Trends in Cigarette Discontinuation Rates in the United States Across 2014/15-2021 Among Adults Who Use Electronic Nicotine Delivery Systems (ENDS): Trends by ENDS Flavor, ENDS Device Type, and Age Group From the PATH Study.

INTRODUCTION

Cigarette discontinuation rates among adults who smoked cigarettes in the United States (US) diverged across 2013/14-2021 between those who did and did not use electronic nicotine delivery systems (ENDS). We evaluate whether trends in cigarette discontinuation rates among adults who used ENDS differed by ENDS flavor, ENDS device type, and age group.

METHODS

Adults aged ≥18 who smoked cigarettes in the past 30 days (P30D) and used ENDS in the P30D were evaluated from biennial pairs of interviews using nationally representative longitudinal Population Assessment of Tobacco and Health (PATH) Study data (2014/15-2021, Waves 2-6, n = 3054). Weighted generalized estimating equation (GEE) analyses were used to evaluate and test for differences in trends in cigarette discontinuation rates (no P30D smoking at follow-up) stratified by ENDS flavor (tobacco flavor only, menthol/mint flavor only, fruit/sweet/other flavor only, any combination flavor), ENDS device type (disposable, cartridge, tank), and age group (18-24, ≥25). Analyses were adjusted for demographic characteristics, cigarette smoking variables, other tobacco use, and other ENDS use variables.

RESULTS

Cigarette discontinuation rates increased for those who used menthol/mint flavor ENDS (trend adjusted odds ratio [AOR] = 3.18, 95% CI:1.21 to 8.32), fruit/sweet/other flavor ENDS (AOR = 2.13, 95% CI: 1.43 to 3.16), any combination flavor ENDS (AOR = 2.89, 95% CI: 1.49 to 5.62), disposables (AOR = 3.38, 95% CI: 1.25 to 9.16), cartridge devices (AOR = 2.33, 95% CI: 1.49 to 3.63), tanks (AOR = 2.05, 95% CI: 1.43 to 2.94), those aged 18-24 (AOR = 3.29, 95% CI: 2.22 to 4.88), and those aged ≥25 (AOR = 1.83, 95% CI: 1.35 to 2.48).

CONCLUSIONS

Increasing trends in cigarette discontinuation rates among adults who used ENDS were not specific to any ENDS flavor, ENDS device type, or age group examined here.

IMPLICATIONS: Further research may identify factor(s) not examined in this study, such as the availability of nicotine salt-based ENDS products, account for the increasing trend in cigarette discontinuation rates among adults who use ENDS in the United States, which can further inform tobacco regulation.