Switching to alternative tobacco products during unsuccessful smoking quit attempts is not linked to improved quit intention or interest

Background Among adults who smoke cigarettes daily, attempts to quit smoking may involve using alternative tobacco products (ATPs) or evidence-based cessation aids, such as Nicotine Replacement Therapy (NRT). This study examined use of ATPs and aids during the last serious smoking quit attempt as well as quit intentions and interest in quitting among adults who smoke daily. Methods This cross-sectional study utilized the 2022-23 Tobacco Use Supplement to the Current Population Survey data collected for U.S. adults (18+; n = 3,038 for using an ATP or aid, n = 2,962 for quit intention, and n = 3,000 for interest in quitting). Statistical methods accounted for the complex survey sampling design, e.g., multiple logistic regression models with balanced repeated replication for variance estimation. Results Among the ATPs considered, switching to e-cigarettes (20.93%) or nicotine pouches (5.46%) was most common. Switching to cigars/pipes (adjusted Odds Ratio (aOR) = 2.38, 95% CI = 1.26–4.47), smokeless tobacco (aOR = 2.92, 95% CI = 1.61–5.30), or using NRT (aOR = 1.50, 95% CI = 1.13–1.99) was associated with switching to e-cigarettes. Switching to cigars/pipes (aOR = 3.01, 95% CI = 1.37–6.62), e-cigarettes (aOR = 1.74, 95% CI = 1.03–2.93), smokeless tobacco (aOR = 7.33, 95% CI = 3.42–15.72), or using NRT (aOR = 6.34, 95% CI = 3.79–10.61) was associated with switching to nicotine pouches. Among adults who used an ATP or aid, quit intention was lowest among those who switched to cigars/pipes (63.90%) and highest among those who used a digital tool or program (84.99%). Switching to any ATP was not associated with quit intention or interest in quitting. In contrast, use of any aid, except group counseling or support groups, was positively associated with quit intention, and use of any aid was associated with greater interest in quitting (all p’s < 0.05). Conclusions The study highlights the emerging role of e-cigarettes and nicotine pouches as alternative quitting strategies, although no evidence was found that using these ATPs is associated with improved quit intentions or interest in quitting. In addition, the study demonstrates that evidence-based cessation aids continue to be underutilized. Further research is needed to elucidate the role of ATPs in smoking cessation alongside evidence-based cessation aids, as well as their potential for harm reduction among adults who smoke heavily.