E-Cigarettes Hinder Smoking Cessation

As use of electronic cigarettes continues to climb, especially among youth and young adults, researchers at Wake Forest (N.C.) School of Medicine sought to determine whether there was a relationship between e-cigarette use and smoking cessation in a sample of college student smokers. They published their findings in the August 2015 issue of the American Journal of Public Health.

Researchers studied students from seven colleges in North Carolina and four in Virginia, between the fall of 2010 and the fall of 2013, using one baseline survey and five follow-up surveys. Participants chosen from the Smokeless Tobacco Use in College Students study were first-year college students who were current smokers and reported no history of e-cigarette use in the initial survey. The baseline survey was conducted in their first fall semester, and five follow-up surveys were conducted each semester through the fall of their senior year.

Researchers invited 4,902 eligible students to participate in the longitudinal cohort study and 3,146 (64.2 percent) completed the baseline survey. Of this group, 669 (21.3%) were current cigarette smokers with no history of e-cigarette use at baseline. Follow-up surveys had a retention rate between 78.2 percent and 80.1 percent. Researchers’ surveys measured demographics (gender, race, ethnicity and mother’s educational level), membership in Greek letter organizations, tobacco use (smoking and smoking frequency) and e-cigarette use.

At wave 6 — the final survey — researchers also questioned participants on lifetime use of smokeless tobacco, including chew, dip, snus, hookah tobacco, little cigars, cigarillos and large cigars; exposure to peers’ smoking and family smoking; and reasons for e-cigarette use.

The authors examined the variables associated with trying an e-cigarette between baseline and wave 5. Of the 669 participants who were smokers at baseline with no history of e-cigarette use, researchers excluded 73 participants who first tried an e-cigarette between wave 5 and wave 6 and 15 participants who were not current smokers when they first tried e-cigarettes. Of the remaining participants, 323 individuals had sufficient data to determine whether they had tried an e-cigarette while being a current smoker and the researchers studied an analytic sample of 271 participants. Most participants were considered by researchers to be “occasional” smokers.

Just over half (51.7 percent) of participants were female and most were White (89.7 percent) and non-Hispanic (94.1 percent). Nearly 60 percent had a mother with a college degree or higher and less than a quarter had joined a Greek letter organization by wave 6. The percentage of participants who tried an e-cigarette between wave 2 and wave 5 increased from 13.3 percent to 43.5 percent. Those who tried e-cigarettes were less likely to have a mother with a college or higher degree and more likely to smoke cigarettes on more days at baseline, have tried more tobacco products in their lifetime and have family members and friends that smoke.

At wave 6, participants’ responses on why they tried e-cigarettes included curiosity (91.6 percent), having friends that used them (70.2 percent) and believing they were safer than cigarettes (69.9 percent). About half responded that they tried them because they cause less odor and could be used where smoking was not allowed and 31 percent said they used them to cut down on smoking. Only 20.2 percent responded that they tried e-cigarettes to help with smoking cessation.

The authors noted that e-cigarette use in the college student population may be associated more with novelty seeking than as a cessation aide. They also say the data show that not only did using e-cigarettes not deter cigarette smoking, e-cigarettes may have contributed to continued smoking. They called for more research to determine whether continued, higher e-cigarette use, defined as using daily for at least 1 month, is associated with higher rates of smoking cessation among college students.

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