Do people who smoke and vape experience different cravings for each product? Insights from a dual cessation intervention

INTRODUCTION: Many people who smoke and start using e-cigarettes continue both (dual use). Nicotine dependence symptoms, such as cravings, may sustain this behavior. Prior research shows cue-specific factors influence cravings, suggesting product-specific cravings may emerge. This secondary analysis examined whether cravings differ between cigarettes and e-cigarettes for those who dual use, and whether product-specific cravings predict abstinence. METHODS: Data were derived from a pilot dual use cessation trial (N=46) capturing daily reports of cigarette, e-cigarette, and Nicotine Replacement Therapy (NRT) use, cigarette craving (Questionnaire of Smoking Urges [QSU]), and e-cigarette craving (Questionnaire of Vaping Craving [QVC]). Correlations between QSU and QVC were calculated daily. Generalized estimating equations modeled log-odds of abstinence as a function of product-specific cravings, with subsequent models accounting for dependence and NRT use. Additional models tested the association of craving for one product with abstinence from the opposing product. RESULTS: QSU and QVC scores were weakly correlated (mean correlation coefficient=0.18, SD=0.19). Higher QSU scores were associated with lower odds of combustible tobacco cigarette abstinence (OR=0.85 [95% CI=0.79-0.92], p<.001), and higher QVC scores were associated with lower odds of e-cigarette abstinence (OR=0.86 [95% CI=0.80-0.92], p<.001). Adjusting for product-specific dependence and NRT use did not meaningfully change these associations. In contrast, craving for one product was not associated with abstinence from the other product, providing no evidence of cross-product craving effects. CONCLUSIONS: During cessation attempts, product-specific cravings were associated with abstinence from that product only. Individuals engaging in dual use may experience differentiated cravings rather than generalized nicotine cravings. Future work should address craving differentiation in dual use.