Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Mar 15;10(3):e036055.
doi: 10.1136/bmjopen-2019-036055.

Is Dual Use of Nicotine Products and Cigarettes Associated With Smoking Reduction and Cessation Behaviours? A Prospective Study in England

Free PMC article

Is Dual Use of Nicotine Products and Cigarettes Associated With Smoking Reduction and Cessation Behaviours? A Prospective Study in England

Sarah E Jackson et al. BMJ Open. .
Free PMC article


Objectives: To investigate associations of dual use of e-cigarettes and cigarettes with subsequent quitting activity (smoking reduction, quit attempts and use of evidence-based cessation aids). To overcome potential confounding by factors associated with use of pharmacological support, we selected dual use of over-the-counter nicotine replacement therapy (OTC NRT) and cigarettes as a behavioural control.

Design: Prospective cohort study with 6-month follow-up.

Setting: England, 2014-2016.

Participants: 413 current smokers participating in the Smoking Toolkit Study, a representative survey of adults in England, who reported current use of e-cigarettes or OTC NRT and provided data at 6-month follow-up.

Main outcome measures: The exposure was dual use of e-cigarettes or OTC NRT at baseline. Outcomes were change in cigarette consumption, quit attempts and use of evidence-based cessation aids during quit attempts over 6-month follow-up. Relevant sociodemographic and smoking characteristics were included as covariates.

Results: After adjustment for covariates, dual e-cigarette users smoked two fewer cigarettes per day at follow-up than at baseline compared with dual OTC NRT users (B=2.01, 95% CI -3.62; -0.39, p=0.015). While dual e-cigarette users had 18% lower odds than dual OTC NRT users to make a quit attempt at follow-up (risk ratio (RR) 0.82, 95% CI 0.67 to 1.00, p=0.049), the groups did not differ in use of cessation aids (RR 1.06, 95% CI 0.93 to 1.21, p=0.388).

Conclusions: Dual use of e-cigarettes is associated with a greater reduction in cigarette consumption than dual use of OTC NRT. It may discourage a small proportion of users from making a quit attempt compared with dual OTC NRT use but it does not appear to undermine use of evidence-based cessation aids.

Keywords: cigarette consumption; dual use; e-cigarettes; nicotine replacement therapy; smoking cessation.

Conflict of interest statement

Competing interests: LS has received a research grant and honoraria for a talk and travel expenses from manufacturers of smoking cessation medications (Pfizer and Johnson & Johnson). JB has received unrestricted research funding from Pfizer, who manufacture smoking cessation medications. All authors declare no financial links with tobacco companies or e-cigarette manufacturers or their representatives.

Similar articles

See all similar articles


    1. Action on Smoking and Health Facts at a Glance - Key Smoking Statistics, 2018. Available: file:///N:/Downloads/Facts-at-a-Glance-12-Sept-2018-FINAL.pdf [Accessed 26 Jun 2019].
    1. Office for National Statistics Adult smoking habits in the UK: 2017, 2018. Available: [Accessed 22 Aug 2018].
    1. Beard E, Brown J, Michie S, et al. Is prevalence of e-cigarette and nicotine replacement therapy use among smokers associated with average cigarette consumption in England? A time-series analysis. BMJ Open 2018;8:e016046 10.1136/bmjopen-2017-016046 - DOI - PMC - PubMed
    1. Patel D, Davis KC, Cox S, et al. Reasons for current e-cigarette use among U.S. adults. Prev Med 2016;93:14–20. 10.1016/j.ypmed.2016.09.011 - DOI - PMC - PubMed
    1. West R, Proudfoot H, Beard E, et al. Electronic Cigarettes in England - Latest Trends, 2019. Available: [Accessed 26 May 2019].

LinkOut - more resources