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Associations between electronic cigarette use and quitting behaviours among South African adult smokers
  1. Israel Agaku1,2,
  2. Catherine O Egbe3,4,
  3. Olalekan Ayo-Yusuf5
  1. 1School of Health System and Public Health, University of Pretoria, Pretoria, Gauteng, South Africa
  2. 2Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
  3. 3Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
  4. 4Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, Gauteng, South Africa
  5. 5Africa Centre for Tobacco Industry Monitoring and Policy Research, Sefako Makgatho Health Sciences University, Pretoria, Gauteng, South Africa
  1. Correspondence to Dr Israel Agaku, School of Health System and Public Health, University of Pretoria, Pretoria, Gauteng, South Africa; u16218435{at}


Background The South African Medicines Control Council classifies e-cigarettes as Schedule 3 substances and requires them to be dispensed only within pharmacies. e-Cigarettes are however ubiquitous and are marketed as cessation aids. We investigated the relationship between e-cigarette use and smoking cessation among South African adult smokers.

Methods Data came from a 2018 web survey of South African adults aged ≥18 years (n=18 208). Cessation-related attitudes and behaviours were assessed. Using multivariable logistic regression, we measured the association between e-cigarette use and cessation behaviours among ever-established combustible tobacco smokers who tried to quit.

Findings Among current combustible smokers, more e-cigarette ever versus never users believed e-cigarettes could assist smokers to completely quit (35.5% vs 20.4%) or cut down (51.7% vs 26.5%) (all p<0.05). Among ever-established smokers, the odds of sustained quitting at the 12-month mark were lower among those who used e-cigarettes once off/rarely (adjusted OR (AOR)=0.20, 95% CI=0.16–0.24), former e-cigarette users (AOR=0.30, 95% CI=0.24–0.38) and current e-cigarette users (AOR=0.23, 95% CI=0.18–0.29), compared with never e-cigarette users. Among ever-established smokers who had ever tried to quit, 53.6% relapsed into smoking after quitting for any length of time. The odds of relapsing among ever-established smokers who had made a quit attempt and had a quit intention were higher among those who used e-cigarettes once off/rarely (AOR=2.66; 95% CI=2.31–3.08), former e-cigarette users (AOR=1.41; 95% CI=1.18–1.69) and current e-cigarette users (AOR=1.85; 95% CI=1.55–2.22) than never e-cigarette users.

Conclusion e-Cigarette use depressed long-term cessation. These findings can inform restrictions on unsubstantiated claims of e-cigarettes as cessation aids within South Africa.

  • cessation
  • electronic nicotine delivery devices
  • global health
  • low/middle income country
  • public policy

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  • Contributors IA conceptualised and designed the study and drafted the initial manuscript. COE and AA helped conceptualise the study and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding Support from the African Capacity Building Foundation to OAA (Grant No 333).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Requests should be directed to the corresponding and will be considered on a case-by-case basis.

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