Predictors of cigarette discontinuation and reduction among adults never planning to quit smoking: Longitudinal findings from the U.S. Population Assessment of Tobacco and Health (PATH) study, 2014/15-2021.

Introduction: E-cigarettes have increased in use prevalence among adults who smoke cigarettes. However, the population-based literature on e-cigarette use and smoking cessation largely still focuses on those planning or attempting to quit smoking. We evaluated predictors of cigarette discontinuation or reduction among adults not planning to ever quit smoking. Methods: We conducted secondary data analyses using the Population Assessment of Tobacco and Health (PATH) Study (2014-2021; Waves 2-6) cohort data collected in the United States. Data were collected using audio computer-assisted in-person or telephone self-interviews. Participants were aged ≥21 years who smoked cigarettes every day, did not plan to ever quit smoking, and did not use e-cigarettes at baseline assessment. Predictors were previous quit attempt, quitting interest, nicotine dependence, cigarette pack-years, e-cigarette uptake (none, non-daily, daily uptake), e-cigarette flavor (tobacco, menthol/mint, fruit/sweet/other, combination flavors), e-cigarette device type (disposable, cartridge, tank/mod). Outcomes were cigarette discontinuation (from daily to no smoking) and cigarette reduction (from daily to non-daily smoking) among those who did not discontinue smoking. Weighted and adjusted generalized estimating equation logistic regression analyses were conducted. Results: Assessment in 2018/19-2021 (vs 2014/15-2015/16) was associated with higher odds of cigarette reduction (adjusted odds ratio, AOR=2.32; 95% CI: 1.01-5.36). Higher nicotine dependence (vs lower) was associated with lower odds of cigarette reduction (2.3% vs 6.7%, AOR=0.48; 95% CI: 0.25-0.90). Uptake of daily e-cigarette use (vs no uptake) was associated with reducing or discontinuing cigarette smoking (53.5% vs 10.0%, AOR=14.58; 95% CI: 5.99-35.50); the rate of daily e-cigarette uptake was 2%. Conclusions: Uptake of daily e-cigarette use was associated with cigarette reduction/discontinuation among people who smoked daily and did not plan to ever quit. Findings add to growing evidence on the role of e-cigarettes in moving adults who smoke down the continuum of risk, particularly among an understudied population at high risk of smoking-attributable morbidity and mortality.