Electronic cigarettes, despite the fact that there are lingering questions in some people’s minds, are thought by many to be a potentially successful tool to quit smoking. One concern, however, is that using electronic cigarettes will create what is known as a “dual user,” in other words, a person who vapes and continues to smoke regular cigarettes. Some people are concerned that the dual use phenomenon is only proof that e-cigarettes don’t help users quit smoking, they only give people one more habit to have.
It’s not hard to see why people have a negative opinion of dual use in their minds. It was only a few months ago that the Center for Disease Control released a campaign, targeting e-cigarettes by attacking them for allowing smokers to become these so-called dual users. The CDC campaign focused on a young woman named Kristy, who began using e-cigarettes to stop smoking, but was unable to quit smoking completely. What she ended up doing was using both traditional cigarettes and electronic ones, until she suffered a collapsed lung. The campaign aims to attack the idea that electronic cigarettes can help people quit.
Whether electronic cigarettes can help you quit or not, many believe they are much healthier than their combustible counterparts. A report published by Public Health England recently made the claim that e-cigarettes are as much as 95% less harmful than regular cigarettes, meaning that even if you don’t quit, they can still help you reduce the harm that is done to your system.
But what does this mean? Harm reduction is a thought that is thrown around a lot in the e-cigarette community. If e-cigs are healthier than regular ones, and you cut down on your use as a result of vaping, does that mean you are reducing your harm even if you don’t quit fully? Arguments come from all angles and some research shows that certain people find success quitting with e-cigs, while others says they can’t can’t. If you are a dual user does that make you better or worse off than you were as just a smoker? All the questions surrounding dual use are beginning to require answers. In fact, the University of Wisconsin Center for Tobacco Research and Intervention was recently awarded a 1.8 million dollar grant to delve into the story behind dual use and if true harm reduction is something that can be achieved with e-cigarettes.
Who are the Dual Users?
Harm reduction aside, questions need to be answered about what being a dual user even means. A new survey study, led by Dr. Christopher Russell is helping to shed a little more light on who is likely to be a dual user. His findings were presented at the 2015 Tobacco Science Research Conference just this September. Dr. Russell works for the Centre for Drug Misuse Research in Glasgow, and his presentation claims that dual use is not a negative consequence, as an anti-vaping advocate would have you believe. Instead, he shows that dual use may put many users on the path to eventual and complete smoking cessation.
The study included a worldwide survey conducted via the Internet and held in several different languages. The sample study participants were adults who had at least used an electronic cigarette at one point, even if it was only one small puff. This differs from many surveys that have focused on longer term and more experience electronic cigarette users. The survey included 7,326 participants.
First and foremost it revealed a strong trend of success with smoking cessation using e-cigarettes. The study sums up the results on their webpage: “To give a quick overview, we surveyed 7,326 current regular vapers, of whom, 5,000 (75%) were smoking regularly at the point of their first vape. Of these individuals, 4,235 (85.9%) had quit smoking completely since they started vaping regularly, and of the 754 respondents who were still smoking, 56% had reduced their daily smoking by at least 50% since they started vaping regularly.” The researchers also revealed an interesting amount of information about dual users, and how they see e-cigarettes as a tool working toward their overall cessation. Of all the surveyed that are classified as dual users, 64% report having at least reduced their cigarette consumption. Overall, the dual users report having cut their cigarette consumption by 56%. Perhaps even more startling, 81% of dual users report experiencing a long period of smoking cessation lasting at least one week, if not longer. This fact alone reveals that whether the initial intention was smoking cessation or not, at least part of the majority result was a significant reduction in regular cigarette consumption. 70% of the dual users also say their plan is to quit smoking within six months, with 88% planning to cut their cigarette consumption by at least half in the same amount of time.
These numbers suggest a trend among dual users that is not revealed when one simply asks if they still smoke cigarettes. This seems to confirm that dual users, in fact, most e-cigarette users, are actually at least trying to quit or significantly cut back. What’s more, the majority of these users in almost all cases seem to be making some strides in the direction toward quitting. Even more importantly they continue to have the attitude that quitting is not only an option, but it is attainable in the near future.
Of course a sampling this small only gives us a glimpse into how people really feel about e-cigarettes, but it’s a telling glimpse nonetheless. Realistically, most people try to quit smoking several times; it is not often you hear about a person who quits cold turkey the first time and never looked back.
Smokers who Vape or Vapers who Smoke?
Another recent study out just this October, brings up an important point about the versatility in e-cigarette use, and that in reality there are two different kinds of dual users. Those who think of e-cigarettes as replacements and those who think of them as complementary to their regular smoking routine.
The study suggests “that a substantial minority do not perceive e-cigarettes as a substitute but rather, as a complement.” While the study does raise many questions, it also confirms that the majority of those who decide to become e-cigarette users do so as a replacement for regular cigarettes. This means that the likelihood of dual users having the intention to quit is only that much stronger. When considering dual use it’s important to remember there is a difference between non-smoking vapers who smoke an occasional cigarette and smokers who enjoy an occasional vape.
Another study published in the International Journal of Drug Policy delves into the question of dual use, and immediately the researchers make a similar distinction between the different kinds of electronic cigarette and cigarette dual users. The researchers also uncovered some truths about dual users that change the perception of who they are. The study states:
Dual users had longer smoking history, lower daily cigarette consumption, and similar cigarette dependence compared to non-smoking vapers. Their daily consumption was reduced after initiation of EC use from 20 to 4 cigarettes per day. Most of them were using ECs daily, however, more were occasional EC users compared to non-smoking vapers.
Most of the subjects involved in this study wanted to quit smoking before they started vaping and the majority showed serious harm reduction and significant decrease in cigarette consumption as a result of their e-cigarette use. In other words, just because you are a dual user, it doesn’t mean you vape and smoke BOTH at high levels, you usually will do one more than the other. Since most e-cigarette users surveyed are attempting to get off cigarettes, they are occasional smokers, more than dual users. This paints a different picture than what the CDC shows us of girls like Kristy.
The study authors believe that there is even a correlation between dual users and those who believe that e-cigarettes are more dangerous, stating in their conclusion, “ The results of this case-control study indicate that higher risk perceptions about, and less frequent use of, ECs was associated with dual use of ECs and tobacco cigarettes.” This correlation may suggest that people’s trepidation about e-cigarettes is keeping them tied to the original, combustible cigarette. They also believe that those who use e-cigarettes less, seem to be dual users more, suggesting that those dual users adore likely smokers that are occasional vapers, rather than the other way around.
Improved Health with Dual Use
While there isn’t much research on the health effects of dual use, the preliminary reports seem to show that even if a user continues to smoke regular cigarettes they stand a chance of improving their healthy dramatically with the addition of e-cigarettes. One study which was published in the Cancer Prevention Research journal claims that even in a dual use situation, there is less toxins in a users’ system. The report states that, “In dual users, EC use significantly reduced exposure to CO and acrolein because of a reduction in smoke intake. EC may reduce harm even in smokers who continue to smoke.”
Having less CO and acrolein in your system is clearly a benefit and a strong indicator of the success of the harm reduction theory. If this is true, then e-cigarette use that truly results in fewer tobacco cigarettes being consumed could really stand a chance to reduce the harm of the users.
Much more we find that using the e-cigarettes that are absent of the tar and smoke of regular cigarettes are not just reducing their harm intake but these studies are showing that many people who do use them at least have the intention to quit smoking altogether. This promising news could someday save thousands if not millions of lives and improve the public health of all of those around us.
If harm reduction isn’t considered a viable option, then we find ourselves in an all or nothing scenario. However, those who have smoked and tried to quit know that the struggle is not just black and white. There are so many gray areas and if something gets you from point a, or smoking, to point b, tobacco free, how important is what’s in-between a and b anyway? If we lived in a world where nicotine wasn’t as addictive and insidious as it really is everyone would be able to quit cold turkey, which is unquestionably the healthiest option. However, that clearly does not work for everyone. Getting to the end, getting to tobacco free, may take days for some, but honestly it will take months and years for most people. What studies are showing is that dual use isn’t then end of the line, but rather just a stop along the path to a totally tobacco-free lifestyle; dual use isn’t a failure, it should be looked at as what it is for most: a step.
Quitting is a long process, different people use different strategies, and the inevitable slip up does happen. The only thing that is really constant in everyone’s own stop smoking journey is that it is a long and hard road—and that road looks different for everyone. For some dual use is part of that journey, for others it is not. If you are using e-cigarettes and you just can’t seem to kick the regular ones, maybe electronic cigarettes are not the right avenue for you. That does not, however, seem to be the case for the majority of those surveyed in the above reports, who claim that they find themselves smoking less and less and that they intend on quitting completely in the near future. Findings like this suggest that dual users are not just adding another habit to their lives, but they are more likely just on their way to kicking their tobacco habit—and leaving the cigarettes behind for good.