The discussion around the safety and benefits of electronic cigarettes has been energized by a groundbreaking study that explores how different usage patterns affect people’s health and quality of life. This research, led by Dr. Xiaona Liu from Smoore Research Institute, in collaboration with Prof. Xuxi Zhang, Dr. Ian Fearon, Yue Cao, and others, analyzed data from 7,225 American adults over an eight-year period (2013-2021) through the PATH study, a comprehensive longitudinal investigation of tobacco use and health outcomes in the United States.
“Our research provides crucial evidence that individuals who exclusively use electronic cigarettes experience notably better quality of life outcomes compared to traditional cigarette smokers, particularly in terms of physical well- being,” explains Dr. Liu. “While complete abstinence from all nicotine products shows the best health outcomes, our findings suggest that electronic cigarettes may offer a less harmful alternative for those who cannot or choose not to quit smoking entirely.”
The study revealed significant trends in tobacco use patterns, with exclusive combustible cigarette use decreasing from 40% to 32% between 2013 and 2021, while exclusive e-cigarette use increased from 2.2% to approximately 5%. Dual use remained stable at around 4% throughout the study period.
Using a sophisticated 5-point scale measurement system, researchers found that exclusive e-cigarette users reported significantly better outcomes in several areas. They showed a 0.07-point lower fatigue score and a 0.2-point reduction in pain compared to traditional cigarette smokers. Additionally, e- cigarette users demonstrated a 0.1-point improvement in overall quality of life scores.
“What makes these results particularly significant,” Dr. Liu points out, “is their potential impact on public health strategies. Our data suggests that smokers who switch completely to electronic cigarettes may experience meaningful improvements in their physical well-being, though emotional health outcomes showed no significant differences between groups.”
The study also confirmed that people who neither smoked nor vaped had consistently better health outcomes across all categories. Non-users maintained the lowest frequency of fatigue (below 2.3 out of 5 points) compared to both cigarette and e-cigarette users, who ranged between 2.2 and 2.5 points.
However, people who used both traditional cigarettes and electronic cigarettes simultaneously showed no significant health improvements. The research emphasized that switching completely to electronic cigarettes, rather than partial switching, is key to experiencing these benefits.
The study’s findings are particularly relevant for public health efforts aimed at reducing smoking-related illnesses. Unlike traditional cigarettes, which burn tobacco and release harmful chemicals, electronic cigarettes heat a liquid to produce vapor, containing fewer dangerous substances.
While acknowledging limitations such as reliance on self-reported data and the need for longer-term research, this comprehensive study provides valuable insights into the potential role of electronic cigarettes in harm reduction strategies. The research team emphasized the importance of continued investigation to better understand how different usage patterns affect long- term health outcomes.
Journal Reference
Cao Y, Zhang X, Fearon IM, et al. “The effects of electronic cigarette use patterns on health-related symptom burden and quality of life: analysis of US prospective longitudinal cohort study data.” Frontiers in Public Health, 2024. DOI: https://doi.org/10.3389/fpubh.2024.1433678
About the Authors
Dr. Xiaona Liu is an Epidemiologist who currently serves as the Head of Clinical and Behavioral Sciences at the SMOORE Research Institute in China. Dr. Liu previously worked as a senior physician on Infection Control at a local CDC’s office in China, and a postdoctoral researcher on Health Technology Assessment & Implementation at Erasmus University Medical Center in the Netherlands. She received a PhD in Infectious Disease Control from the Erasmus University Medical Center in 2015, a MPH from Netherlands Institute for Health Sciences in 2013, and a MSc in Social Medicine from Peking University Health Science Center in 2011. She has first- and/or corresponding- authored 22 scientific journal articles related to disease prevention and control. She has given more than 15 invited presentations at renowned international conferences.
Dr. Xuxi Zhang is an Assistant Professor who is currently working at Department of Social Medicine and Health Education, School of Public Health, Peking University. She received a B.S. (2014) and a Master of Public Health (2017) from Peking University. She received her Ph.D. in Public Health from the Erasmus University Rotterdam in 2020. She worked as a Postdoctoral Research in National School of Development at Peking University from 2021 to March 2023. Her research interests span both healthy aging and eldercare innovation. She has published more than 30 scientific papers, and much of her work focuses on the health promotion of frailty, chronic conditions, disability, cognitive impairments and mental health among older adults.
Dr. Ian M. Fearon is a consultant specialising in the scientific basis for tobacco harm reduction. He provides scientific consulting support to tobacco and nicotine product manufacturers, and pharmaceutical companies, helping them bring novel harm-reduced products to market and to support their scientific advocacy. Dr. Fearon has authored almost 70 peer-reviewed scientific publications, which in recent years have focussed on the pharmacological and behavioural impacts of nicotine-containing products among individuals and populations.
Ms. Yue Cao is a biostatistician currently working at the SMOORE Research Institute in China, where she focuses on clinical and behavioral studies on the effects of novel tobacco products. She previously worked as a statisitician at the National Clinical Research Center for Kidney Disease, contirbuting to the development of the Chinese Renal Disease Data System. Ms. Cao received her MSc in Biostatistics from the Yale School of Public Health in 2019 and her B.S. in Mathematics and Statistics from Tongji University in Shanghai in 2017. She has a strong interest and experience in applying statistical methods and machine learning techniques to analyse public health data and its determinants.
