Dual use of cigarettes and vapes can reduce risks of smoking and help smokers quit
A study by Wolfson Institute of Population Health researchers shows that smokers who use cigarettes and e-cigarettes simultaneously (dual use) are reducing their intake of harmful chemicals, and are more likely to quit smoking than those who continue to smoke only cigarettes. The findings challenge common fears about dual use.
Researchers conducted a secondary analysis of data from an NIHR/CRUK-funded randomised controlled trial of 886 adult smokers, comparing e-cigarettes and nicotine replacement therapy in attempts to stop smoking. The most important finding was that dual use of both cigarettes and ECs in people unable to stop smoking early in their attempts to quit was associated with stopping smoking later. Results also showed that people who did not manage to stop smoking, but became dual users, substantially reduced their smoking and their intake of tobacco toxicants. While dual use is sometimes portrayed as risky, it actually presents a risk reduction.
The study generated three other important findings: People who used e-cigarettes experienced lower urges to smoke than those using nicotine replacement therapy, which can explain why vaping helps smokers quit and why dual users find it easier to smoke less and eventually stop. Most e-cigarette users started on high nicotine strengths and moved to lower strengths over time. By one year, around one in 10 people using e-cigarettes had shifted to nicotine-free e-liquids; smokers may benefit from knowing that vaping can provide an avenue to gradually wean themselves off nicotine.
Lead author, Francesca Pesola, said: ‘The sooner smokers quit the better, but for those who find it difficult to stop smoking abruptly, vaping can help with doing it gradually over time’.
Co-Lead, Peter Hajek, said: ‘Smokers (and clinicians) sometimes believe that if smokers do not manage to stop smoking soon after starting vaping, they should stop using e-cigarettes to avoid ‘dual use’. These results show that dual use promotes genuine harm reduction and that it can be a useful step to stopping smoking altogether.’
Francesca Pesola, Katie Myers-Smith, Dunja Przulj, Daniella Ladmore, Anna Phillips-Waller, Hayden McRobbie, Peter Hajek. Patterns of e-cigarette use and smoking cessation outcomes: Secondary analysis of a large RCT to inform clinical advice. Nicotine & Tobacco Research 10 December 2025. https://doi.org/10.1093/ntr/ntaf240