New research has revealed that people who simultaneously smoke cigarettes and use e-cigarettes face greater challenges in breaking their nicotine addiction compared to those who engage in only one of these habits. The findings raise significant concerns about the effectiveness of vaping as a smoking cessation strategy.
A comprehensive review published in the journal Open Research analyzed data from 16 previous studies involving more than 9,300 participants, including over 2,400 dual users. The results showed that only 24% of dual users successfully quit nicotine completely within two years, compared to 25% of exclusive smokers and 35% of exclusive vapers.
"Given the extensive marketing of vapes as healthier alternatives to conventional smoking, they have gained popularity among people trying to quit smoking," explained Josef Hamoud, research assistant at the University Medical Center Gottingen in Germany and lead investigator of the study. "Some people are using them in addition to their conventional cigarettes, classifying them as dual users."
Dual Use Leads to Continued Smoking, Not Cessation
Perhaps most concerning is the finding that 55% of dual users eventually abandoned vaping and returned exclusively to cigarettes after two years. Additionally, about 38% of dual users continued both habits for 8-12 months, suggesting this is not merely a transitional phase but a pattern of prolonged double exposure.
"This cannot be considered a simple 'transitional state,' but rather a risk for prolonged double exposure," Hamoud noted, adding that "dual use might be even more harmful than conventional smoking."
Dr. Filippos Filippidis, chair of the European Respiratory Society Tobacco Control Committee, who was not involved in the study, agreed with these conclusions: "This large study examined all existing evidence on dual users, and it showed that, for most people, this is not a stepping stone to quitting."
Equivalent Health Risks to Exclusive Smoking
A separate study published in Nicotine and Tobacco Research reinforces these concerns by demonstrating that dual users face similar health risks as exclusive cigarette smokers. Researchers from the American Cancer Society analyzed data from nearly 2,700 adults and found that dual users and cigarette smokers had equivalent levels of tobacco-specific nitrosamines—probable carcinogens—in their systems.
"In the U.S., dual-use of combustible cigarettes and e-cigarettes is the most common multiple tobacco-use behavior. Some individuals try to cut back on cigarettes or work toward quitting cigarettes this way," explained Zheng (Ashley) Xue, senior associate scientist of tobacco control research at the American Cancer Society and lead researcher of the study.
The research also revealed that dual users had higher levels of three volatile organic compounds linked to cancer compared to exclusive vapers, further undermining the notion that partial substitution with vaping reduces health risks.
High Nicotine Content in Vapes Contributes to Addiction
Experts point to the high nicotine content in modern e-cigarettes as a key factor in maintaining addiction rather than facilitating cessation.
"While it may have been argued that heavy smokers might benefit from dual use by reducing their daily cigarette consumption, the high nicotine content of vapes adds to the risk of continued nicotine addiction," Hamoud emphasized.
Dr. Filippidis added, "Nicotine in vapes is highly addictive, so we need to do all we can to discourage non-smokers from starting to vape. E-cigarettes may have a role in smoking cessation for some people, but we need to make sure appropriate support is freely available to help people to quit."
Clinical Implications and Recommendations
The findings have important implications for healthcare providers and public health officials. Xue stressed that "clinicians and public health practitioners should increase awareness that dual use of cigarettes and e-cigarettes is not safe and may present similar risks as continuing to smoke cigarettes, especially if one does not reduce the number of cigarettes smoked."
Lisa Lacasse, president of the American Cancer Society Cancer Action Network, suggested that smokers would be better served by entering tobacco cessation programs and using evidence-based medications to overcome nicotine addiction.
"These fact-based tobacco prevention and cessation programs are critical to help those addicted to quit and prevent anyone, especially youth, from ever starting," Lacasse stated. She also called for stronger regulatory oversight, adding that "the FDA must use the full weight of its authority to regulate all tobacco products, including removing the thousands of illegal products on the market that have not been shown to benefit the public health."
As the prevalence of dual use continues to rise, these studies provide crucial evidence that challenges industry claims about vaping as a harm reduction strategy. For those seeking to quit smoking, the research suggests that evidence-based cessation methods remain the most effective approach rather than supplementing cigarette use with e-cigarettes.
