Does switching from cigarettes to e-cigarettes facilitate smoking cessation? Researchers investigating the incidence of relapse among smokers who had switched to e-cigarettes or other tobacco products found no evidence that switching prevents a relapse to cigarette smoking. The results of their study were published in JAMA Network Open.

The researchers conducted a cohort study of smokers who smoked but had recently quit. They collected data from the US Population Assessment of Tobacco and Health (PATH) study, using 4 annual waves from the Path study to identify 2 cohorts of people who had recently quit smoking cigarettes and who completed 2 follow-up surveys. This included 13,604 adults. The researchers then delved into whether those recent former smokers were still using some type of tobacco product.

They found that the more dependent on cigarettes a former smoker had been, the more likely they were to be using some sort of tobacco product at the first follow-up. “Those in the lowest tertile of dependence were less likely to use an e-cigarette than those in the highest tertile,” they noted, adding that people who viewed e-cigarettes as roughly equivalent to regular cigarettes in terms of harm potential had a lower prevalence of being tobacco-free at that first follow-up.

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At a second follow-up approximately 12 months later, the researchers found that a higher proportion of former smokers who were tobacco-free at the first follow-up had successfully quit by the second follow-up. However, those former smokers who had switched to e-cigarettes at the time of the first follow-up were more likely to have relapsed by the second follow-up.

They also found that former smokers who switched to some other type of tobacco product were more likely to make another quit attempt, which the researchers suggested could show a need to investigate quit and relapse patterns. This could provide more information about whether such a switch may be an example of progress toward a sustained quit attempt.

“This longitudinal follow-up cohort study of a large representative sample of US recent former smokers showed that switching to e-cigarettes (even on a daily basis) was not associated with helping smokers remain abstinent from cigarettes,” the researchers concluded. “Indeed, the evidence suggested that switching to alternate tobacco products by recent former smokers may be associated with increased risk of a relapse to cigarette smoking.”

As a population study, this study was observational, which is a limitation. The researchers also noted that “the exposure variable was not under experimental control, thus limiting causal inference.”


Pierce JP, Chen R, Kealey S, et al. Incidence of cigarette smoking relapse among individuals who switched to e-cigarettes or other tobacco products. JAMA Netw Open. 2021;4(10):e2128810. doi:10.1001/jamanetworkopen.2021.28810