United States: How and why two thirds of vapers want to quit

A US study looked at e-cigarette users who had made at least one attempt to quit vaping. By exploring the motivations, expectations and methods of these vapers, the authors outline some avenues for developing a method for quitting vaping based on scientific evidence.

In the United States, the PATH (Population Assessment of Tobacco and Health) study showed that nearly two-thirds of e-cigarette users want to quit vaping.[1], a proportion similar to that of smokers wishing to quit smoking. As very few studies have been devoted to weaning off electronic cigarettes, there are currently no validated scientific recommendations for this type of weaning. It is from these observations that a team of researchers wanted to explore the motivations, expectations and methods used by vapers wishing to quit electronic cigarettes.

The study is based on a convenience sample drawn from a crowdsourcing platform. Participants had to speak English, be over 18 years old, have used an e-cigarette regularly in their life and have tried at least once to quit e-cigarettes. They were given a questionnaire to collect their sociodemographic data, their use and attempts to quit e-cigarettes, as well as their use of different tobacco products. A sample of 787 adults was retained, after excluding 350 incomplete or unusable questionnaires.[2].

Lack of knowledge about the nicotine levels delivered

The results indicate that 72% of participants had used an e-cigarette in the past 30 days. The actual proportion of people who had completely stopped vaping is more uncertain, with 42% of participants reporting this, but a large proportion also reporting current use; this suggests that further studies should more precisely articulate what it means to have “completely stopped” and situate this experience in time.

Current or past use of e-cigarettes was observed within 30 minutes of waking up for 67 % of participants. 89 % of the e-cigarettes used contained nicotine, but 23 % of the participants were unable to indicate this nicotine level. The reported nicotine levels also appeared to be underestimated. In this sample, 77 % of the devices used were closed system e-cigarettes, whether systems with pods or cartridges (51 %) or disposable e-cigarettes (26 %), which may explain the significant lack of knowledge of the nicotine levels delivered.

A significant proportion of vape smokers

Dual use of e-cigarettes and conventional cigarettes in the past 30 days was reported by 53 % respondents, with only 19 % reporting exclusive use of e-cigarettes, data that contrast with other studies. While 60 % participants reported using conventional cigarettes in the past 30 days, use of other tobacco products suggests greater lifetime experimentation with cigars.

84 % of the participants had tried to quit e-cigarettes in the past year, with 57 % having preferred the abrupt quit method, the other methods being reduction of use (56 %), reduction of nicotine level (38 %), nicotine replacement therapy (15 %) and change of flavour (12 %). Results that seem close to those spontaneously mentioned by smokers wishing to quit traditional cigarettes. Significant withdrawal symptoms were reported during e-cigarette withdrawal, including intense craving (41 %), headaches (30 %) and anxiety (23 %).

Health concerns top reason to quit vaping

Among the reasons for quitting e-cigarettes, health (42 %) and cost (23 %) were the most frequently cited, which is consistent with other available data. 19 % of participants said they wanted to quit e-cigarettes because they had not helped them quit traditional cigarettes, which is similar to the results of two waves of the PATH study (wave 4 2016-2018, wave 5 2019-2019). Among the people considered relevant to provide quitting advice regarding the use of e-cigarettes, doctors and other caregivers (63 %) appeared at the top, followed by family and friends (45 %) and scientists (42 %).

The authors acknowledge that the data from this study are imperfect, but emphasize that they have the merit of clearing the way for a field that has not yet been explored and that they remain partly consistent with other studies, despite the low representativeness of the sample. In terms of weaning off e-cigarettes, they recommend relying on the advice of caregivers, combined with active moral support from those around them. They believe that the treatment of withdrawal symptoms due to e-cigarettes can be provided by nicotine replacement treatments. They believe that the smoking status of vapers is crucial to determine, as the strategies for quitting vaping are quite similar to those for quitting smoking.

Keywords: electronic cigarette, withdrawal, lack, TSN, vapers,

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[1] Rosen RL, Steinberg ML. Interest in Quitting E-cigarettes Among Adults in the United States. Nicotine Tob. Res. 2020, 22, 857–858.

[2] Bluestein MA, Bejarano G, Tackett AP, Duano JC, Rawls SG, Vandewater EA, Ahluwalia JS, Hébert ET. E-Cigarette Quit Attempts and Experiences in a Convenience Sample of Adult Users. International Journal of Environmental Research and Public Health. 2023; 20(3):2332.