“There is no one giant step that does it. It’s a lot of little steps on the journey…”

The transition from smoking to vaping is a journey. Some people pick up their first vape and immediately, or soon after, stop smoking completely.  Many others take months, or even years, to make the transition. This is the reality of transitioning from combustible tobacco to E liquid vapourisers (ELVs) aka “vaping”.  It is also why they are so effective for so many people and why dual use has been studied by such esteemed scientists as Riccardo Polosa and Konstantinos Farsolinos.   Both Drs. proved that a reduction in use of combustible tobacco, concomitant with use of ELVs shows improved respiratory and cardiovascular outcomes.   In other words, dual use is a form of harm reduction, albeit not at the same level of a complete transition from combustible tobacco.  We, as vapers, know this. 

Some researchers, however, do not know or do not wish to acknowledge this.   A perfect case in point is the recent research published from the University of Otago entitled “Dual use of electronic nicotine delivery systems (ENDS) and smoked tobacco: a qualitative analysis.”

Interestingly though, the information outlined in this report appears to have approached the data with the premise that ‘dual use’ prevents people from stopping smoking completely. The researchers also seem to consider people who both smoke and vape as people who have failed at reducing harm, then they appear to be surprised when some of the research participants do not view their behaviour in the same way.   It is not unusual for new vapers to feel happy that they have made a substantial reduction in the number of cigarettes they smoke because for many it is their first step to becoming smoke free.  The researchers also appear to be unaware of a phenomenon –  well known to the vaping community – of accidental quitting – It is not unusual for people to start vaping with little or no intention of quitting smoking but end up quitting cigarettes anyway.  Lastly, the researchers seem to be completely unaware of the clear link between reduction in cigarettes + intensity of vaping, and how addicted the users is (Fagerström test). This indicates that e-cigarettes can actually wean the smokers off combustible tobacco slowly. So dual use could have significant benefits for heavy smokers from just picking up a vape and trying it if it replaces any of the normally consumed combustible tobacco product.

There is some data presented that provides evidence of factors that may have affected the participants that are not psychosocial:

  • Two of the twenty participants in this study did not own a vapouriser so there can be no real expectation that they would completely switch to vaping.
  • One participant, who was smoking 30 cigarettes a day at the time of interview, did not vape with nicotine so it is hardly surprising that this person did not transition.
  • Only five of the participants had not reduced the amount of cigarettes that they smoked. Most of the participants reported using a second generation vape pen which is often not quite powerful enough for some long term/heavy smokers.
  • One of the participants commented “…it depends because probably the days I take my vape pen would be with the friends that don’t smoke…so you just sit there and just puff and get that fix, that feeling you’re needing, without it irritating everyone around you.”

The last commenters statements are telling to an experienced vaper,  it shows that they are: A) Not really a vaper and  B) still smoke as many cigs as he/she always has. As such, that does not denote dual user but instead an experimenter and not a valid subject for the study as outlined in the methodology.

The emphasis of the study that dual use should be eradicated as it does not offer harm reduction is false, as within the study itself it states that “reducing from 20 down to 1 gives at least 50% reduction in harm”.  Combined with the assertion that indoor vaping bans should be included in legislation, will only make vaping less attractive to smokers and is wildly counterproductive towards reducing harm from combustible tobacco.  Research on what what WE, the vapers do – the WHO WHAT WHEN WHERE AND WHY of our use, needs to involve US, in order to have any relevance in real world applications in terms of policy and legislation.

REFERENCES:

Polosa, R., Cibella, F., Caponnetto, P., Maglia, M., Prosperini, U., Russo, C., & Tashkin, D. (2017, November 17). Health impact of E-cigarettes: a prospective 3.5-year study of regular daily users who have never smoked. Retrieved February 09, 2018, from https://www.nature.com/articles/s41598-017-14043-2

Farsolinos, K. E., Romagna, G., & Voudris, V. (2015, June 15). Factors associated with dual use of tobacco and electronic cigarettes: A case control study. Retrieved February 09, 2018, from https://doi.org/10.1016/j.drugpo.2015.01.006

Robertson, L., Hoek, J., Blank, M., Richards, R., Ling, P., & Popova, L. (2018, February 01). Dual use of electronic nicotine delivery systems (ENDS) and smoked tobacco: a qualitative analysis. Retrieved February 09, 2018, from http://tobaccocontrol.bmj.com/content/early/2018/01/31/tobaccocontrol-2017-054070.long

Pérez-Ríos, M., Santiago-Pérez, M., Alonso, B., Malvar, A., Hervada, X., & Leon, J. D. (2009, December 30). Fagerstrom test for nicotine dependence vs heavy smoking index in a general population survey. Retrieved February 09, 2018, from https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-9-493.

Author

Nancy comes from a diverse administrative background that includes surgical research administration, teaching (primary and tertiary level), executive administration and community property management. For over 15 years she has been very active in community advocacy with youth, lower income folk needing advocacy and now, vaping advocacy. She brings a wealth of scientific, medical and research administrative/management knowledge with her to her role as CEO/Director at AVCA.