Occasional smokers who vape smoke more cigarettes

(Reuters Health) - Tobacco companies have been selling electronic cigarettes as a way to wean smokers off paper cigarettes, but a new study suggests the strategy could backfire.

The report in Preventive Medicine found that young adults who occasionally smoked conventional cigarettes smoked more of them if they also used e-cigarettes – battery-powered gadgets that heat liquid nicotine into vapor.

“The participants who were vaping ended up using more cigarettes. It’s actually a risk factor for increasing their cigarette use,” lead author Neal Doran said in a phone interview.

“They’re not using e-cigarettes to try to stop smoking,” said Doran, a psychologist and psychiatry professor at the University of California, San Diego School of Medicine.

Though smokers have been turning to e-cigarettes since they came on the market in 2007 as a healthier alternative to smoking tobacco, little is known about the long-term effects of the practice known as “vaping.”

E-cigarette use grew 900 percent among high school students from 2011 through 2015, according to a report from U.S. Surgeon General Vivek Murthy. The 2016 report declares e-cigarettes “unsafe” for youth and young adults (

The new study’s findings are “consistent with the worry that, regardless of whether vaping is itself unsafe, vaping causes worse outcomes because it leads to more consumption of cigarettes,” Doran said.

Stanton Glantz, who directs the Center for Tobacco Control Research and Education at the University of California, San Francisco, said the study “has tremendous policy implications.”

“What this study shows very convincingly is that if they’re using e-cigarettes it’s actually leading them to smoke more conventional cigarettes, not less,” he said.

Glantz was not involved with the new study, but the findings are consistent with those of previous research he conducted on adolescents.

“The e-cigarettes are having the effect of stimulating conventional cigarette smoking,” he said in a phone interview. “They’re propping up and reinforcing the conventional cigarette market.”

Doran and his team studied 319 Californians, ages 18 to 24. At the start, participants did not smoke daily but had smoked at least one cigarette in the prior six months. During the study, they reported their frequency of cigarette and e-cigarette use five times at three-month intervals.

Those who vaped more also reported smoking 18 percent more cigarettes, the study found.

“In the larger scheme of things, e-cigarettes could be good, bad or neutral,” Doran said. “I don’t think we know the answers yet. This is one of the ways in which they could be bad – by people increasing their cigarette use if they’re using both.”

Dual users may be exposed to more nicotine and wind up at risk for chronic tobacco use and dependence, the authors write. Previous studies have shown that e-cigarette use increases the risk of smoking tobacco-filled cigarettes.

Some prior studies suggest that e-cigarette vapor may be less toxic than traditional cigarette smoke. But electronic alternatives nonetheless release potentially hazardous chemicals.

Sales of vaping products are expected to reach $4.4 billion this year, according to Wells Fargo Securities analysts.

With flavors like bubble gum and chocolate peanut butter cup, e-cigarettes or vape pens are often packaged to appeal to youth, who experts believe are more vulnerable to becoming dependent on nicotine.

The San Francisco Board of Supervisors is considering banning flavored tobacco products. Residents opposed to the legislation recently argued that e-cigarettes help them smoke less.

But, Glantz said, “This paper shows exactly the opposite is true.”

Numbers released this month from the U.S. Centers for Disease Control and Prevention showing declines in youth use of both cigarettes and e-cigarettes have led some to claim that as proof of the benefits of vaping.

But Doran and Glantz don’t see it that way.

Instead, Glantz said he views the smoking decreases as evidence of efforts to educate youth about the potential harms of e-cigarettes as well as the results of efforts to regulate e-cigarettes with clean-indoor air laws and minimum-age requirements.

States and local jurisdictions have imposed a patchwork of laws pertaining to the use of electronic cigarettes, and some states, including California, now tax vape products.

“There’s this Wild West atmosphere with e-cigarettes, and there’s a lot of controversy and disagreement about whether they’re good or bad,” Doran said.

“If they’re harmless, and they help people quit, then they’re great. If they make it harder to quit and also encourage people to smoke cigarettes who would not have smoked otherwise, then they’re terrible,” he said. “The truth probably lies in the middle, but where exactly is the key question.”

SOURCE: and Preventive Medicine, online June 3, 2017.