Targeted intervention could help promote smoking cessation among dual users

E-cigarettes spark many concerns, especially when it comes to youth vaping. However, emerging evidence suggests that e-cigarettes can be a helpful tool in smoking cessation. Researchers in Moffitt Cancer Center's Tobacco Research and Intervention Program wanted to build upon this evidence by testing whether they could help dual users, people who use both combustible cigarettes and e-cigarettes, quit smoking.

In a new article published in The Lancet Public Health, they report results from a first-of-its kind nationwide study evaluating a targeted intervention aimed at transforming dual users' e-cigarettes from a product that might maintain smoking into a tool that can be used to aid smoking cessation.

An estimated 8 million adults in the U.S. use e-cigarettes, often with the goal of quitting or reducing cigarette smoking. Nearly 41% are dual users, a practice that maintains, and in some cases might increase, both nicotine dependence and exposure to toxins.

We were concerned that smokers who started vaping in order to quit smoking often ended up instead using both products. This prompted our team to develop an easy-to-distribute intervention that could enhance dual users' smoking cessation efforts and maintain smoking abstinence."

Thomas Brandon, Ph.D., Chair of the Health Outcomes & Behavior Department and Director of the Tobacco Research and Intervention Program, Moffitt cancer Center

The research team, which included collaborators from Virginia Commonwealth University; Eastern Virginia Medical School; and the University of Auckland, New Zealand, interviewed vapers who were and were not able to quit smoking. Based on what they learned, they developed a series of "If You Vape" booklets that includes smoking cessation advice geared specifically for dual users.

To test their intervention, the Moffitt team launched a national trial with nearly 2,900 dual users. Participants were randomized into three groups: an assessment group receiving no intervention, a generic self-help group receiving standard smoking cessation materials, and the targeted intervention group receiving the new "If You Vape" booklets. Participants completed surveys every three months for two years to report their current smoking and vaping.

The results showed that the targeted intervention produced smoking abstinence rates about 5 to 10 percentage points higher than the assessment group over the 18 months of treatment. The generic intervention produced abstinence rates in between the two other arms. The researchers noted that while those who reported little to no dependence on combustible cigarettes had greater overall success in quitting, more dependent smokers benefited the most from the new intervention. For example, among dependent smokers who received the booklets, about 20% had quit smoking by six months, compared to 13% of those in the assessment arm.

"Our study indicates that dual users could benefit from specific interventions that leverage their ongoing e-cigarette use, which in turn could expand the public health potential of e-cigarettes," said Brandon. "I think it is important to note that while our materials did not endorse the initiation of vaping, it also didn't demonize use. We treated vapers with respect and passed along information to help them achieve their goal of quitting smoking."

Although the booklets suggest that participants might eventually consider giving up all nicotine, the researchers found no differences in vaping across groups.

The research team would like to expand their efforts to include testing alternative intervention modalities such as a mobile app, improving long-term smoking cessation, and testing the intervention in clinical settings.