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Redefining understanding of tobacco smoking lapse in the context of vaping

First published: 10 May 2019 | Last updated: 20 May 2019

Aims: Although many smokers manage to quit, in the general population the majority of quit attempts result in eventual relapse back to smoking. Most vapers state that they use e-cigarettes for smoking cessation or to cut down from smoking (McNeill et al, 2015). Many have periods of dual use with tobacco smoking before eventually quitting smoking. This presentation uses subjective data from vapers to redefine understanding of smoking lapse.

Methods: Combined qualitative analysis using thematic coding with ethnographic observation and discourse analysis techniques. In-depth interviews were undertaken with 40 participants, complemented by innovative photo elicitation methodology to specifically examine the social contexts and meaning of e cigarette use in the daily lives of consumers. Data were iteratively analysed to situate experiences of smoking lapse within trajectories of e cigarette use.

Results: Variable aspects of e cigarettes offer the ex-smoker a unique experience beyond other methods of smoking cessation. Ex-smokers can choose a substitute ‘ smoking-like ‘ experience, preferable for some, or a move away from smoking towards a new vaping identity, attractive to others. Importantly, our sample of vapers demonstrate how smoking lapse may be perceived qualitatively differently than for other ex-smokers, as a ‘ permissive lapse ‘. Having the alternative of vaping means that full relapse to smoking is not perceived as inevitable following a lapse, as it may have been previously.

Conclusions: We demonstrate how the role of smoking lapse is theoretically redefined, drawing on novel data from ex-smokers in the context of vaping. Vaping offers a viable substitution option for smoking and an alternative to relapse.

Co-Authors

Dr Lynne Dawkins, London South Bank University Professor Richard Holland, Leicester Medical School, UK. Sarah Jakes, New Nicotine Alliance Dr Emma Ward, Norwich Medical School, University of East Anglia, UK.

Conflicts of interest:

No conflict of interest

Report Author

Dr Caitlin Notley

Professor of Addiction Sciences


Dr Caitlin Notley was successful in securing funding from the SSA for their first ever Post-Doctoral Fellowship post. She began a five year programme of work in May 2013, focusing on tobacco smoking relapse prevention. This work is a public health priority as most people who manage to successfully quit smoking in the short term will relapse back to smoking within 12 months. There are currently no effective interventions to prevent smoking relapse [1], either in the general population or amongst specific at risk populations, such as postpartum women [2]. Dr Notley’s mixed methods programme of work explores the phenomenon of smoking relapse and will develop an intervention to support women to stay abstinent from smoking postpartum.

As part of her fellowship Dr Notley has led and completed two linked research studies:

  • SHARPISH Q – Qualitative study of Self-help and Relapse Prevention in Smoking. This study collected qualitative process evaluation data alongside an HTA funded trial of a self-help relapse prevention intervention. The RCT was a randomised study (n=1407) exploring educational booklets for the specific purpose of preventing relapse to smoking. Process evaluation and qualitative investigation explored patient reported experiences of using the self-help materials, focusing on the response of individuals to the intervention being tested. Dr Notley completed and has widely disseminated the trial process evaluation findings and is undertaking further analytical work on patient experience of smoking lapse and relapse.
  • PReSeRVE – Postpartum Smoking Relapse Prevention Qualitative Systematic Review. This review synthesised patient reported barriers and facilitators for smoking relapse prevention and was published in Addiction: http://onlinelibrary.wiley.com/doi/10.1111/add.13062/abstract.

Dr Notley has been successful in securing additional external funding from Cancer Research UK and the Medical Research Council to lead two further linked studies:

  • ECtra Study (E Cigarette Trajectories) Real world experiences of using e-cigarettes for avoiding relapse to smoking: success or failure. A qualitative study. (Notley, C, Dawkins, L, Holland, R).
  • Preventing Return to Smoking Postpartum (PReS Study) – Development of a complex intervention to sustain smoking cessation in postpartum women. (Notley, C, Ussher, M, Bauld, L, Holland, R, Naughton, F, Hardeman, W).

SSA fellowship funding has supported Dr Notley to lead and develop these interlinked research projects, and has provided her with opportunities for national and international collaboration with other research centres. The funding has enabled Dr Notley to develop her methodological expertise in qualitative research methods and systematic reviewing, through involvement with a supportive network of SSA academics.

[1] Hajek P, Stead LF, West R, Jarvis M, Lancaster T. Relapse prevention interventions for smoking cessation. Cochrane database of systematic reviews (Online) 2009(1):CD003999.
[2] Agboola S, McNeill A, Coleman T, Leonardi Bee J. A systematic review of the effectiveness of smoking relapse prevention interventions for abstinent smokers. Addiction. 2010;105(8):1362-80.

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