Successful tobacco quitters were more likely to not use cannabis, perceive smoking as harmful, and have no environmental smoke exposure | Research

The takeaway

A nationally representative French survey found that successful and unsuccessful smoking cessation shared some predictors (no cannabis use, older age), while successful quitters specifically were distinguished by no e-cigarette use, no environmental tobacco exposure, and perceiving smoking as harmful.

Read this if you use both cannabis and tobacco and are trying to quit smoking, or if you work in smoking cessation.

Cannabis use was a barrier to smoking cessation regardless of quit trajectory

What the researchers found

Researchers analyzed data from a nationally representative French survey of 2,110 current or former smokers, comparing three groups: those who never quit or quit less than 6 months, unsuccessful quitters (relapsed after 6+ months), and successful quitters (abstinent 6+ months).

Both successful and unsuccessful quitting shared common predictors: no cannabis use, older age, and intermediate or high occupational grade.

Factors that specifically distinguished successful quitters from unsuccessful ones were no e-cigarette use, no environmental tobacco smoke exposure, fear of health consequences, perceived harmfulness of smoking, high educational attainment, and good overall health.

Notably, cannabis use was associated with both failed quit attempts and never quitting, suggesting it is a barrier to smoking cessation regardless of the quit trajectory.

Why it matters

Identifying what differentiates successful from unsuccessful quitters helps target interventions. The finding that cannabis use is a barrier to smoking cessation is particularly relevant as cannabis legalization expands and dual use becomes more common.

The numbers in context

4,342 adults surveyed, 2,110 current/former smokers analyzed. Three-group comparison. No cannabis use associated with both successful and unsuccessful cessation vs. not quitting. E-cigarette use associated with unsuccessful rather than successful quitting.

How the study worked

Cross-sectional analysis of the DePICT nationally representative telephone survey of 4,342 French adults aged 18-64. Among 2,110 current or former smokers, multinomial logistic regression compared predictors of no quit attempt, unsuccessful cessation, and successful cessation.

What this study cannot tell us

Cross-sectional design cannot establish temporal relationships. Self-reported data subject to recall bias. French population may not generalize to other countries with different cannabis and tobacco use norms. E-cigarette technology and use patterns have evolved since data collection.

How to read the evidence

Nationally representative survey with multivariate analysis provides moderate cross-sectional evidence, though it cannot establish causation.

When this study was published

Published in 2018 with French data. E-cigarette products and cannabis legalization have evolved significantly since.

The bigger picture

This study highlights that quitting tobacco and using cannabis are linked behaviors. People who use cannabis are less likely to successfully quit tobacco, which has implications for cessation programs that may need to address cannabis use concurrently. The finding about e-cigarettes is also notable, associating their use with unsuccessful rather than successful quitting.

Questions still open

Would addressing cannabis use improve tobacco cessation outcomes? Is the e-cigarette association causal (e-cigarettes failing as cessation tools) or are unsuccessful quitters more likely to try e-cigarettes as another strategy? Do these patterns hold in countries with legal recreational cannabis?

Common questions

Does cannabis use make it harder to quit tobacco?

This study found that cannabis use was associated with both never quitting and unsuccessful quitting, suggesting it is a barrier to smoking cessation. However, the cross-sectional design cannot prove causation.

Did e-cigarettes help people quit smoking?

In this study, e-cigarette use was associated with unsuccessful rather than successful smoking cessation. The authors noted this should be verified in longitudinal studies.

Read the original research

Factors associated with successful vs. unsuccessful smoking cessation: Data from a nationally representative study.

Addictive behaviors, 80, 110-115

View on PubMed ↗Publisher’s paper ↗

Citation

El-Khoury Lesueur, Fabienne; Bolze, Camille; Melchior, Maria. (2018). Factors associated with successful vs. unsuccessful smoking cessation: Data from a nationally representative study.. Addictive behaviors, 80, 110-115. https://doi.org/10.1016/j.addbeh.2018.01.016