Repeated point-prevalence of switching away from smoking after electronic nicotine delivery systems (ENDS) purchase

Adults who smoke cigarettes can benefit from switching completely to electronic nicotine delivery systems (ENDS). Research is needed to examine longer-term switching trajectories beyond one year of follow-up.

This analysis of a previously-described longitudinal cohort study of adults who smoke and purchased JUUL focused on N = 11,153 who completed the 12-month (12 M) follow-up and ≥ 1 of 4 surveys in the second year (Y2; at 15, 18, 21, and 24 months). Outcomes were repeated point prevalence of product use over the past-30-days (P30D) at each Y2 follow-up: repeated point prevalence-switching (i.e., no P30D smoking at any available Y2 follow-ups), repeated point prevalence-smoking, or varying status. Associations between product use status at 12M (switched, exclusive smoking, or dual used) and Y2 product use patterns were examined.

Most adults who smoked at baseline and were switched at 12 M reported repeated point prevalence-switching over Y2 (69.5%); repeated point prevalence-smoking was rare (6.2%). In contrast, > 50% of those who were smoking at 12 M (exclusively or with ENDS [JUUL or other brand]) persistently smoked over Y2. Supplementary analyses showed that among adults who exclusively used ENDS at 12 M, those who used ENDS daily were more likely to persistently switch over Y2; similarly, among adults who smoked at 12 M (either exclusively or dual-use with ENDS) those who smoked nondaily were more likely to persistently switch over Y2. Over half of adults who dual used at both 12 M and 24 M substantially reduced (i.e., by 50%+) their baseline cigarette consumption.

For the majority of participants, product use status at 12 M was consistent with use patterns in the second year: most adults who smoked at baseline and were switched at 12 M reported repeated point prevalence-switching over Y2, while any smoking at 12 M- especially daily smoking- was usually followed by repeated point prevalence-smoking. These findings indicate that switching and smoking behavior is generally maintained and remains stable one year after purchasing ENDS.