Divergence in Cigarette Discontinuation Rates by Use of Electronic Nicotine Delivery Systems (ENDS): Longitudinal Findings From the United States PATH Study Waves 1-6

Introduction: We compare real-world trends in population-level cigarette discontinuation rates among adults (ages >= 21) who smoked cigarettes, by electronic nicotine delivery systems (ENDS) use. Aims and Methods: U.S nationally representative data from adults in the Population Assessment of Tobacco and Health (PATH) Study (2013/14-2021, Waves 1-6) who smoked cigarettes in the past 30 days (P30D) were analyzed (n = 13 640). The exposure was P30D ENDS use. The outcome was P30D cigarette discontinuation at biennial follow-up. Weighted trend analyses were conducted to test for differences in cigarette discontinuation trends by ENDS use. Results: Between 2013/14 and 2015/16, cigarette discontinuation rates were both 16% for those who used ENDS and for those who did not; between 2018/19 and 2021, rates were similar to 30% for those who used ENDS and similar to 20% for those who did not; the time by ENDS use interaction was significant. Conclusions: The relationship between adults' ENDS use and cigarette discontinuation in the context of an expanded ENDS marketplace, new tobacco regulatory actions, and COVID-19 differs from the relationship in earlier years. Implications It is important for public health decisions to be informed by research based on the contemporary ENDS marketplace and circumstances.