Dual use of cigarettes and vapes can reduce risks of smoking and help smokers quit

A new major study from Queen Mary University of London has found that smokers who use both cigarettes and e-cigarettes at the same time – known as dual use – are reducing their intake of harmful chemicals and are also more likely to eventually quit smoking than those who continue to smoke only. This challenges common fears about dual use.

The study examined data from a large trial, funded by the National Institute for Health and Care Research (NIHR) and Cancer Research UK (CRUK), which followed 886 adult smokers over one year. Participants were offered e-cigarettes or nicotine replacement products as part of a stop-smoking attempt.

Published in Nicotine & Tobacco Research, the research looked closely at how people used e-cigarettes during this period and whether different patterns of use were linked to long-term success.

Smokers who were still smoking after they started their quit attempt but also used an e-cigarette were more likely to stop smoking at four weeks and at one year than people who continued to smoke without vaping. Importantly, dual users who did not manage to stop smoking altogether were far more likely to substantially reduce their smoking rate and their objectively measured intake of chemicals in cigarette smoke, than unsuccessful quitters who did not vape.

Dr Francesca Pesola, Senior Lecturer in Statistics at Queen Mary and lead author of the study said: ‘The sooner smokers quit the better, but for those who find it difficult to stop smoking abruptly, vaping can help with doing it gradually over time’.

Dr. Peter Hajek, Professor of Clinical Psychology, Director of the Health and Lifestyle Research Unit at Queen Mary and co-lead author of the study said: ‘Smokers (and clinicians) sometimes believe that if smokers do not manage to stop smoking soon after starting vaping, they should stop using e-cigarettes to avoid ‘dual use’. These results show that dual use promotes genuine harm reduction and that it can be a useful step to stopping smoking altogether.’

The study generated three other important findings.

People who used e-cigarettes experienced lower urges to smoke than those using nicotine replacement therapy. This can explain why vaping helps smokers quit and why dual users find it easier to smoke less and eventually stop.

Most e-cigarette users started on high nicotine strengths and moved to lower strengths over time. By one year, around one in 10 people using e-cigarettes had shifted to nicotine-free e-liquids. Smokers may benefit from knowing that vaping can provide an avenue to gradually wean themselves off nicotine.

Tobacco flavoured e-liquid was unpopular and seems to have been less helpful than other flavours. All participants were initially given tobacco-flavoured e-liquid, but most quickly switched to other flavours such as fruit; and those who stuck with tobacco flavour were less likely to remain smoke-free at one year.

Approximately 11.9 per cent of adults in the UK smoke and quitting smoking remains one of the most effective steps a person can take to improve their health.