A New Study Suggests That Dual-Use Is Safer Than Smoking Cigarettes


by Jeffrey Buckley

Updated: November 4, 2022

new review says dual use less toxic than cigarette smoking alone

A new study published in the scientific journal, Addiction shows that people who smoke and vape while trying to quit have lower levels of toxic chemicals in their bodies. The study looked at the biomarkers of almost 1300 people who are either smokers, vapers, or both smokers and vapers, known as dual-use. The researchers found that dual-users had less prevalence of toxic chemicals like carbon monoxide in their bodies than people who only smoked. This new research discredits the previously-held belief that using vaping as a quit-smoking method only led to more smoking and ingestion of more harmful chemicals from both cigarettes and e-cigarettes.

What Is Dual-Use Vaping?

Dual-use refers to someone who continues to smoke, even if they have started vaping. It has become a common practice among people who have tried to use e-cigarettes to help them quit smoking. Many anti-vaping advocates pointed to the prevalence of dual-use as proof that e-cigarettes did not help people quit smoking but only encouraged another dangerous habit: vaping.

The fact that many people continued to smoke while also vaping was undeniable. Studies from the past two years have found time and time again that people who try to quit smoking by using e-cigarettes invariably keep smoking. They also pointed out that dual-users did not have higher rates of quitting cigarettes or e-cigarettes than those who used nicotine replacement therapies.

Rates of Dual-Use

e-cigarette users often engage in dual use

Many studies from the past decade have consistently shown that e-cigarette users often engage in dual use, meaning they continue to smoke while vaping. This has been the case in the US, the UK, and the EU. For example, smokers in the US reported a consistent level of e-cigarette use in three consecutive years ranging from 29.8% in 2015 to 27.7% in 2018.

The same has been reported in the UK. One study found that dual-use was higher in adolescents who only used e-cigarettes, even though the largest group in the survey was e-cigarette-only users. It also showed that young people who began smoking cigarettes first continued to smoke even if they took up vaping.

The prevalence of dual-use behavior among many people – from different countries and backgrounds, regardless of race and gender – all seemed to cement the idea that vaping did not help people quit smoking. But this new study goes against that assumption by stating that dual-use is only a transition period, not permanent.

Is Dual-Use Dangerous?

Many studies have alluded to the potential dangers of smoking and vaping simultaneously. For example, one study showed that people who smoke and vape have a higher incidence of cardiovascular problems than only-vapers but less than only-smokers. But this new study uncovered new evidence suggesting the opposite.

The new study looked at the levels of carbon monoxide in the exhaled breath of smokers, vapers, and dual-users. It found that only-vapers had lower carbon monoxide levels than smokers and dual-users. Still, dual-users also had lower levels of carbon monoxide compared to only-smokers.

Another study found that dual-users were also more likely to quit smoking after some time rather than go back to exclusively smoking or not. But it also found that other factors other than dual-use made them stop, independent of whether they were smoking or not. This same study also showed that people who smoke and vape often go back to exclusively smoking.

Can E-Cigarettes Help You Quit?

Even with this new study, it is unlikely that many public health organizations and policy-makers will change their minds about vaping, at least in the US. Yet, despite its risks, countries like the UK have adopted e-cigarettes as yet another tool to help people quit the much-more destructive habit of smoking.

While this new study does present new evidence that at least supports the idea that dual-use is not as harmful as only-cigarette smoking, it is not a smoking gun. Other factors that determine if a person can successfully quit smoking have nothing to do with vaping or e-cigarettes. But this study suggests that it is not harmful to go through a period of transition on the way to quitting.

Published: November 6, 2022

Jeffrey Buckley

I was a smoker for over 25 years. In this time I also earned my medical degree with a specialization in addiction treatment and counseling. That period has led me to vaping, my interest started around 2011. I’m fighting the tide of hysteria and dis-information around vaping that emanates from various fronts legislative, cultural and scientific. Having scientific councils support, I’m happy to contribute my thoughts, articles, and expertise.