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Original research
Is dual use of nicotine products and cigarettes associated with smoking reduction and cessation behaviours? A prospective study in England
  1. Sarah E Jackson,
  2. Emma Farrow,
  3. Jamie Brown,
  4. Lion Shahab
  1. Department of Behavioural Science and Health, University College London, London, United Kingdom
  1. Correspondence to Dr Sarah E Jackson; s.e.jackson{at}


Objectives To investigate associations of dual use of e-cigarettes and cigarettes with subsequent quitting activity (smoking reduction, quit attempts and use of evidence-based cessation aids). To overcome potential confounding by factors associated with use of pharmacological support, we selected dual use of over-the-counter nicotine replacement therapy (OTC NRT) and cigarettes as a behavioural control.

Design Prospective cohort study with 6-month follow-up.

Setting England, 2014–2016.

Participants 413 current smokers participating in the Smoking Toolkit Study, a representative survey of adults in England, who reported current use of e-cigarettes or OTC NRT and provided data at 6-month follow-up.

Main outcome measures The exposure was dual use of e-cigarettes or OTC NRT at baseline. Outcomes were change in cigarette consumption, quit attempts and use of evidence-based cessation aids during quit attempts over 6-month follow-up. Relevant sociodemographic and smoking characteristics were included as covariates.

Results After adjustment for covariates, dual e-cigarette users smoked two fewer cigarettes per day at follow-up than at baseline compared with dual OTC NRT users (B=2.01, 95% CI −3.62; −0.39, p=0.015). While dual e-cigarette users had 18% lower odds than dual OTC NRT users to make a quit attempt at follow-up (risk ratio (RR) 0.82, 95% CI 0.67 to 1.00, p=0.049), the groups did not differ in use of cessation aids (RR 1.06, 95% CI 0.93 to 1.21, p=0.388).

Conclusions Dual use of e-cigarettes is associated with a greater reduction in cigarette consumption than dual use of OTC NRT. It may discourage a small proportion of users from making a quit attempt compared with dual OTC NRT use but it does not appear to undermine use of evidence-based cessation aids.

  • e-cigarettes
  • nicotine replacement therapy
  • dual use
  • smoking cessation
  • cigarette consumption

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  • Twitter @DrSarahEJackson, @jamiebrown10

  • Contributors EF, JB and LS conceived and designed the study. SJ and EF analysed the data and drafted the manuscript. JB and LS provided critical revisions. All authors read and approved the submitted version.

  • Funding Cancer Research UK funded data collection (C1417/A22962; C44576/A19501) and SJ and JB’s salary (C1417/A22962). SJ’s salary was also supported by the Economic and Social Research Council (ES/R005990/1). The funders had no final role in the study design; in the collection, analysis and interpretation of data; in the writing of the report or in the decision to submit the paper for publication. All researchers listed as authors are independent from the funders and all final decisions about the research were taken by the investigators and were unrestricted.

  • Competing interests LS has received a research grant and honoraria for a talk and travel expenses from manufacturers of smoking cessation medications (Pfizer and Johnson & Johnson). JB has received unrestricted research funding from Pfizer, who manufacture smoking cessation medications. All authors declare no financial links with tobacco companies or e-cigarette manufacturers or their representatives.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The University College London Ethics Committee provided ethical approval for the Smoking Toolkit Study (ID 0498/001).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available from the corresponding author on reasonable request.