A Self-Help Smoking Cessation Intervention Designed for Dual Users

A recent study published in the International Journal of Environmental Research and Public Health, gathered data about smokers who are using e-cigarettes in a bid to quit smoking, with the intention of developing specific smoking cessation interventions targeted at dual users.

Diane Caruana

July 26, 2021

A smoking cessation plan designed for dual users should include e-cigarette-specific strategies used by successful quitters.

Studies keep indicating that most vapers use e-cigarettes as intended, to quit smoking. However while switching, some users end up getting stuck in the dual use phase where they start vaping but also keep smoking.

Dual use of e-cigarettes and cigarettes tends to be discouraged by tobacco harm reduction experts and vaping advocates alike, as the whole point of vaping is cutting down on cigarettes. On the other hand, some argue that those who engage in dual use are still smoking less cigarettes, ie. reducing harm.

Two studies conducted in England in 2020, aimed to determine the relationship between dual use and smoking cessation success. The study titled, “Associations Between Dual Use of E-Cigarettes and Smoking Cessation: A Prospective Study of Smokers in England,” looked into this by analyzing the tobacco use behaviour within a cohort of 1,498 smokers in England.

The obtained results indicated that while dual use of e-cigarettes was not associated with reduced overall quit rates when compared to exclusive smoking or dual use of NRT, it was associated with a slightly higher quit attempt rate than exclusive smoking, but lower than dual use of NRT.

A program designed specifically for dual users

The second study, “Is Dual Use of Nicotine Products and Cigarettes Associated With Smoking Reduction and Cessation Behaviours? A Prospective Study in England,” analyzed once again the relationship between dual use and quitting activity (smoking reduction, quit attempts and use of evidence-based cessation aids).

A total of 413 current smokers taking part in the Smoking Toolkit Study, a representative survey of adults in England, were recruited, and provided data at baseline and at a 6-month follow-up. The compiled data indicated that dual users of e-cigarettes and cigarettes smoked fewer cigarettes per day at follow-up than at baseline, when compared to dual users of NRTs and cigarettes.

This study addressed this issue, by trying to develop a specific smoking cessation program that is tailor made for people who are stuck in this pattern. “Using formative data from in-depth interviews and employing learner verification, we adapted an existing, validated self-help smoking-cessation intervention (Stop Smoking for Good; SSFG) to create a targeted intervention for dual users, If You Vape: A Guide to Quitting Smoking (IYV).”

Strategies used by successful cigarette quitters

The research team looked into vape strategies used by successful quitters, suggesting they should be implemented. “Findings led to the inclusion of e-cigarette-specific strategies used by successful quitters such as gradually reducing nicotine levels, switching from tobacco flavor to alternative flavors, and limiting e-cigarette use to places one would normally smoke (i.e., not expanding use).”

“Suggestions from Phase II learner verification included broadening the visual appeal for a younger, more diverse demographic, expanding tips for quitting smoking via e-cigarettes, and expanding terminology for e-cigarette devices. Beginning with an efficacious self-help intervention, we used a systematic process to develop a version specifically for dual users.”