ASHES, Vol. 19(10) – Experiences of smokers who returned to smoking after exclusive electronic nicotine delivery systems use


While more than half of U.S. adult smokers attempt to quit every year, fewer than 10% actually succeed. Electronic nicotine delivery systems (ENDS)—also known as e-cigarettes or vapes—may help people quit smoking cigarettes. But, as with other cessation methods, the majority of quit attempts are unsuccessful and smoking resumption is common. This week, ASHES reviews a study by Lindsay Robertson and colleagues that explored current smokers’ experiences with ENDS and return-to-smoking after exclusive ENDS use.

What was the research question?
What are current smokers’ experiences with ENDS use and return-to-smoking after exclusive ENDS use?

What did the researchers do?
The researchers conducted semi-structured interviews with 20 current smokers in New Zealand recruited via social media. All participants had used ENDS to stop smoking for at least 30 days, and had subsequently resumed smoking. Participants were asked about their experiences with ENDS, their experiences with return-to-smoking (including triggers), and strategies that could help prevent smoking resumption. The researchers analyzed the interviews for common themes pertaining to ENDS use and return-to-smoking.

What did they find?
Three themes emerged (see Figure). First, ENDS plays a positive functional role by simulating smoking. Participants noted that similarities between ENDS use and smoking (e.g., hand movements, inhaling) helped them transition from cigarettes while maintaining familiar smoking and socializing practices. Despite these similarities, ENDS were viewed as inauthentic and less satisfying than smoking. For example, participants felt ENDS were a poor substitute for cigarettes, for example because they do not provide the same feelings of relaxation and pleasure as cigarettes. Finally, many participants thought that ENDS use could perpetuate addiction and risk of harm. ENDS were viewed as more convenient than cigarettes and participants noted this made using them difficult to control and could lead to overconsumption. Some participants were also concerned about the unknown long-term effects of ENDS use. Despite having resumed smoking, participants generally viewed ENDS favorably and as a means to help them stop smoking in the future.

Figure. Common experiences with ENDS among people who resumed smoking after exclusive ENDS use. Quotes are from participant interviews and correspond with the three themes that emerged from the interviews: ENDS’ functional role, ENDS’ inauthenticity, and ENDS perpetuating addiction and risk of harm. Click image to enlarge.

Why do these findings matter?
These findings suggest that ENDS may be particularly helpful during the initial transition from cigarette use, given their functional properties are similar to smoking. However, over time, ENDS users may be left feeling unsatisfied and still attracted to cigarette smoking. This suggests that people might need additional support making the transition to exclusive ENDS use. For example, it may be beneficial to provide education on the potential challenges of switching, like dissatisfaction or how to handle cigarette cravings. These findings also highlight ENDS users’ concerns about overconsumption and difficulty controlling their ENDS use. They may benefit from strategies to help them manage their ENDS use, such as treating ENDS use like smoking (e.g., using ENDS outdoors only to prevent constant use and limit overconsumption).

While some research suggests ENDS may help people quit smoking, the evidence is inconclusive and additional research is needed to fully understand the risks and benefits of ENDS and its effectiveness as a cessation tool. Such research into the short- and long-term health effects of ENDS use is needed for individuals to make informed decisions about ENDS use as a smoking cessation tool.

Every study has limitations. What are the limitations of this study?
Findings from this study might not be generalizable to other geographic regions where tobacco laws, regulations, and norms are different. Findings from this study are self-reported and might be subject to biases, such as recall bias.

For more information:
SmokeFree offers tools and tips for quitting and maintaining abstinence from smoking tobacco. The Centers for Disease Control and Prevention also provides research and tips about cigarettes and how to quit. For additional self-help tools, please visit the BASIS Addiction Resources page.

— Kira Landauer, MPH

What do you think? Please use the comment link below to provide feedback on this article.

Leave a Reply

Your email address will not be published. Required fields are marked *