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Palmer AM, Smith TT, Nahhas GJ, et al. Interest in Quitting e-Cigarettes Among Adult e-Cigarette Users With and Without Cigarette Smoking History. JAMA Netw Open. 2021;4(4):e214146. doi:10.1001/jamanetworkopen.2021.4146
Approximately 2.8% to 3.2% of US adults are current e-cigarette users, with a majority being current cigarette smokers or former cigarette smokers.1 The most common use for e-cigarettes is to quit smoking, but e-cigarette use may continue even after discontinuation of combustible cigarettes.2 Furthermore, those who initiate e-cigarettes to quit smoking may not be successful, leading to dual use of both tobacco cigarettes and e-cigarettes, which increases potential health harms.3
Previous studies have shown that people who use e-cigarettes, also called vaping, are interested in quitting.4,5 No published randomized clinical trials for e-cigarette discontinuation exist, and evidence on how to aid e-cigarette users in stopping is limited. It is important to understand interest in quitting among e-cigarette users, including dual users. The purpose of this study was to provide the most up-to-date estimate of interest in e-cigarette discontinuation among US adults.
Data were collected as a part of the Population Assessment of Tobacco and Health (PATH) Wave 4 adult cohort (December 2016 – January 2018), a comprehensive, publicly available longitudinal US survey approved by the Westat institutional review board.6 Participants provided written informed consent. This survey study follows the American Association for Public Opinion Research (AAPOR) reporting guideline.
Outcomes of interest included: (1) those who attempted to quit e-cigarettes in the past 12 months, (2) those who plan to eventually quit e-cigarettes, and (3) level of interest in quitting (measured by a scale of 1 to 10, with higher scores indicating a higher interest in quitting). Those who endorsed a quit attempt were asked how many attempts had been made in the past 12 months. Balanced repeated replication weighting procedures were used for analyses, completed on SAS version 9.4 (SAS Institute) from October to November 2020. χ2 tests examined differences in prevalence for dichotomous outcomes, and t tests examined continuous outcomes with a 2-tailed significance threshold of P < .05.
Of the 30 191 adults who completed the survey, 1988 (6.5%) were identified as established e-cigarette users (every day or some days for more than 30 days; Table 1). Among the analyzed sample of 1988 e-cigarette users, 1332 (59%) were male, 1384 (75%) were non-Hispanic White, 1189 (59%) had income less than $50 000 (representing lower levels of median income and educational attainment), and most were aged 44 years or younger (aged 18-24 years: 128 participants [17.9%; 95% CI, 14.8%-21.0%]; aged 25-34 years: 75 participants [14.1%; 95% CI, 9.7%-18.5%]; aged 35-44 years: 42 participants [12.3%; 95% CI, 8.4%-16.2%]). Of the established e-cigarette users, dual users were identified as concurrent established cigarette smokers who smoked every day or some days for more than 30 days (1053 participants [53.56%]); former cigarette smokers, as those who had quit smoking more than 30 days ago (540 participants [31.0%]); and never cigarette smokers, as those who denied smoking (371 participants [14.5%]). Within the full sample, 302 participants (15.2%) endorsed having made a past-year quit attempt and 1208 participants (60.7%) endorsed future plans to quit e-cigarettes.
Dual users, former smokers, and never smokers differed in rates of attempting to quit in the past 12 months and plans to quit in the future. Never smokers endorsed the highest rates of past quit attempts (69 never smokers [20.9%]; 95% CI, 15.2%-26.6% vs 177 dual users [15.3%]; 95% CI, 12.8%-17.8% vs 52 former cigarette smokers [7.9%]; 95% CI, 5.2%-10.7%; P < .001), whereas former smokers represented the highest proportion of participants planning to quit (357 former cigarette smokers [66.1%]; 95% CI, 60.4%-71.8% vs 624 dual users [59.0%]; 95% CI, 55.2%-62.8% vs 213 never cigarette smokers [55.4%]; 95% CI, 49.2%-61.6%; P = .02). Although the differences were not statistically significant, former cigarette smokers rated higher interest in quitting compared with other groups (former cigarette smokers’ mean [95% CI] level of interest in quitting: 4.2 [3.9-4.4] vs dual users: 3.8 [3.6-4.0]; P = .06; and vs never cigarette smokers: 3.8 [3.4-4.1]; P = .09) (Table 2). Of those who tried to quit, no group differences were found regarding number of quit attempts.
A majority of e-cigarette users expressed interest in eventually quitting vaping. Not surprisingly, since e-cigarette use is often initiated to quit cigarettes, former cigarette smokers had the highest levels of intention to quit and interest in quitting vaping. Results suggest that dual users and never smokers are somewhat less inclined to consider stopping e-cigarettes, which may be related to health and/or risk perceptions of vaping. These groups also endorsed higher rates of failed attempts to quit vaping, suggesting difficulties in stopping use. A limitation of the present analysis is that the anticipated timeframe for discontinuing e-cigarettes is unknown.
There is an urgent need for development of interventions to help individuals quit vaping, regardless of their cigarette smoking status. Future research should also continue to monitor characteristics of e-cigarette users interested in quitting.
Accepted for Publication: February 7, 2021.
Published: April 2, 2021. doi:10.1001/jamanetworkopen.2021.4146
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Palmer AM et al. JAMA Network Open.
Corresponding Author: Benjamin Toll, PhD, Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon St, MSC 835, Charleston, SC 29425 (email@example.com).
Author Contributions: Drs Palmer and Toll had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Palmer, Smith, Carpenter, Toll.
Acquisition, analysis, or interpretation of data: Palmer, Smith, Nahhas, Rojewski, Sanford, Toll.
Drafting of the manuscript: Palmer.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Palmer, Nahhas.
Administrative, technical, or material support: Toll.
Conflict of Interest Disclosures: Dr Carpenter reported receiving personal fees from Pfizer and Frutarom during the conduct of the study. Dr Toll reported receiving personal fees from Pfizer and personal fees from expert testimony on behalf of plaintiffs who filed litigation against the tobacco industry outside the submitted work. No other disclosures were reported.
Funding/Support: This research was supported by NIH Institutional Postdoctoral Training Grant NIH-T32-HL144470, NIDA grant K01DA047433 (Smith), NCI grants R01CA235697 and R01CA207299 (Toll) and K07CA214839 (Rojewski), and Biostatistics Shared Resource, Hollings Cancer Center (P30 CA138313).
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.