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Former smokers are nearly three times more likely to abstain from cigarette smoking if they puff on an e-cigarette two out of every three days a month, according to the analysis of a federal survey on smoking.
"E-cigarettes are an effective way to get cigarette smokers to quit, but you really need to use those e-cigarettes," said lead researcher David Levy. "Using them a couple days a month isn't going to be anywhere near as effective as if you use them most, if not all, days in a month."
The odds of a smoker successfully quitting increases by 10 percent with each additional day of e-cigarette use, said Levy, a professor with Georgetown University's Lombardi Comprehensive Cancer Center, in Washington, D.C.
However, pulmonologist Dr. Louis De Palo said he's concerned e-cigarettes do too good of a job replacing traditional tobacco cigarettes.
"People don't get addicted to the other forms of nicotine replacement because they aren't fun," said De Palo. He's an associate professor of pulmonary, critical care and sleep medicine with the Icahn School of Medicine at Mount Sinai in New York City.
"Gum doesn't taste very good. The nose inhaler burns a little bit. The patches are irritating. And none of them give you the psychological satisfaction of holding something in your hand and smoking," he explained.
"E-cigarettes are highly addictive, easy to use, and fun," De Palo continued. "This study doesn't address the strategy for eventually weaning people off e-cigarettes."
For this study, Levy and his colleagues reviewed data from more than 24,000 participants in the 2014/2015 Tobacco Use Supplement-Current Population Survey, a regular survey on smoking administered by the U.S. Census Bureau.
The researchers chose that specific time period because "that's the year when e-cigarette use really took off," Levy said.
The research team compared patterns of e-cigarette use with a former smoker's ability to abstain from traditional cigarettes for at least three months.
"We used three months because people argue that's more relevant, because you see a lot of relapse within the first three months," Levy said.
The investigators found that former smokers were 2.8 times more likely to remain smoke-free if they used an e-cigarette at least 20 days in a month.
By comparison, those who used an e-cigarette only five or more days a month were only 60 percent likely to abstain from traditional cigarettes for three months, the results showed.
About one-third of smokers who used e-cigarettes nearly every day successfully quit, researchers said, compared with 5 percent to 6 percent of those who used e-cigarettes between 5 and 14 days in a month.
Smokers who used an e-cigarette two out of every three days also were nearly five times more likely to attempt to quit tobacco, the researchers found.
"We're not saying doctors should recommend e-cigarette use before other methods are tried, but if other methods are tried and fail, our results strongly indicate a potential for people to quit using e-cigarettes," Levy said.
However, it only works if people toss their cigarette packs in the trash for good, Levy added.
"The benefits of e-cigarette use are only seen if the individual completely quits smoking," Levy said.
Concerns also remain regarding the safety of e-cigarettes, De Palo said, including the potential for their vapor to contain heavy metals and other harmful chemicals. The U.S. Food and Drug Administration is rolling out regulations for e-cigarettes, but the process is still underway.
"There may be as-yet-unrecognized health consequences of e-cigarettes," De Palo said, adding that e-cigarettes also provide a means for addicting people to nicotine who may never have chosen to smoke tobacco.
The best way to quit smoking is to combine nicotine replacement with cognitive behavioral therapy or some other type of therapy, De Palo said. That way, both the physical and psychological aspects of addiction are addressed at the same time.
The study was published Aug. 31 in the journal Nicotine & Tobacco Research.
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