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Electronic Cigarette Use and Smoking Reduction in France
Study Questions:
Is electronic cigarette (e-cigarette) use associated with changes in smoking patterns among current cigarette smokers and former smokers?
Methods:
The CONSTANCES (Consultants des Centres d’Examens de Santé) is a cohort study that enrolled participants starting in January 2012. This community sample of adults residing in France allows for prospective follow-up of smoking patterns in association with the use of e-cigarettes. Participants enrolled through 2015 who had completed ≥1 questionnaire who were current smokers or had quit in 2010 or later were included in this analysis. The present study population included 5,400 smokers (mean follow-up was 23.4 [SD 9.3] months) and 2,025 former smokers (mean follow-up 22.1 [SD 8.6] months). Former smokers had quit smoking in 2010, the year in which e-cigarettes were introduced in France, or afterward. The primary outcomes of interest were number of cigarettes smoked per day during follow-up, change in number of cigarettes per day from baseline to follow-up, and the likelihood of smoking cessation and smoking relapse (among former smokers).
Results:
A total 5,400 daily smokers (2,906 women and 2,494 men; mean age 44.9 years) were included in the present analysis. E-cigarette use was reported among 15.2% of smokers and 8.7% of former smokers. E-cigarettes users were more likely to be male, older, and were heavier smokers compared to non–e-cigarettes users. Regular e-cigarette use was associated with a significantly higher decrease in the number of cigarettes smoked per day compared to daily smokers who did not use e-cigarettes (-4.4; 95% confidence interval [CI], -4.8 to -3.9 vs. -2.7; 95% CI, -3.1 to -2.4). E-cigarettes were also associated with a higher adjusted relative risk (RR) of smoking cessation (RR, 1.67; 95% CI, 1.51-1.84). However, among the 2,025 former smokers (1,004 women and 1,021 men, mean age 43.6 years), e-cigarette use was associated with an increase in the rate of smoking relapse among former smokers (adjusted hazard ratio, 1.70; 95% CI, 1.25-2.30).
Conclusions:
The investigators concluded that among adult smokers, e-cigarette use appears to be associated with a decrease in the number of cigarettes smoked and an increase in smoking cessation attempts. E-cigarette use was also associated with an increase in the level of smoking relapse after approximately 2 years of follow-up.
Perspective:
These data suggest that e-cigarettes may be helpful to some during smoking cessation; however, e-cigarettes may not help maintain smoking cessation.
Clinical Topics: Prevention, Smoking
Keywords: Electronic Nicotine Delivery Systems, Primary Prevention, Risk, Smoking, Smoking Cessation, Tobacco Products, Tobacco Use Cessation Devices
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