Sex differences in tobacco use, attempts to quit smoking, and cessation among dual users of cigarettes and e-cigarettes: Longitudinal findings from the US Population Assessment of Tobacco and Health Study

Significance: A growing number of adults use more than one tobacco product, with dual use of cigarettes and ecigarettes being the most common combination. Monitoring sex disparities in tobacco use is a public health priority. However, little is known regarding whether dual users differ by sex. Methods: Data came from Waves 4-6 (12/2016-11/2021) of the Population Assessment of Tobacco and Health Study, a US nationally-representative longitudinal survey. This analysis included current adult dual users of cigarettes and e-cigarettes. We used weighted generalized estimating equations to assess the association between sex and (1) making a cigarette quit attempt (n = 1882 observations from n = 1526 individuals) and (2) smoking cessation (n = 2081 observations from n = 1688 individuals) across two wave pairs, adjusting for age, education, ethnicity, time-to-first cigarette after waking, and e-cigarette use frequency. Results: Among US dual users, 14.1% (95% Confidence Intervals [Cl] = 11.9-16.4) of females and 23.4% (20.0-26.9) of males were young adults (aged 18-24), 11.7% (9.2-14.2) of females and 14.4% (11.6-17.2) of males had 82.2% (79.4-84.5) of females and 78.7% (75.1-82.4) of males were white. Overall, 44.9% (41.6-48.1) of females compared with 37.4% (33.5-41.3) of males made an attempt to quit smoking between a baseline and follow-up wave (Adjusted Risk Ratio [ARR] = 1.23, 1.05-1.45). In contrast, there were no apparent differences between females (22.1%, 19.0-25.2) and males (24.3%, 21.5-27.1) in smoking cessation (ARR = 1.06, 0.84-1.35). Conclusion: US females who dual use e-cigarettes and cigarettes were more likely to attempt to quit smoking, but not more likely to succeed at quitting, than males.