Why do some vapers continue to smoke? Risk perception could be a possible early answer.

Factors associated with dual use of traditional cigarettes and electronic cigarettes: A comparison study


  • A comparison study was conducted on 7,060 electronic cigarette users
  • Factors associated with the dual use of electronic cigarettes and traditional cigarettes were evaluated
  • The risk perception is the most convincing independent indicator of dual use
  • The occasional use and the use of previous generations of devices have also been associated with dual use
  • Adequate information about the risks associated with the electronic cigarette is important to avoid double use.


Many electronic cigarette users reduce their cigarette consumption without completely quitting smoking. It is important to evaluate the characteristics and experiences of these users, commonly known as “dual users”, compared to users of e-cigarettes who have totally dropped traditional cigarettes.


A questionnaire was posted online and electronic cigarette users were asked to answer regardless of their current smoking habits. Dual users were paired with vapers based on age and gender.


Of the 19,441 participants, 3,682 were dual users. After having randomly paired these dual users with vapers (all former smokers), 3,530 participants were compared in each group.

Dual users had a longer smoking history, a lower daily consumption of cigarettes and an identical addiction to cigarettes as of vapers. Their daily consumption of tobacco cigarettes declined from 20 to 4 cigarettes a day after they started using electronic ones. Most of them were daily vapers but many of them were using their electronic cigarette occasionally compared to vapers.

The use of the third generation of devices (note: Type Mods) and the daily consumption of e-liquids were lower for dual users than for vapers. For the both groups, the most important reasons for using electronic cigarettes were to reduce tobacco consumption and to prevent relatives from being exposed to smoke and this .

However, an even more important reason was to “circumvent the smoking ban in public places” mentioned by more dual users than vapers. The most convincing indicators of dual use are:

  • a higher risk perception among vapers (OR = 2.27 , 95% CI = 1.40-3.68 ),
  • the use of first generations of devices (OR = 1.98 , 95 % CI = 1.47-2.66 ),
  • the use of pre-filled cartomizers (OR = 1.94 , 95 % CI = 1.23-3.06 ) and
  • the occasional use of electronic cigarettes (OR = 1.62 , 95% CI = 1.21-2.17 ).


The results of this study show that higher risk perception and less frequent use of electronic cigarettes are associated with the dual use of electronic and tobacco cigarettes. Since it is a cross-sectional study that explores the association but not the cause, longitudinal studies are needed to further analyze the reasons for this dual use.

Our analysis: The researchers show once again that perception is a key element in the approach of the smoker. In order not to discourage million smokers to try the electronic cigarette in a logic of risk reduction or of a withdrawal process, the information that is conveyed by the media has to be the most accurate and responsible possible.

Finally the diversity of available models in the market are involved in the attractiveness of the product to smokers. Overly restrictive measures on its use could slow down innovation and then reduce diversity by favoring inefficient models.

[1] Konstantinos E. Farsalinos, Giorgio Romagna, Vassilis Voudris – Factors associated with dual use of tobacco and electronic cigarettes: a case control study – DOI: http://dx.doi.org/10.1016/j.drugpo.2015.01.006

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