How Does Smoking and Nicotine Dependence Change After Onset of Vaping? A Retrospective Analysis of Dual Users

Nicotine Tob Res. 2020 Apr 21;22(5):764-770. doi: 10.1093/ntr/ntz043.


Introduction: Although some smokers switch to exclusive use of electronic cigarettes (e-cigarettes), others become dual users of combustible cigarettes and e-cigarettes. Little is known about how the onset of vaping affects the use of and dependence on combustible cigarettes or total nicotine use and dependence, which may influence health-related and cessation outcomes. Using self-report data of current combustible and e-cigarette use and retrospective recall of pre-vaping smoking in a sample of dual users, the aims of this study were (1) to compare pre- and post-vaping number of cigarettes per day and combustible cigarette dependence; (2) to compare pre- and post-vaping total nicotine use frequency (number of vaping sessions and cigarettes smoked per day), and total nicotine dependence; and (3) to examine predictors of nicotine dependence.

Methods: We used baseline data from a smoking cessation trial with 2896 dual users. Nicotine use frequency and the Heaviness of Smoking Index were used as measures of nicotine use and dependence, respectively.

Results: Participants decreased cigarettes/day from pre- (M = 19.24, SD = 9.01) to post-vaping (M = 11.15, SD = 8.02, p < .0001) and combustible cigarette dependence declined from pre- (M = 3.55, SD = 1.51) to post-vaping (M = 2.11, SD = 1.60, p < .0001). Total daily nicotine use frequency increased after initiating vaping (M = 19.25, SD = 9.01 vs. M = 29.46, SD = 8.61; p < .0001), as did total nicotine dependence (M = 3.55, SD = 1.51 vs. M = 4.68, SD = 1.38; p < .0001). Hierarchical regression analyses indicated that variables associated with greater overall nicotine dependence included: younger age, lower education, more years smoking, higher pre-vaping nicotine dependence, using e-cigarettes more days per month, more puffs per vaping session, higher e-liquid nicotine concentration, and longer vaping history.

Conclusions: Dual use leads to a reduction in the number of combustible cigarettes, but total nicotine use and dependence increases.

Implications: In dual users, a reduction in smoking following onset of vaping may offer some harm reduction via reduction in cigarette intake. However, the increase in total nicotine use and dependence could affect the ability to quit either or both products.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Electronic Nicotine Delivery Systems / statistics & numerical data*
  • Female
  • Harm Reduction
  • Humans
  • Male
  • Retrospective Studies
  • Self Report
  • Smokers / psychology*
  • Smoking Cessation / psychology*
  • Tobacco Smoking / epidemiology
  • Tobacco Smoking / psychology*
  • Tobacco Use Disorder / epidemiology
  • Tobacco Use Disorder / psychology*
  • United States / epidemiology
  • Vaping / epidemiology
  • Vaping / psychology*