ATLANTA — e-cigarette smokers are highly likely to use the alternative nicotine product as part of their effort to quit smoking tobacco, according to results from a new survey on e-cigarette usage.

In the Tennessee-based study, current cigarette smokers were seven times more likely than nonsmokers to be e-cigarette users. Additionally, tobacco smokers who also smoked e-cigarettes were at least 3.5 times more likely than non-e-cigarette users to have quit smoking for a day or longer during the past 12 months for the sake of quitting.

"There's evidence here that Tennessee smokers are using e-cigarettes as an aid to quit smoking," said investigator Ransom Wyse, MPH, an epidemiologist with the Tennessee Department of Health in Nashville.

"This is the first time we've seen this," he said here at the American Public Health Association (APHA) 2017 Annual Meeting.

e-cigarettes have been marketed as a less-harmful alternative to cigarettes as well as a useful stop-smoking aid because the level of nicotine can be adjusted, but the US Food and Drug Administration (FDA) has not approved the product for this purpose, he pointed out.

Wyse's research aimed to determine how many smokers in Tennessee — who comprise 20% to 25% of the adult population there — might be using e-cigarettes as a cessation aid.

This is the first time we've seen this.

The survey didn't specifically ask if smokers were using e-cigarettes as a way to quit their tobacco habit, but much of the related behavioral information collected lends credence to the notion that they are, he told Medscape Medical News.

The 2016 Tennessee Behavioral Risk Factor Surveillance System data included 6167 respondents, 1178 (22.1%) of whom were current cigarette smokers.

Only adults who self-reported as current smokers were asked if they had tried to quit in the prior 12 months.

More than 16% of smokers in the study said they also smoked e-cigarettes, and 60% of all cigarette smokers reported they'd attempted to quit in the prior 12 months. Among e-cigarette users, however, the proportion of attempted efforts to stop smoking rose to more than 83% in the same time frame.

This research represents the first statewide e-cigarette usage data in the state of Tennessee, said Wyse. Additionally, he said, the topic aligns with the "Big 4" preventable epidemics of smoking, substance abuse, obesity, and physical inactivity of Tennessee's Commissioner of Health John Dreyzehner, MD, MPH.

Wyse held back from stating that the new data could be generalizable to other states or the United States as a whole. But "in the past, Tennessee has compared a weighted sample of our respondents to national statistics and we've seen that it's a high-percent agreement," he said.

He added that he hopes a "strong public health message" can be crafted that describes the risks of e-cigarette use and that the FDA will decide whether or not to back e-cigarettes as a useful stop-smoking aid.

"If the FDA truly believes this is a not-so-harmful alternative, it would be very effective if they could say you should use e-cigarettes as a cessation aid," he said.

Asked to comment on the study, Tom Eckstein, MBA, from the epidemiology firm Arundel Metrics in St Paul, Minnesota, said that collecting e-cigarette data is an important first step in changing attitudes and behaviors related to smoking.

"We can't change what we don't measure," Eckstein told Medscape Medical News. "The data show, in my mind, that we're starting to find the effects of e-cigarette use on the nicotine problem, particularly in Tennessee and how it's factoring into getting people off that addiction."

Shirley Cramer, MSc, from the Royal Society for Public Health in London, United Kingdom, said smokers in England are already actively encouraged to switch to e-cigarettes. Research there has suggested that e-cigarettes are 98% less harmful than tobacco, "though they do have harms," she added.

"A lot of the evidence we have is slightly at odds with the American experience," Cramer told Medscape Medical News. "For us, it's been very clear that e-cigarettes are a very useful tool if you're trying to stop smoking."

Ransom Wyse, Tom Eckstein and Ms Shirley Cramer have disclosed no relevant financial relationships.

American Public Health Association (APHA) 2017 Annual Meeting: Abstract 2041.2. Presented November 5, 2017.

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