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Pennsylvania State University: Using vape to quit smoking may not increase nicotine dependence

Vape reduces users' exposure to carcinogens and other harmful toxic substances.

Bluehole reports that vape have attracted media and consumer attention due to their addictive nature, multiple flavors, and increased teen use, triggering regulation and policy.

A study by the Pennsylvania State University College of Medicine suggests that the devices can help people reduce their dependence on combustible cigarettes which contain a range of harmful chemicals known as toxic substances without increasing their overall dependence on nicotine.

Smoking is the leading cause of death in the United States. Despite the interest in quitting and the availability of FDA-approved cessation methods, smokers still find it difficult to quit.

Some public health experts, citing a report from the National Academies of Sciences, Engineering and Medicine, say vape could be an alternative for those who are not interested or able to quit. Vape can reduce users' exposure to carcinogens and other harmful toxic substances.

Jessica Yingst, assistant professor of public health sciences and a researcher at Penn State's Cancer Institute, and colleagues at Penn State's Center for Tobacco and Health Research studied vape and whether they could help nicotine users quit or reduce their exposure to harmful toxic substances in cigarettes.

Their latest study investigated a common question. Whether starting to use vape to reduce smoking would increase nicotine dependence.

"Studies on this topic are contradictory because in previous studies, participants used their own devices, but nicotine release was unknown," said Yingst." Our study used devices with known nicotine release, which allowed us to effectively compare how different levels of nicotine in the devices might affect users' nicotine dependence and ability to reduce cigarette consumption."

Researchers recruited 520 participants who were interested in reducing cigarette intake but had no plans or interest in quitting, instructed them to reduce cigarette consumption during the six-month study period.

Participants were randomly assigned to receive vape containing 36, 8 or 0 mg/ml of nicotine, or a smokeless cigarette substitute to help them reduce cigarette consumption.

Participants self-reported their dependence on cigarettes and vape at 1, 3, and 6 months using validated measures of dependence, including a questionnaire developed by Penn State University, ranging from 0 (no dependence at all) to 20 (high dependence). Urine samples were also collected throughout the study to measure nicotine, a biomarker of nicotine exposure.

After six months, all participants in the e-cigarette group reported significantly lower cigarette consumption, with participants in the 36 mg/ml group smoking the least number of cigarettes per day. Compared to the cigarette replacement group, those in the e-cigarette group were significantly less dependent on the Pennsylvania Cigarette Dependence Index.

Participants also reported their dependence on vape using the Pennsylvania vape Dependence Index.

Vape dependence did not change significantly throughout the study, except for participants in the 36 mg/ml group who found a significant increase in dependence over the course of the study, but it was still much lower compared to cigarette dependence.

Urinary nicotine levels remained consistent across all groups during the study, indicating no increase in overall nicotine exposure during the study period. The results were published in the journal Nicotine and Tobacco Research.

"Our findings suggest that using vape or cigarette substitutes to reduce cigarette consumption can reduce self-reported cigarette use and dependence," said Yingst, director of the School of Medicine's Doctor of Public Health program." Importantly, compared with cigarette substitutes, the use of high-concentration vapes did not increase overall nicotine dependence and was associated with a reduction in smoking."

While it was hypothesized that e-cigarette use might increase overall nicotine dependence, the team said their study found that initiating vape use to reduce cigarette consumption led to a decrease in cigarette dependence and in vape dependence. In the future, they will evaluate the health effects of switching from cigarettes to vape altogether.

This study was supported by the National Institute on Drug Abuse of the National Institutes of Health and the Center for Tobacco Products of the U.S. Food and Drug Administration (Grant Nos. P50DA036105 and U54DA036105). Data collection was supported by the Institute for Clinical and Translation Science at Pennsylvania State University (authorization number UL1TR002014) and the C. Kenneth and Dianne Wright Center for Clinical and Translation Research at Virginia Commonwealth University (authorization number UL1TR002649) through the National Center for Advancing Translation Science of the Institute of Health.