E-Cigarettes May Be Inadequate as a Smoking Cessation Tool

Electronic cigarette
Electronic cigarette
Dual users of conventional cigarettes and electronic cigarettes had the highest prevalence of respiratory symptoms.

Electronic cigarettes (e-cigarettes) do not serve as an effective smoking cessation tool according to the results of a cross-sectional, population-based study performed within the Obstructive Lung Disease in Northern Sweden (OLIN) study and West Sweden Asthma Study (WSAS) and published in JAMA Network Open.

In the 10 years since they were introduced, use of e-cigarettes has grown rapidly, and they are now a billion-dollar industry. However, it is a major point of contention as to whether e-cigarettes offer a possible solution to the tobacco epidemic or constitute a potential danger to those who use them. Some experts argue that e-cigarettes help wean smokers off cigarettes and that they reduce the harm caused by tobacco, while others contend that they have adverse effects on respiratory health, prolong smoking or have no effect on smoking cessation, and serve as a gateway to smoking conventional cigarettes in adolescent nonsmokers. 

Linnea Hedman, PhD, of the OLIN Studies in Lulea, Sweden, and colleagues analyzed e-cigarette use, smoking habits, and respiratory symptoms in participants taken from the OLIN and WSAS studies.

Of the 30,272 participants in the 2 studies, 3694 (12.3%) were current smokers and 7305 (24.4%) were former smokers, and 529 (2.0%) were e-cigarette users. E-cigarette use was more common in men (2.2%) than in women (1.8%). Of the e-cigarette users, 66.7% were also current smokers, and 9.8% of smokers also used e-cigarettes. Of the e-cigarette users, 15% were former smokers, but only 1.1% of former smokers used e-cigarettes; 18.3% of e-cigarette users were nonsmokers, and 0.6% of nonsmokers used e-cigarettes. Other factors associated with e-cigarette use were younger age and lower education level.

The finding that nearly 1 out of 5 e-cigarette users was a nonsmoker is noteworthy in light of the argument that e-cigarettes serve as a gateway to smoking. This group is at risk of becoming addicted to nicotine, which may increase the risk for cardiovascular disease. Current smokers, and particularly those who smoked the highest number of cigarettes per day, were most likely to use e-cigarettes, which may be the result of their wanting to augment their smoking habit in situations where cigarette smoking is not allowed or the result of their attempting to stop smoking. Nonetheless, evidence from this study does not support using e-cigarettes as a smoking cessation tool.

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In addition, respiratory symptoms were more common in e-cigarette users, particularly in current smokers, but also in nonsmokers and former smokers, which supports the growing evidence that suggests that e-cigarettes have adverse respiratory and vascular effects.

The researchers called for longitudinal studies to determine the long-term health effects of e-cigarettes and whether their use will increase respiratory disease or serve to advance smoking cessation, particularly in dual users.


Hedman L, Backman H, Stridsman C, et al. Association of electronic cigarette use with smoking habits, demographic factors, and respiratory symptoms. JAMA Network Open. 2018;1:e180789.