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Researchers recently studied whether using electronic cigarettes increases the risk of smoking relapse.

About 34 million Americans smoke, and smoking usually starts during the teen years. While only about 6% of teens smoke cigarettes, almost 28% of them smoke electronic cigarettes. Youth are more likely to try smoking flavored products, and this is causing the number of young smokers to increase.

Like any addiction, once started it is not so easily quit. However, most smokers want to quit and about half of them try to do so every year. Quitting smoking has both immediate and long-term benefits for smokers’ health and well-being. But quitting is difficult, and many people relapse for numerous reasons, such as age, length of time since quitting, marital status, and BMI.

Previous research has shown that the recent (less than a year) ex-smoker is 50% more likely to relapse than the long-term ex-smoker. However, these studies did not include the effects of newer electronic smoking devices such as e-cigars, e-pipes, and e-hookahs. To eliminate this gap, researchers from the National Institute on Drug Abuse recently studied whether the use of electronic smoking devices increases the risk of traditional cigarette smoking relapse among recent and long-term ex-smokers. Their results were published in JAMA Network Open.

The study used data from the Population Assessment of Tobacco and Health (PATH) study. This study was conducted in four waves from December 2013 to March 2018. The study examined three groups of adult ex-smokers that were not using any tobacco products at the beginning of the study. 

The participants were divided into all ex-smokers, recent ex-smokers who had quit within the past 12 months, and long-term ex-smokers who had quit more than 12 months before the study began.

The research data were statistically analyzed to develop hazard models and the effects of past smoking behaviors, socioeconomic variables, time since quitting, and any substance abuse problems. Data were also collected to predict the survival curve for the different groups of ex-smokers.

The study found that there was a much greater risk of a smoking relapse for those who used an electronic smoking device, regardless of how long they had been ex-smokers. Recent ex-smokers were more likely to have a smoking relapse than long-term ex-smokers. The study also found that recent ex-smokers had more possible reasons for a smoking relapse, such as stronger and more frequent cravings and withdrawal symptoms, poor coping behaviors, and being around smoking paraphernalia.

Based on the study data, researchers suggest health practitioners discourage ex-smokers from the use of any nicotine product, including electronic cigarettes, because of the increased risk for smoking relapse and poor survival curve for recent ex-smokers.


1. Everard C, Silveira M, Kimmel H, Marshall D, Blanco C, Compton W. Association of Electronic Nicotine Delivery System Use With Cigarette Smoking Relapse Among Former Smokers in the United States. JAMA Netw Open. 2020;3(6):e204813. doi:10.1001/jamanetworkopen.2020.4813

2. Youth and Tobacco Use. Centers for Disease Control and Prevention. Published 2020. Accessed June 9, 2020.

3. Benefits of Quitting. Centers for Disease Control and Prevention. Published 2020. Accessed June 9, 2020.

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