Contexts of Cigarette and E-Cigarette Use Among Dual Users

People who use both conventional cigarettes and e-cigarettes do not necessarily use the two products in the same situations. For some adults, cigarette smoking remains connected with established routines, cravings, stress, social situations, or alcohol, while e-cigarette use may occur in a different set of environments.

A qualitative study by Pokhrel and colleagues examined exactly this question: when and why do dual users choose cigarettes versus e-cigarettes? Published in BMC Public Health in 2015, the study used 12 focus-group discussions involving 62 young adult daily e-cigarette users, almost all of whom were current or recent cigarette/e-cigarette dual users.

This article explains the main findings and, importantly, their limitations. The study provides insight into behavioral patterns, but it should not be interpreted as proving that every dual user behaves in the same way.

Table of Contents

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Key Takeaways

Cigarette use in the study was frequently connected with strong cravings, stress, established routines, social situations, and the use of substances such as alcohol or coffee.
Being around other cigarette smokers could act as a smoking cue for some participants.
E-cigarette use was reported in settings such as work, home, vehicles, and situations where cigarette smoking was unavailable or restricted.
Product availability mattered: some participants reported smoking cigarettes when their e-cigarette was unavailable.
Dual use did not always represent a straightforward transition from cigarettes to e-cigarettes.
Because this was a small qualitative study conducted in 2015, its findings should not be generalized to all current adult smokers or e-cigarette users.

Cigarette vs E-Cigarette Use Contexts at a Glance

Context	Cigarette Use Reported in the Study	E-Cigarette Use Reported in the Study
Strong craving	Frequently mentioned	Some participants considered it less suitable in these moments
Stress	Commonly associated with cigarette use	Less prominent as a specific theme
Before or after meals	Reported cigarette cue	Less prominent
Coffee	Associated with cigarettes for some participants	Less prominent
Alcohol and parties	Frequently associated with cigarettes	Could also occur
Around cigarette smokers	Important cigarette cue	Sometimes less preferred
At work	Cigarette use could be less convenient	Commonly discussed context
At home	Both could occur	Frequently reported
Indoors	Cigarettes could be restricted	E-cigarette use commonly discussed
In a vehicle	Cigarette use could be less convenient	Reported by participants
Cigarettes unavailable	—	E-cigarette could serve as an alternative
E-cigarette unavailable	Cigarette could become an alternative	—

The table summarizes themes identified in Pokhrel et al. (2015). These were qualitative observations from study participants and should not be treated as population-wide statistics.

What Is Cigarette and E-Cigarette Dual Use?

In general, dual use refers to using both conventional combustible cigarettes and e-cigarettes.

However, this broad definition can include very different patterns. One adult might smoke cigarettes every day and vape occasionally, while another might primarily use an e-cigarette but continue to smoke cigarettes in particular social situations.

The CDC also uses the term “dual use” when discussing people who both vape and smoke cigarettes. Public-health guidance emphasizes that simply adding e-cigarettes while continuing to smoke should not be considered a way to eliminate the health risks associated with cigarette smoking.

Understanding these differences is important because simply labeling someone a “dual user” tells us relatively little about when, where, and why each product is used.

What Did the Pokhrel Study Examine?

The study titled Contexts of Cigarette and E-Cigarette Use Among Dual Users: A Qualitative Study was published in BMC Public Health on September 4, 2015.

Researchers conducted:

12 focus-group discussions
62 participants
Current daily e-cigarette users
An average participant age of 25.1 years
A sample that was 63% male
A population made up almost entirely of current or recent cigarette/e-cigarette dual users

The purpose was not to determine how common each behavior was in the general population. Instead, the researchers wanted to identify recurring themes describing the circumstances in which participants chose one product rather than another.

You can read the original research through PubMed or the full BMC Public Health article.

What Contexts Were Associated With Cigarette Use?

The study identified several broad categories connected with cigarette smoking among participants.

These included:

Specific daily activities
Strong cravings
Stress or a desire for stimulation
Social settings
Other cigarette smokers being present
Alcohol or coffee consumption
Situations where an e-cigarette was unavailable

These findings suggest that cigarette use among dual users may be strongly connected with previously learned routines and environmental cues.

Strong Cravings and Stress

Strong cravings were one of the situations participants associated with cigarette use.

Stress also appeared repeatedly in the discussions. Some participants described wanting a cigarette during stressful situations or at moments when they felt a stronger need for stimulation.

This should not be interpreted as evidence that cigarettes are an appropriate way to manage stress. Instead, the finding demonstrates how stress can become associated with established smoking behavior.

For habitual users, these associations may persist even when another nicotine product is available.

Daily Routines Can Become Smoking Cues

Cigarette smoking was also associated with ordinary daily activities.

Participants mentioned situations such as:

Before or after eating
After waking up
Before going to sleep
Following particular activities
Established personal routines

These types of associations can be thought of as habitual cues.

For example, repeated cigarette use after a meal can eventually create a strong association between finishing food and wanting to smoke. Coffee can operate in a similar way for some people.

This helps explain why dual use is not simply a question of having access to two products. Existing behavioral routines may influence which product a person chooses in a particular situation.

The people around a dual user may also affect smoking behavior.

Being Around Other Cigarette Smokers

One of the clearest social themes in the study was the presence of other cigarette smokers.

Some participants reported being more likely to smoke when friends, partners, or other people nearby were smoking cigarettes. Seeing cigarettes or being around established smoking situations could therefore operate as a cue.

This illustrates an important feature of tobacco behavior: product choice can be influenced by social environment as well as individual preference.

Parties, Weekends, and Socializing

Cigarette use was also discussed in connection with:

Parties
Weekends
Social gatherings
Special occasions
Spending time with friends
Outdoor social situations

For some participants, cigarette smoking had a stronger social association than vaping.

However, that should be described as a participant perception, not as a universal characteristic of cigarettes or e-cigarettes.

Different adults may develop very different social patterns around nicotine use.

The study also identified the use of other substances as a cigarette-smoking context.

Alcohol was especially prominent.

Some participants reported wanting or smoking cigarettes while drinking alcohol, and coffee or caffeine was also mentioned as a smoking-related cue.

These findings do not mean that drinking alcohol or coffee automatically causes someone to smoke.

Instead, repeated pairing of two behaviors may establish an association. Someone who has repeatedly smoked while drinking coffee, for example, may experience the coffee-drinking situation itself as a smoking cue.

When Were E-Cigarettes Used Instead?

The study identified a somewhat different pattern for e-cigarette use.

Participants described using e-cigarettes during particular activities and in specific locations, but two themes were especially important:

Using an e-cigarette when a cigarette was unavailable.
Using an e-cigarette where cigarette smoking was prohibited or inconvenient.

This suggests that at least some dual use may involve context-dependent switching rather than a complete replacement of one product by another.

E-Cigarette Use at Work

Work was one environment discussed in relation to e-cigarette use.

Some participants described vaping as more compatible with their work routine than leaving an area to smoke a cigarette.

However, workplace policies have changed substantially since the study was conducted, and regulations vary between jurisdictions and individual employers.

The fact that study participants reported vaping at work should therefore not be interpreted as meaning that vaping is currently permitted in workplaces.

Always follow current employer policies and local regulations.

E-Cigarette Use at Home and Indoors

Participants also discussed using e-cigarettes:

At home
Indoors
While alone
In vehicles

Some participants believed vaping was less disruptive than smoking in these situations.

Again, this represents participants’ perceptions at the time of the study rather than proof that indoor vaping is harmless.

Current public-health information notes that people nearby can also be exposed to e-cigarette aerosol. Indoor-use rules should therefore be based on current local policies rather than assumptions about exposure.

Smoking Restrictions Can Change Which Product Is Used

One particularly important finding was that some participants used e-cigarettes when cigarette smoking was prohibited.

This could create a pattern such as:

Smoking-permitted situation → cigarette

Smoking-restricted situation → e-cigarette

The significance of this finding is that dual use does not necessarily indicate that cigarette smoking is steadily disappearing.

For some participants, the e-cigarette functioned as an alternative during situations in which cigarettes were unavailable or smoking was inconvenient.

Device Availability Can Also Influence Dual Use

Availability worked in the opposite direction as well.

Researchers found that when an e-cigarette was unavailable, some participants returned to cigarettes.

Practical problems could therefore affect product choice in addition to cravings or social factors.

This is an important distinction because it suggests that dual-use behavior can depend on a combination of:

Habit
Environment
Product availability
Social setting
Craving
Established routines

Rather than treating vaping and cigarette smoking as completely separate behaviors, the study suggests they may interact with the same set of everyday cues.

Does Dual Use Mean Someone Is Trying to Quit Smoking?

Not necessarily.

One reason people sometimes assume that an adult uses both products is that the person is transitioning away from cigarettes. That may describe some users, but it does not describe everyone.

The researchers specifically distinguished between people potentially using e-cigarettes as cessation aids and people using them mainly as cigarette alternatives when smoking was unavailable or restricted. They concluded that more research was needed to understand the differences between these groups.

Current CDC information similarly notes that some adults use e-cigarettes in attempts to stop smoking, but no e-cigarette has been approved by the U.S. FDA as a smoking-cessation medication. CDC also advises that dual use should not be regarded as an effective way to protect health.

Anyone who wants help stopping cigarette smoking should consider discussing evidence-based cessation options with a qualified healthcare professional.

Why Context Matters When Studying Dual Users

The main lesson from this research is that product choice can be situational.

A dual user may not simply prefer cigarettes or prefer e-cigarettes across every situation.

Instead, behavior may follow patterns such as:

Stress → established cigarette cue

Meal → cigarette routine

Friends smoking → cigarette cue

Alcohol → cigarette-associated situation

Work or smoking restriction → e-cigarette

E-cigarette unavailable → cigarette

These are not rules that apply to every adult user. They are examples of patterns identified in the study.

The larger point is that cigarette and e-cigarette use can be shaped by psychological, behavioral, social, and environmental factors at the same time.

How Modern Vape Products Differ From Those Used in Earlier Research

The Pokhrel study was conducted more than a decade ago.

E-cigarette technology has changed substantially since then. Current products can vary widely in:

Battery capacity
E-liquid capacity
Nicotine strength
Nicotine formulation
Coil resistance
Mesh-coil design
Rechargeability
Charging port
Airflow
Puff-count claims
Device displays
Power modes

That technological evolution is another reason not to assume that behavior observed in 2015 perfectly describes adult vaping behavior today.

For legal-age adults who already use vaping products and want to understand current specifications rather than health outcomes, the VozolVapen online vape shop allows visitors to compare currently listed devices and product specifications.

Readers specifically researching the VOZOL range can also compare models in the VOZOL Vape product category.

Product specifications should always be checked on the individual product page, since battery capacity, e-liquid capacity, coil resistance, nicotine strength, airflow, charging features, and other parameters vary by model.

Important Limitations of the Study

Good research interpretation requires looking at what a study cannot tell us as well as what it can.

1. It Was a Qualitative Study

Focus groups are useful for discovering patterns and experiences, but they are not designed to estimate how common a behavior is in the entire population.

Therefore, statements such as “most dual users smoke after drinking alcohol” cannot be inferred from this research.

The study identified themes, not population prevalence.

2. The Sample Was Relatively Small

There were 62 participants.

That is appropriate for qualitative focus-group research, but it is not representative of all adults who smoke or vape.

3. Participants Were Young Adults

The mean age was approximately 25 years.

Patterns among older adults, occasional users, long-term smokers, or people in other cultural environments may differ substantially.

4. Participants Did Not All Have the Same Smoking History

The sample included both current and recent dual users.

Someone smoking cigarettes daily while occasionally vaping may behave differently from someone who primarily vapes but smokes cigarettes during certain social situations.

5. The Research Was Published in 2015

Device technology, nicotine products, vaping culture, smoking regulations, and public awareness have changed considerably since 2015.

The paper is therefore especially valuable for understanding behavioral context, but it should not be treated as a direct description of every dual user in 2026.

Common Misinterpretations to Avoid

When discussing cigarette and e-cigarette dual use, several conclusions should be avoided.

“Dual use means someone is quitting cigarettes.”
Not necessarily. Motivation varies between users.

“Using an e-cigarette somewhere means vaping is permitted there.”
No. Workplace, indoor-use, transportation, and public-space rules vary by jurisdiction.

“If someone vapes indoors, there is no exposure to other people.”
That conclusion is not supported. E-cigarette aerosol can be inhaled by nearby people.

“E-cigarettes are harmless.”
No nicotine or tobacco product should be described as risk-free.

“Every dual user experiences the same triggers.”
The Pokhrel study identified recurring themes in a specific qualitative sample; individual behavior can differ substantially.

What Should Adult Readers Take From This Research?

The study helps explain why understanding dual use requires looking beyond the devices themselves.

For some participants, cigarette smoking remained connected with cravings, stress, meals, coffee, alcohol, friends, and established routines.

E-cigarette use was more commonly discussed in contexts where cigarette smoking was unavailable, restricted, or inconvenient.

Device availability could then shift behavior in the opposite direction.

Taken together, these findings suggest that dual use may involve ongoing switching between products according to context rather than a simple linear movement from cigarettes to e-cigarettes.

That distinction matters for researchers, healthcare professionals, policymakers, and adults trying to better understand their own nicotine-use patterns.

Buyer and Information Checklist for Legal-Age Adult Vape Users

If you are already a legal-age adult vape user and are comparing devices, keep health questions separate from product-specification questions.

Before selecting a product, check:

Your legal age and local vaping regulations
Whether the product contains nicotine
Nicotine strength shown on the label
Battery capacity
E-liquid capacity
Coil type and coil resistance
Rechargeable or non-rechargeable design
Charging-port type
Airflow options
Manufacturer instructions
Storage requirements
Local rules concerning indoor or public use
Import, shipping, customs, and disposal requirements

Never assume that a larger puff count, stronger nicotine concentration, or larger battery automatically makes a product more appropriate for you.

Legal-age customers can review currently listed products through the VozolVapen Shop. For questions about specifications, wholesale supply, stock, or shipping, use the VozolVapen Contact page.

FAQ

What is cigarette and e-cigarette dual use?

Dual use generally means using both conventional cigarettes and e-cigarettes. Frequency can vary considerably: one person may use both daily, while another may primarily use one product and use the other only in particular situations.

Why might dual users continue smoking cigarettes?

In the Pokhrel study, cigarette use was associated with factors including strong cravings, stress, habitual routines, being around other smokers, social situations, alcohol, coffee, and temporary unavailability of an e-cigarette. These findings describe themes from participants rather than universal causes.

When might a dual user choose an e-cigarette instead?

Participants discussed e-cigarette use in environments including work, home, vehicles, and situations where cigarette smoking was unavailable or restricted.

Local rules must still be followed because vaping is not necessarily allowed wherever cigarette smoking is prohibited.

Does vaping automatically replace cigarette smoking?

No.

The research showed that some users switched between products depending on circumstances. E-cigarette use therefore did not necessarily mean cigarette smoking had stopped.

Does dual use mean someone is trying to quit smoking?

Not always.

Some users may have cessation goals, while others may use an e-cigarette primarily as an alternative when cigarette smoking is impractical or restricted.

Are e-cigarettes safe?

They should not be described as safe or risk-free. Public-health authorities state that e-cigarettes can expose users to nicotine and other substances, and nicotine is addictive.

Is this 2015 study still relevant?

It remains useful for understanding how habits, environments, social cues, cravings, and product availability may influence dual-use behavior.

However, the age of the study is an important limitation because products, regulations, and patterns of e-cigarette use have changed.

For further research:

For legal-age adults researching product specifications:

Conclusion

The contexts of cigarette and e-cigarette use among dual users are more complex than simply preferring one product over another.

The Pokhrel et al. study found that cigarette smoking among participants could be linked to strong cravings, stress, meals, social situations, other smokers, alcohol, coffee, and the absence of an available e-cigarette. E-cigarette use, meanwhile, was commonly discussed in situations where cigarette smoking was unavailable, restricted, or inconvenient.

These findings support a broader understanding of dual use as a context-dependent behavioral pattern. They do not prove that every dual user follows the same pattern, nor do they establish e-cigarettes as safe or as a guaranteed smoking-cessation method.

Adults who use nicotine products should pay attention to their own behavioral cues, understand that nicotine is addictive, and follow applicable local laws. Legal-age adult customers who are researching device specifications can compare available products through VozolVapen and check individual product pages for nicotine strength, battery capacity, e-liquid capacity, coil configuration, airflow, charging features, and other specifications before making a purchasing decision.

Reference

Pokhrel P, Herzog TA, Muranaka N, Regmi S, Fagan P. Contexts of cigarette and e-cigarette use among dual users: a qualitative study. BMC Public Health. 2015;15:859. DOI: 10.1186/s12889-015-2198-z.