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Smoking
Original research
Assessment of formal tobacco treatment and smoking cessation in dual users of cigarettes and e-cigarettes
  1. Brendan T Heiden1,2,
  2. Timothy B Baker3,
  3. Nina Smock4,
  4. Giang Pham4,
  5. Jingling Chen4,
  6. Laura J Bierut4,
  7. Li-Shiun Chen2,4,5
  1. 1 Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
  2. 2 Division of Public Health Sciences, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
  3. 3 Center for Tobacco Research and Intervention, University of Wisconsin-Madison, Madison, Wisconsin, USA
  4. 4 Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
  5. 5 Alvin J. Siteman Cancer Center, Washington Univeristy in St Louis, St Louis, Missouri, USA
  1. Correspondence to Dr Brendan T Heiden, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA 63110; bheiden{at}wustl.edu

Abstract

Background The utility of electronic cigarettes (‘e-cigarettes’) as a smoking cessation adjunct remains unclear. Similarly, it is unclear if formal tobacco treatment (pharmacotherapy and/or behavioural support) augments smoking cessation in individuals who use both cigarettes and e-cigarettes.

Methods We performed a longitudinal cohort study of adult outpatients evaluated in our tertiary care medical centre (6/2018–6/2020). E-cigarette use, smoking status and formal tobacco treatment (deterrent pharmacotherapy and/or behavioural support) were assessed in 6-month blocks (eg, cohort 1 (C1)=6/2018–12/2018, C2=1/2019–6/2019 and so on) using our electronic health record. We assessed the relationship between e-cigarette use (either with or without formal tobacco treatment) and point prevalence of smoking cessation at 6 and 12 months.

Results 111 823 unique patients were included in the study. The prevalence of dual use of cigarettes and e-cigarettes increased significantly over the study period (C1=0.8%; C2=1.1%; C3=1.8%; C4=2.3%; p<0.001). The prevalence of smoking cessation at 12 months was higher among e-cigarette users (20.8%) compared with non-users (16.8%) (risk difference, 4.0% (95% CI 2.5% to 5.5%); adjusted relative risk (aRR) 1.354, 95% CI 1.252 to 1.464, p<0.0001). Further, among dual users of cigarettes and e-cigarettes, the prevalence of smoking cessation at 12 months was higher among individuals who received tobacco treatment (29.1%) compared with individuals who did not receive tobacco treatment (19.6%) (risk difference, 9.5% (95% CI, 4.6% to 14.4%); aRR 1.238, 95% CI 1.071 to 1.432, p=0.004).

Interpretation These results suggest that dual users of cigarettes and e-cigarettes benefit from formal tobacco treatment. Clinicians should consider offering formal tobacco treatment to such patients, though future trials are needed.

  • smoking cessation
  • tobacco control
  • tobacco and the lung

Data availability statement

No data are available. Data from this study are not publicly available.

https://doi.org/10.1136/thorax-2022-218680

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    Data availability statement

    No data are available. Data from this study are not publicly available.

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    Footnotes

    • Twitter @BrendanHeiden

    • Contributors Study conception and design: BTH, NS, L-SC. Data acquisition and analysis: BTH, NS, GP, JC, LS-C. Data interpretation and manuscript writing: BTH, NS, L-SC. Critical revision and final approval of the manuscript: all authors. L-SC is responsible for the overall content as the guarantor.

    • Funding Funded in part by NIH 5T32HL007776-25 (BTH), NIH P30 CA091842-19S5 (L-SC), NIH P50 CA244431 (L-SC), NIH R01DA038076 (L-SC), NIH U19 CA203654 (LJB), Alvin J Siteman Cancer Center Investment Program 5129—Barnard Trust and The Foundation of Barnes Jewish Hospital Cancer Frontier Fund.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.