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Dual Use of Tobacco Products

Outlook for Smokers Who Also Use Electronic Cigarettes

When you cut down on cigarettes—by adding another tobacco product—you may feel that you're improving your health. This is called “dual use.” It is not an effective way to safeguard your health, whether you’re using electronic cigarettes (e-cigarettes), smokeless tobacco, or other tobacco products in addition to regular cigarettes. Quitting smoking completely is very important to protect your health. Smoking even a few cigarettes a day can be dangerous.

How Does Smoking Less Compare to Quitting Completely?

Even light smokers or social smokers can have serious health problems from smoking.1,2,3

  • Smoking just five cigarettes a day doubles your risk of dying from heart disease.
  • Just cutting back on cigarettes may not protect you from an early death. Heavy smokers who reduce their cigarette use by half still have a very high risk for early death. And on average, smokers die 10 years earlier than nonsmokers.

In contrast, completely quitting smoking improves your health. The health differences are dramatic for heart disease and illnesses that can cause an early death.4,5,6,7

  • When you quit smoking completely, you begin to reduce your heart disease risk right away. Your risk is cut in half 1 year after quitting and continues to drop over time.
  • People who quit smoking completely live longer than those who keep smoking. The earlier you quit, the lower your risk for early death. Even quitting at age 50 cuts your risk in half for early death from a smoking-related disease.

Today in the United States, there are more former smokers than current smokers.8 It often takes several tries to quit smoking. Using proven quitting methods, such as medications and counseling, can double your chances for success.

What Are E-Cigarettes?

E-cigarettes come in many shapes and sizes, but most have a battery, a heating element, and a place to hold a liquid. The liquid typically contains nicotine—which is the addictive drug in regular cigarettes—as well as chemicals like propylene glycol or glycerin and flavorings such as fruit and chocolate. E-cigarettes are a type of electronic nicotine delivery system (ENDS). Other ENDS products include e-hookahs, e-cigars, e-pipes, vape pens, and many more.9

These devices warm the liquid and produce an aerosol that commonly contains a variety of chemicals. Users breathe this chemical solution directly from the mouthpiece. Puffing on an e-cigarette is sometimes called "vaping." Bystanders can breathe in this aerosol, too, which is exhaled into the air.10

How Do E-Cigarettes Affect Your Health?

E-cigarettes are fairly new. There are important questions about their ingredients and how those ingredients may affect the health of people who use e-cigarettes and bystanders around them, both in the short term and over time.11

E-cigarettes and their ingredients are not regulated by the Food and Drug Administration (FDA) right now.12 So there's no way to know for sure what is in them or how much nicotine they contain. Current research shows that:

  • Nicotine from e-cigarettes is absorbed by users and bystanders.2,10,11
    • Nicotine is highly addictive.
    • Nicotine is especially a health danger to youth who use e-cigarettes. It may have long-term, negative effects on brain growth.
    • Nicotine is a health danger for pregnant women and their developing babies. Using an e-cigarette and even being around someone else using an e-cigarette can expose pregnant women to nicotine and other chemicals that may be toxic.
  • E-cigarette aerosol is not "water vapor." It contains nicotine and can contain other chemicals. It is not as safe as clean air.13
  • The nicotine solution in e-cigarettes is not harmless “juice.” Children and adults have been poisoned by swallowing, breathing, or absorbing the liquid through their skin or eyes.14
  • Additional chemicals that are harmful or may be harmful have been found in some e-cigarettes. These substances include traces of metal, volatile organic compounds, and nitrosamines. The levels tend to be lower than in regular cigarettes, but there's no way to know what you're getting because e-cigarettes are not yet regulated.15

Help for Quitting Smoking

E-cigarettes are not approved by FDA to help people quit smoking. However, FDA has approved the following seven medicines as safe and effective to help smokers quit:

  • Five types of nicotine replacement therapy
    • Patch*
    • Gum*
    • Lozenge*
    • Inhaler
    • Nasal spray
      *Available without a prescription
  • Two non-nicotine medications
    • Bupropion
    • Varenicline

Individual, group, and telephone counseling have also been found to be effective in helping smokers quit. While cessation counseling and FDA-approved cessation medications are each effective alone, they are even more effective when used in combination.

Cessation counseling is available free through state quitlines. Quit-smoking medications may be available free or at a discount through state quitlines, various types of health insurance, health plans, or clinics. State Medicaid programs cover quit-smoking treatments. While the coverage varies by state, all states cover some treatments for at least some Medicaid enrollees.

Whether or not you use a stop-smoking medicine to help you quit, people who reach out for help are more likely to succeed than those who go it alone. Help is available in the Quit Guide on this Web site and by calling 1-800-QUIT-NOW (1-800-784-8669) or 1-855-DÉJELO-YA (1-855-335-3569 for Spanish speakers). Quitline coaches can answer questions, help you develop a quit plan, and provide support for your smokefree life.

References

  1. Bjartveit K, Tverdal A. Health Consequences of Smoking 1-4 Cigarettes Per Day. Tobacco Control 2005;14(5):315–20 [accessed 2015 Jun 2].
  2. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2015 Jun 2].
  3. Tverdal A, Bjartveit K. Health Consequences of Reduced Daily Cigarette Consumption. Tobacco Control 2006;15(6):472–80 [accessed 2015 Jun 2].  
  4. National Heart, Lung, and Blood Institute. What Are the Benefits of Quitting Smoking? [last reviewed 2011 Dec 20; accessed 2015 Jun 2]
  5. U.S. Department of Health and Human Services. A Report of the Surgeon General. How Tobacco Smoke Causes Disease: What It Means to You. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010 [accessed 2014 Jun 2].
  6. Centers for Disease Control and Prevention. Quitting Smoking [last reviewed 2015 May 21; accessed 2015 Jun 2].
  7. National Cancer Institute. Harms of Smoking and Health Benefits of Quitting [last reviewed 2014 Dec 3; accessed 2015 Jun 2].
  8. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, Executive Summary. [PDF - 2.14MB] Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2015 Jun 2].
  9. National Cancer Institute. Debate, Research on E-Cigarettes Continues [last reviewed 2014 Dec 11; accessed 2015 Jun 2].
  10. Ballbé M, Martínez-Sánchez JM. Cigarettes vs. E-Cigarettes: Passive Exposure at Home Measured by Means of Airborne Marker and Biomarkers. Environmental Research 2014;135:76–80 [accessed 2015 Jun 2].
  11. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, Smoking and Youth. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2015 Jun 2].
  12. U.S. Food and Drug Administration. E-Cigarettes: Questions and Answers [last reviewed 2015 Jan 21; accessed 2015 Jun 2].
  13. Goniewicz ML, Kuma T. Nicotine Levels in Electronic Cigarettes. Nicotine & Tobacco Research 2013;15(1):158–66 [accessed 2015 Jun 2].
  14. Centers for Disease Control and Prevention. Notes from the Field: Calls to Poison Centers for Exposures to Electronic Cigarettes—United States, September 2010–February 2014. Morbidity and Mortality Weekly Report 2014;63(13):292–3 [accessed 2015 Jun 2].
  15. Cheng T. Chemical Evaluation of Electronic Cigarettes. Nicotine & Tobacco Research 2014;23:ii11–7 [accessed 2015 Jun 2].

Meet Kristy

  	Kristy

At age 33, Kristy , a heavy smoker and mother of three, tried using e-cigarettes as a way to cut back on cigarette smoking, but she continued to smoke regular cigarettes. Eventually, she stopped using e-cigarettes, went back to smoking only cigarettes, and later had a collapsed lung.

"I could never get completely off regular cigarettes until I wound up in the hospital."

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