- Smokers who quit smoking with the help of vapes were less likely to relapse than those who quit using nicotine replacement therapy.
- Continued use of vapes after quitting was linked to lower relapse rates up to one year.
- The study analysed data from 886 people attending stop-smoking services in the UK.
- Researchers found relapse was lower between both four weeks and one year, and six months and one year, among people who kept vaping.
Smokers who quit with the help of vapes and continue using them are less likely to return to smoking, according to a new study published in the journal Addiction.
The research provides what the authors describe as the first evidence that ongoing vaping after quitting may reduce the risk of relapse.
The study analysed data from a large randomised controlled trial involving people seeking help to stop smoking through UK stop-smoking services. Participants were originally assigned either vapes or nicotine replacement therapy, such as patches and gum.
Researchers then examined whether continued use of vapes after quitting affected the likelihood of returning to smoking.
Secondary analysis of a major trial
The new paper is a secondary analysis of the Trial of Electronic Cigarettes, which enrolled 886 smokers. Participants had a median age of 41, smoked an average of 15 cigarettes per day, and 48 per cent were women.
In the original trial, participants were randomly assigned to receive either a starter pack of “e-cigarettes” or a combination of licensed nicotine replacement products.
The new analysis focused on people who had successfully stopped smoking and examined whether they relapsed by 12 months.
Abstinence was defined as not smoking in the previous seven days. Relapse was defined as being abstinent at four weeks or six months but not at one year. Participants were classed as vape users if they reported using them on at least one day per week at the time they were abstinent.
Lower relapse in the vape group
The researchers compared relapse rates in two ways: between those assigned to vapes and those assigned to nicotine replacement therapy, and between people who did and did not continue vaping.
They found that people in the vape group were less likely to relapse than those in the nicotine replacement group.
Between four weeks and one year, the relative risk of relapse in the vape group was 0.78. Between six months and one year, it was 0.71. This means relapse was lower among those who had been assigned to vapes in both time periods.
A similar pattern was seen when researchers looked at continued use. People who kept using vapes after quitting were less likely to relapse than those who did not.
Between four weeks and one year, the relative risk was 0.79. Between six months and one year, it was 0.75. Overall, the data suggests that people who continued vaping were around 20 to 25 per cent less likely to return to smoking.
Why continued vaping may matter
The authors note that vapes deliver nicotine and sensory cues that are closer to smoking than traditional nicotine replacement products. This may explain why people who quit using vapes are more likely to keep using them.
Previous research has shown that only a small proportion of people who quit using nicotine replacement therapy continue to use it long term. In contrast, people who quit using vapes are more likely to carry on.
Until now, it has been unclear whether this should be encouraged or discouraged.
The paper states that “use of e-cigarettes after stopping smoking is associated with a reduced risk of relapse.”
However, the authors also note that lower relapse rates among people who choose to keep vaping may partly reflect self-selection.
They write that “the finding concerning randomised groups suggests causality,” while results based on personal choice “do not necessarily show a causal effect.”
‘Small fraction of smoking risks’
Peter Hajek, Director of the WIPH Health and Lifestyle Research Unit and lead author, said: “E-cigarette use carries only a small fraction of risks of smoking. Among people who quit smoking with the help of vapes, on-going vaping prevents relapse. It would have a positive health impact and should not be discouraged.”
Hayden McRobbie, Professor of Population Health at the WIPH Centre for Public Health and Policy, said: “A big question in helping people stay smokefree is how best to prevent relapse. For people who have quit smoking using e-cigarettes, carrying on vaping, for as long as they need to feel confident they won’t slip back to smoking, is likely to be beneficial.”
Limitations and next steps
The researchers note that smoking status was based on self-report rather than biochemical testing, and follow-up was limited to one year. They describe the analysis as exploratory and say further studies are needed to confirm whether the findings apply over longer periods.
In their conclusion, the authors state: “The current study provides the first evidence that smokers who successfully stop smoking and continue EC use reduce their risk of relapse back to smoking, but further studies are needed to verify this finding.”
