Smokers Who Try E-Cigarettes to Quit Smoking: Findings From a Multiethnic Study in Hawaii

Objectives. We characterized smokers who are likely to use electronic or “e-”cigarettes to quit smoking.Methods. We obtained cross-sectional data in 2010–2012 from 1567 adult daily smokers in Hawaii using a paper-and-pencil survey. Analyses were conducted using logistic regression.Results. Of the participants, 13% reported having ever used e-cigarettes to quit smoking. Smokers who had used them reported higher motivation to quit, higher quitting self-efficacy, and longer recent quit duration than did other smokers. Age (odds ratio OR] = 0.98; 95% confidence interval CI] = 0.97, 0.99) and Native Hawaiian ethnicity (OR = 0.68; 95% CI = 0.45, 0.99) were inversely associated with increased likelihood of ever using e-cigarettes for cessation. Other significant correlates were higher motivation to quit (OR = 1.14; 95% CI = 1.08, 1.21), quitting self-efficacy (OR = 1.18; 95% CI = 1.06, 1.36), and ever using US Food and Drug Administration (FDA)–approved cessation aids such as nicotine gum (OR = 3.72; 95% CI = 2.67, 5.19).Conclusions. Smokers who try e-cigarettes to quit smoking appear to be serious about wanting to quit. Despite lack of evidence regarding efficacy, smokers treat e-cigarettes as valid alternatives to FDA-approved cessation aids. Research is needed to test the safety and efficacy of e-cigarettes as cessation aids.Electronic cigarettes, or e-cigarettes, are battery-powered devices that generate vaporized nicotine or non-nicotine vapor that may be inhaled orally in the manner in which conventional cigarettes are smoked. E-cigarettes deliver the vapor when a cartridge containing nicotine solution is heated. Because e-cigarettes are likely to contain lower levels of toxins or carcinogens than combustible tobacco products,1 e-cigarettes are commonly promoted as safer alternatives to regular cigarettes and even as smoking cessation aids.2,3 Currently, the US Food and Drug Administration (FDA) lacks regulations for e-cigarettes as therapeutic drug delivery devices and intends to regulate them as tobacco products.3Whether e-cigarettes deserve consideration as possibly effective cessation aids is a subject of ongoing debate.1,4 Much of the debate has been fueled by the uncertainties regarding the public health risks and benefits of e-cigarette use.5,6 The FDA has maintained that most available e-cigarettes lack quality control, tend to deliver inconsistent levels of nicotine (which at higher doses can be lethal), and may not be entirely free of toxins or carcinogens.3 Moreover, the FDA is concerned that e-cigarette use may facilitate tobacco use initiation and increased nicotine addiction among youths and young adults.3 Recently, however, researchers have drawn attention to the promising aspects of e-cigarettes as cessation or harm reduction devices.4,7–10E-cigarettes appear promising as cessation aids because e-cigarettes not only deliver nicotine in the manner in which nicotine replacement therapy does but also closely simulate the experience of smoking combustible tobacco. Moreover, e-cigarettes may have a comparative advantage over current FDA-approved cessation aids in terms of user satisfaction because e-cigarettes seem better suited to address both the pharmacological and the sensorimotor aspects of smoking.7,11 However, at present the research examining the efficacy of e-cigarettes as cessation aids is in its early stages. In a study involving 40 non–treatment-seeking daily smokers who were assigned to use a particular brand of e-cigarette with the purpose of helping them quit or reduce smoking, 22.5% of participants showed sustained abstinence at 24-week follow-up and an additional 32.5% were found to have reduced their cigarette consumption by half.12 In another study, a group of first-time purchasers of a brand of e-cigarettes were contacted 6 months after the purchase date.13 Of the 4.5% of potential participants who responded, 31% reported point prevalence abstinence. Thus, the studies that have suggested that e-cigarettes are likely to be effective as cessation aids have been nonexperimental and based on convenience samples. In addition, although studies have tended to agree that e-cigarettes reduce craving and withdrawal symptoms in abstinent smokers,14–16 whether e-cigarettes are efficient as nicotine delivery devices is not clear.14,15,17,18 Hence, the usefulness of e-cigarettes as cessation aids is not certain.However, the popularity of e-cigarettes has continued to soar in the United States and elsewhere.19–22 According to a recent study, approximately 6% of all adults and 21% of adult current daily smokers in the United States report ever using e-cigarettes.19 Although the majority of current e-cigarette users seem to report smoking cessation or reduction as the primary motive for e-cigarette use,11,23–24 limited evidence currently exists regarding smokers’ use of e-cigarettes as cessation aids, especially in the United States.22 Moreover, limited or no data are available on how smokers’ sociodemographic characteristics, nicotine dependence, smoking behavior, motivation and self-efficacy to quit, quit attempts, and use of FDA-approved cessation aids are related to the likelihood of having ever used e-cigarettes as cessation aids. We addressed these gaps in the literature. Specifically, we examined the prevalence of use of e-cigarettes as cessation aids in a multiethnic sample of adult current daily smokers from Hawaii and examined the associations of sociodemographic factors and smoking- and cessation-related characteristics with ever having used e-cigarettes for smoking cessation. Thus, the results of this study will help guide future research by quantifying the nature of the relationships between e-cigarette use for cessation and smokers’ characteristics, including their cessation-related attitudes and behavior. For example, knowledge about the extent of statistically significant associations of e-cigarette use with demographic and cognitive correlates will help guide the design and analytic aspects of future studies on the etiology of e-cigarette use among current smokers. In addition, the results of this study will help guide future studies testing the efficacy of e-cigarettes as cessation aids. For example, cessation-related variables found to be significant correlates of e-cigarette use for cessation may be tested as potential moderators of the efficacy of e-cigarettes as cessation aids. Thus, this study is likely to advance the research on e-cigarette use, especially among smokers.