Consumer Characteristics, Tobacco Control Policies, and Disparities in Discontinued Cigarette Purchases: Evidence from U.S. Households (2010-2021)

Objectives: Smoking cessation efforts may be hindered by certain consumer purchase characteristics, for example, quality/brand and menthol-flavored cigarettes, which are prominently used among U.S. adults, particularly Black adults. Other sociodemographics, such as income, education, and marital status, among others, may also influence smoking cessation. Meanwhile, tobacco control policies play a crucial role in promoting smoking cessation. Given the rapidly changing tobacco market and diverse regulatory environments across states in the United States, we evaluated consumer purchase characteristics, sociodemographics, and state tobacco control policies related to smoking cessation among U.S. households between 2010 and 2021. Methods: We analyzed NielsenIQ Consumer Panel data from 5089 households that purchased ≥20 cigarette packs between 2010 and 2021. Analyses assessed factors associated with smoking cessation, as indicated by discontinued cigarette purchases (≥1-year gap in purchases). Independent variables include sociodemographics; consumer purchase characteristics, including primarily (≥80%) menthol cigarette purchases, quality preference (average price/pack), and purchase recency; and strength of state tobacco control (taxation, smoke-free policies). Cox regression models estimated the associations between the exposures and discontinued purchases, accounting for clustering and reporting adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). Results: Overall, 46% of households discontinued cigarette purchases. About 28% primarily purchased menthol cigarettes. Being non-Hispanic Black (vs all other races/ethnicity groups; aHR = 0.68, 95% CI = 0.53-0.87) and divorced/separated (vs married; aHR = 0.80, 95% CI = 0.65-0.99) were associated with lower hazard rates of discontinued purchases, while infrequent purchases (aHR = 1.35, 95% CI = 1.32-1.38) and higher cigarette taxes (aHR = 1.31, 95% CI = 1.10-1.55) were associated with greater hazard rates of discontinued purchases. Menthol purchasing was not associated with discontinued purchases (aHR = 0.96, 95% CI = 0.82-1.12). Conclusion: Non-Hispanic Black panelists were less likely to discontinue purchases compared to other race/ethnicity groups, emphasizing the need for equity-focused tobacco control interventions and policy frameworks. Findings also highlight the importance of marital status, purchase recency, and cigarette taxes on smoking cessation-related outcomes.