Associations between electronic cigarette use and quitting behaviours among South African adult smokers.

Introduction:
This text summarizes a study examining the relationship between e-cigarette use and smoking cessation among South African adult smokers. The study aimed to provide evidence to inform policy and clinical practice regarding e-cigarettes in South Africa.

Key Points:

* The study used data from a 2018 web survey of South African adults and defined ever-established combustible tobacco product users as individuals who had smoked a combustible tobacco product beyond experimentation.
* The study found that e-cigarette use was unrelated to quit intentions among current smokers but was associated with higher rates of relapse among ever-established smokers who had tried to quit.
* The study also found that e-cigarette-only users reported rates of relapse that were higher than those seen for counseling-only users, NRT-only users, NRT+prescription medication-only users, or those not using any intervention at all.
* The study controlled for age, race/ethnicity, gender, income, self-rated health status, use of NRT, prescription medication, or cessation counselling, and age at tobacco initiation as a marker for extent of nicotine dependence.
* The study found that e-cigarette use was associated with higher likelihood of smoking cessation short term but lowered the likelihood of long-term quitting compared with never using e-cigarettes.
* The study found that e-cigarette users were more likely to cite smoking-related perceptions of safety, enjoyment, and conviviality as reasons for continuing to smoke, relapsing back into smoking, or having never made a quit attempt.
* The study also found that demographic differences noted in sustained quitting mirror previously documented variations in quit attempts among South African smokers.

Main Message:
The study provides evidence that e-cigarette use is associated with lower long-term smoking cessation rates and higher relapse rates among South African adult smokers. The findings can inform comprehensive tobacco prevention and control efforts, including restricting unsubstantiated marketing claims of e-cigarettes as effective smoking cessation aids within South Africa. Regulating e-cigarettes as tobacco products may benefit public health in South Africa and regionally by minimizing population-level harms such as smoking relapse and the perpetuation of smoking behavior.

Agaku I, Egbe CO, Ayo-Yusuf O. Associations between electronic cigarette use and quitting behaviours among South African adult smokers. Tobacco control. 2022;31(3):464-472. doi:10.1136/tobaccocontrol-2020-056102