Individuals who reported exclusive use of combustible cigarettes as well as those who reported dual use of both cigarettes and e-cigarettes showed similarly high toxicant exposure, according to the results of a study published in Nicotine & Tobacco Research. Both groups of smokers showed higher rates of exposure than those who exclusively used e-cigarettes.
“In the U.S., dual-use of combustible cigarettes and e-cigarettes is the most common multiple tobacco-use behavior. Some individuals try to cut back on cigarettes or work toward quitting cigarettes this way,” said lead study author Zheng (Ashley) Xue, MSPH, Senior Associate Scientist, Tobacco Control Research at the American Cancer Society. “However, our results highlight that dual use is not an effective way to safeguard health and more evidence that tobacco use is harmful.”
Study Methods and Results
Investigators from the American Cancer Society analyzed data from 2,679 adults who participated in Wave 5 of the Population Assessment on Tobacco and Health Study. Among these participants, 1,913 reported exclusive cigarette use, 316 reported exclusive e-cigarette use, and 450 reported dual use. Participants were then separated into subgroups based on self-reported daily and monthly usage.
The daily use in smokers who exclusively used cigarettes did not differ significantly from the dual-use group (13.1 vs 11.8, respectively).
In participants who reported dual use, those with higher daily use had higher levels of toxic exposure to 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and three volatile organic compounds compared with those with lower daily use (257.07 ng/mg creatinine vs 312.02 ng/mg creatinine, respectively; P < .001). Higher biomarkers of exposure were found with dual or exclusive cigarette use compared with exclusive e-cigarette use. Exposure to heavy metals did not differ between groups.
“Clinicians and public health practitioners should increase awareness that dual-use of cigarettes and e-cigarettes is not safe and may present similar risks as continuing to smoke cigarettes, especially if one does not reduce the number of cigarettes smoked,” Ms. Xue added.
"It’s essential that we continue to advocate for policies that have been proven to reduce tobacco usage," stated Lisa A. Lacasse, President of the American Cancer Society Cancer Action Network. “We will continue to work with federal, state, and local lawmakers to pass strong laws and implement critical regulations that will increase access to barrier-free, culturally competent proven cessation services, end the sale of all flavored tobacco products, substantially increase tobacco taxes, and implement comprehensive smoke-free policies. These fact-based tobacco prevention and cessation programs are critical to help those addicted to quit and prevent anyone, especially youth, from ever starting. Additionally, the FDA must use the full weight of its authority to regulate all tobacco products, including removing the thousands of illegal products on the market that have not been shown to benefit the public health.”
Disclosure: For full disclosures of the study authors, visit academic.oup.com.
