Cigarette smoking and chronic disease in the United States, 2021-2023

To quantify and describe the U.S. population of adults who smoke cigarettes daily and have chronic disease, determine their use of various products, and determine whether use of each product is associated with cigarette quitting.

PATH Study data collected in 2021 (Wave 6) and 2022/23 (Wave 7) were analyzed. Participants were adults who smoked cigarettes daily ages 40+ who were diagnosed with chronic obstructive pulmonary disease, chronic bronchitis, emphysema, congestive heart failure, heart attack, stroke, cancer, and/or diabetes as of 2021 (N = 1261). We determined in 2022/23 their past 12-month use of e-cigarettes, nicotine pouches, nicotine replacement therapy (NRT), and bupropion or varenicline; we evaluated whether use differed by several characteristics, and whether use was associated with cigarette quitting.

Among adults who smoked with chronic disease, 40 % were not recently advised by a clinician to quit smoking and 27 % did not plan to ever quit. Between 2021 and 2022/23, 16 % used e-cigarettes, 14 % used NRT, 8 % used bupropion or varenicline, 3 % used nicotine pouches. Overall, <6 % quit smoking in 2022/23; quit rates were higher for those who used e-cigarettes (9 %) and those who used NRTs (12 %) than those who did not use each respective product (5 % and 5 %).

There are 9.9 million people with chronic disease who smoke cigarettes daily in the U.S; findings highlight opportunity for healthcare providers to enhance efforts to help people quit smoking, opportunity to improve low use rates of FDA-approved smoking cessation pharmacotherapies, and potential for e-cigarettes as a smoking cessation tool.