Comparison of the characteristics of long-term users of electronic cigarettes versus nicotine replacement therapy: A cross-sectional survey of English ex-smokers and current smokers

Victoria A. Nelson, Maciej L. Goniewicz, Emma Beard, Jamie Brown, Kate Sheals, Robert West, Lion Shahab

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Background: Electronic cigarettes (ECs) and nicotine replacement therapy (NRT) are non-combustible nicotine delivery devices being widely used as a partial or a complete long-term substitute for smoking. Little is known about the characteristics of long-term users, their smoking behaviour, attachment to smoking, experience of nicotine withdrawal symptoms, or their views on these devices. This study aimed to provide preliminary evidence on this and compare users of the different products. Methods: UK participants were recruited from four naturally occurring groups of long-term (≥6 months) users of either EC or NRT who had stopped or continued to smoke (N= 36 per group, total N= 144). Participants completed a questionnaire assessing socio-demographic and smoking characteristics, nicotine withdrawal symptoms, smoker identity and attitudes towards the products they were using. Results: Adjusting for relevant confounders, EC use was associated with a stronger smoker identity (Wald X2(1)=3.9, p=0.048) and greater product endorsement (Wald X2(1)=4.6, p=0.024) than NRT use, irrespective of smoking status. Among ex-smokers, EC users reported less severe mood and physical symptoms (Wald X2(1)=6.1, p=0.014) and cravings (Wald X2(1)=8.5, p=0.003), higher perceived helpfulness of the product (Wald X2(1)=4.8, p=0.028) and lower intentions to stop using the product (Wald X2(1)=17.6, p<0.001) than NRT users. Conclusions: Compared with people who use NRT for at least 6 months, those who use EC over that time period appear to have a stronger smoker identity and like their products more. Among long-term users who have stopped smoking, ECs are perceived as more helpful than NRT, appear more effective in controlling withdrawal symptoms and continued use may be more likely.

Original languageEnglish (US)
Pages (from-to)300-305
Number of pages6
JournalDrug and alcohol dependence
StatePublished - Aug 1 2015

Bibliographical note

Funding Information:
We are grateful to Cancer Research UK for funding the study (C27061/A16929). E.B., J.B., A.Mc., L.S. and R.W. are members of the UK Centre for Tobacco and Alcohol Studies. K.S. is funded by a CRUK Lynn MacFadyen Scholarship (C27061/A18679). J.B.’s post is funded by the Society for Study of Addiction. E.B. is funded by CRUK and the National Institute for Health Research (NIHR)’s School for Public Health Research (SPHR). The views are those of the authors(s) and not necessarily those of the funders. The funders had no involvement in the design of the study, collection, analysis or interpretation of the data, the writing of the report, or the decision to submit the paper for publication.

Funding Information:
L.S. has received a research grant and honoraria for a talk and travel expenses from a Pfizer, manufacturer of smoking cessation medications. M.L.G. received a research grant from Pfizer, manufacturer of smoking cessation medications. J.B. and E.B. have both received an unrestricted research grant from Pfizer to study population trends in smoking. R.W. has received travel funds and hospitality from, and undertaken research and consultancy for, pharmaceutical companies that manufacture or research products aimed at helping smokers to stop. V.N. and K.S. have no competing interests.


  • Electronic cigarettes
  • Harm reduction
  • Identity
  • NRT use
  • Nicotine withdrawal
  • Smoking cessation

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