Tobacco Advertising, that alternative comes at a cost.
“While e-cigarettes may be a potential off ramp for adult smokers,” he said, “they have proved to be a heavily traveled on ramp to nicotine addiction among youth.”