Dual Use of Combustible Cigarettes and E-cigarettes: a Narrative Review of Current Evidence

Abstract

Purpose of review: E-cigarette use (vaping) among adults has increased, and various patterns of concurrent smoking and vaping (i.e., "dual use") have emerged. Understanding dual use is important for mitigating tobacco-related harm. This narrative review summarizes recent research on dual use, including prevalence and types of dual use, sociodemographic and psychiatric characteristics, nicotine dependence, reasons for dual use, harm perceptions, toxicant exposure, trajectories of dual use, and emerging treatments for dual use.

Recent findings: Nearly half of e-cigarette users concurrently use cigarettes, and many smoke more frequently than they use e-cigarettes. This is concerning because dual users are exposed to both cigarette and potential e-cigarette toxicants and the data are mixed regarding the ability of e-cigarettes to promote smoking cessation.

Summary: Further work is needed to identify ways to increase complete smoking abstinence and optimize harm reduction among dual users, including strategies to encourage e-cigarette cessation after stopping smoking.

Keywords: Cigarettes; Concurrent use; Dual use; E-cigarettes; Electronic nicotine delivery systems; Vaping.

Fig. 1

PubMed search results, by year, for English-language articles about the dual use of cigarettes and e-cigarettes as of July 2022 (N = 580). Search terms included “dual use” AND “smoking OR cigarette” AND “vaping OR e-cigarette OR ENDS OR electronic cigarette”