E-Cigarette Characteristics and Cigarette Cessation Among Adults Who Use E-Cigarettes

Importance Population-level health outcomes associated with e-cigarettes depend in part on the association between e-cigarettes and combustible cigarette cessation. The US Food and Drug Administration has authority to regulate e-cigarette characteristics, including flavor and device type. Objective To investigate whether e-cigarette characteristics are associated with cigarette cessation behaviors among adults in the US population who use e-cigarettes. Design, Setting, and Participants This cohort study was conducted using longitudinal data collected in 2014 to 2021 by the Population Assessment of Tobacco and Health Study, a population-based, US nationally representative study. Participants were sampled from the civilian noninstitutionalized population using a 4-staged, stratified sampling design. Data were weighted and analyzed from 1985 adults ages 21 or older who smoked cigarettes daily and had used e-cigarettes in the past 30 days. Data were analyzed in May 2021 to May 2024. Exposures The following e-cigarette characteristics were assessed: use frequency (daily and nondaily), flavor type (tobacco, menthol or mint, sweet, and combination), device type (disposable, cartridge, and tank), and year of data collection as a proxy for the evolving e-cigarette marketplace. Main Outcomes and Measures The following cigarette cessation behaviors were assessed: making a cigarette quit attempt, cigarette cessation among individuals who made a quit attempt, and overall cigarette discontinuation regardless of quit attempts. Associations were evaluated between e-cigarette characteristics (assessed at baseline in 1 approach and assessed at follow-up in another approach) and cigarette cessation outcomes, controlling for demographic, cigarette smoking, and other e-cigarette use characteristics. Results The study sample consisted of 1985 participants representing adults in the population (mean age, 40.0 years 95% CI, 39.2-40.9 years; 49.4% 95% CI, 46.3%-52.6% male; 11.4% 95% CI, 9.6%-13.4% Black, 80.7% 95% CI, 77.8%-83.3% White, and 8.0% 95% CI, 6.3%-10.0% other race; 9.2% 95% CI, 7.5%-11.2% Hispanic). Daily vs nondaily e-cigarette use was associated with greater overall cigarette discontinuation rates (12.8% 95% CI, 9.1%-17.7% vs 6.1% 95% CI, 4.8%-7.7%; adjusted odds ratio aOR, 2.26 95% CI, 1.34-3.81), and use of e-cigarettes in 2019 to 2021 vs 2014-2015 to 2015-2016 was also associated with greater overall cigarette discontinuation rates (12.0% 95% CI, 8.8%-16.0% vs 5.3% 95% CI, 2.9%-9.3%; aOR, 2.75 95% CI, 1.13-6.67). Use of menthol or mint vs tobacco flavor e-cigarettes was associated with greater overall cigarette discontinuation rates (9.2% 95% CI, 6.6%-12.8% vs 4.7% 95% CI, 3.0%-7.1%; aOR, 2.63 95% CI, 1.32-5.27) only when assessing e-cigarette use at baseline. E-cigarette device type was not associated with cigarette discontinuation rates in adjusted analyses. Conclusions and Relevance In this study, daily e-cigarette use and use of e-cigarettes in 2019 to 2021 were consistently associated with greater cigarette discontinuation rates. These findings suggest that research focused on e-cigarettes marketed in recent years is needed to inform product regulation and public health policy decisions.