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. Author manuscript; available in PMC: 2025 Feb 20.
Published in final edited form as: Tob Control. 2024 Feb 20;33(2):186–192. doi: 10.1136/tc-2022-057323

National longitudinal tobacco product cessation rates among US adults from the PATH Study: 2013–2019 (waves 1–5)

Karin A Kasza 1, Zhiqun Tang 2, Haijun Xiao 3, Daniela Marshall 4,5, Cassandra Stanton 2, Amy L Gross 3, Kathy M Jackson 3, Dannielle Kelley 3, Megan J Schroeder 3, Juan C Vivar 3, Andrew Hyland 1
PMCID: PMC10249338  NIHMSID: NIHMS1901933  PMID: 35879095

Abstract

Objective.

To report on longitudinal tobacco product cessation rates, by product type, among adults (ages 18+ years) in the United States (U.S.) between 2013–2019.

Methods.

The Population Assessment of Tobacco and Health (PATH) Study, a nationally representative, longitudinal cohort study was used to report on annual and biennial rates of the following three cessation behaviors across 2013–2019: (1) discontinuing tobacco product use (i.e., transition from past 30-day use to no past 30-day use), (2) attempting to quit tobacco product use, and (3) quitting tobacco product use among those who attempted to quit. Each cessation behavior was evaluated separately for cigarettes, electronic nicotine delivery systems (ENDS), cigars, hookah, and smokeless tobacco. Generalized estimating equations were used to evaluate linear and nonlinear trends in cessation rates across the study period.

Results.

Between 2013–2019, rates of discontinuing cigarette smoking among adults in the U.S. statistically increased from 16% to 18%, though these were consistently lower than rates of discontinuing use of other tobacco products. Similarly, quit attempt rates and rates of quitting among attempters increased for cigarette smokers. However, rates of discontinuing ENDS use sharply declined across the study period, from 62% to 44%.

Conclusions.

Findings show that tobacco product cessation rates have been changing in recent years in the U.S. alongside the changing tobacco product marketplace and regulatory environment, though rates of discontinuing cigarette smoking remain relatively low. Findings can serve as a benchmark against which future cessation rates can be compared to evaluate the impacts of future tobacco regulatory policies.

BACKGROUND

Globally, the majority of tobacco-related morbidity and mortality is due to combustible cigarette smoking1 and smoking cessation reduces the risks of several diseases including heart disease and cancer.2–3 Therefore, a key component to reducing tobacco-related morbidity and mortality globally is to increase combustible cigarette cessation rates.4 For cigarettes or any other type of tobacco product, cessation rates are a function of both quit attempt rates among users, and quit rates among those who attempt to quit, and therefore both such rates can be targeted for improvement and evaluated longitudinally over time.5

In the United States (U.S.), the Population Assessment of Tobacco and Health (PATH) Study is a large nationally representative longitudinal study of tobacco use, allowing for the prospective assessment of tobacco product transition behaviors.6 We previously reported on tobacco product use prevalence and transition behaviors from the PATH Study using data from 2013–2016.7–15 However, since then the tobacco product marketplace in the U.S. has expanded, and new tobacco regulatory actions have been implemented. For example, the market for electronic nicotine delivery systems (ENDS, a term used in the U.S. to refer to products that meet the legal definition of a tobacco product and thus can be regulated by the U.S. FDA) has expanded to include products with high nicotine content/salt-based e-liquid formulations,16 and tobacco regulatory actions have been implemented including ENDS flavor restrictions17 and increases in the minimum age of sale of tobacco products.18

The literature is lacking a U.S. national report on whether/how tobacco product cessation rates have changed alongside the changing marketplace and regulatory environment. Further, such trend data are needed to serve as a benchmark against which future data can be compared to evaluate the impact of market/policy changes that may happen in the future. Therefore, the purpose of this paper is to report the national longitudinal tobacco product cessation rates from the PATH Study among adults (ages 18+ years) in the U.S. between 2013–2019 (Wave (W)1 - W5). Specifically, for cigarettes, ENDS, cigars, hookah, and smokeless tobacco, we report on annual and biennial rates of (1) discontinuing tobacco product use (i.e., transition from past 30-day use to no past 30-day use), (2) attempting to quit tobacco product use, and (3) quitting tobacco product use among those who attempted to quit.

METHODS

Participants

We analyzed data from adults who participated in the PATH Study, which is a nationally representative longitudinal study of youth (ages 12–17 years) and adults (ages 18+ years) in the U.S. 16 Data were collected using audio computer-assisted self-interviews conducted in English or Spanish from September 2013-December 2014 (W1), October 2014-October 2015 (W2), October 2015-October 2016 (W3), December 2016-January 2018 (W4), and December 2018-November 2019 (W5). That is, W5 was conducted approximately two years after W4, whereas W1-W4 were each conducted approximately annually. The PATH Study was conducted by Westat and approved by the Westat Institutional Review Board. All adults ages 18+ years provided informed consent. The weighted response rates for adults conditional on W1 participation ranged from 69% in W5 to 83% in W2.19 Additional details on the PATH Study design and methods6,20–21 and demographic and tobacco use distributions22 are published elsewhere. Details on interviewing procedures, questionnaires, sampling, weighting, response rates, and accessing the data are available at https://doi.org/10.3886/Series606. 19

We evaluated three types of tobacco product cessation behaviors over 1-year periods (annual rates) between 2013–2017, and over 2-year periods (biennial rates, so that W4-W5, which reflected an approximately two-year interval, could be included and compared to other wave intervals) between 2013–2019. Reporting on annual rates capitalizes on the frequency of the PATH Study interview waves and reporting on biennial rates capitalizes on use of the most recent PATH Study wave available at the time of analysis. Analyses were conducted among adult users of at least one type of tobacco product at the baseline wave of any annual or biennial wave pair (e.g., n=26,447 adults at both W1 and W2 for annual wave pair W1-W2, for the W1 cohort (i.e., those recruited in W1), and n=28,536 adults at both W4 and W5 for biennial wave pair W4-W5 for the W4 cohort (i.e., those recruited in W4). Overall, PATH W1-W5 data from a total of 36,397 individuals contributed to this study. [Please see Supplemental Table 1a for more details on sample sizes and please see Statistical analyses section below for a detailed description of how wave pairs were evaluated]) Youth (ages 12–17 years) who became age 18 during the study period were included in analyses using the wave(s) during which they were aged 18+ years at baseline (Supplemental Tables 1a and 1b). An extensive description of how respondents of different ages contributed observations to analyses at different timepoints has been published elsewhere.14 All estimates reported here were weighted to adjust for the PATH Study’s; complex study design characteristics (e.g., oversampling) and attrition, making them representative of the resident adult population of the U.S. at the time of data collection, who were also in the civilian, noninstitutionalized population in 2013/14 or 2016/17 (Supplemental Table 1a).19

Measures

Tobacco product use.

At each interview, respondents were asked about their use of the following types of tobacco products: cigarettes, ENDS (e-cigarettes at W1, and e-cigarettes, e-cigars, e-pipes, e-hookah at W2-W5), cigars (traditional cigars, cigarillos, filtered cigars), hookah, and smokeless tobacco (loose snus, moist snuff, dip, spit, chewing tobacco and snus pouches). For cigarettes, respondents were asked whether they ever smoked a cigarette, and those who had were asked whether they now smoke cigarettes every day, some days, or not at all, whether they smoked in the past 30 days, and how many cigarettes they smoked in their lifetime. Number of cigarettes smoked in the lifetime was asked at each interview until a respondent reached the threshold of having smoked 100+ cigarettes in the lifetime; current smoking behaviors were assessed at each interview. For each other type of tobacco product, respondents were asked whether they ever used the product and those who had were asked whether they now use the product every day, some days, or not at all, whether they used the product in the past 30 days, and whether they ever used the product ‘fairly regularly.’ Ever fairly regular use was asked at each interview until a respondent had used fairly regularly; current use behaviors were assessed at each interview. For each type of tobacco product, two current use measures were defined at the baseline wave of each wave pair:

  • Past 30-day use. For each type of tobacco product, past 30-day use was defined as use of the product in the past 30 days. Additionally, past 30-day use of any tobacco product was defined as use of any tobacco product in the past 30 days.

  • Current established use. For cigarettes, current established use was defined as currently smoking every day or some days and having smoked at least 100 cigarettes in the lifetime. For each other tobacco product, current established use was defined as currently using the product every day or some days and having ever used the product “fairly regularly.”

Cessation behaviors.

At the W2 interview, respondents who were current established tobacco users were asked: “In the past 12 months, have you tried to quit [product/tobaccoi]? Choose all that apply” with the first response option being “Yes, I have tried to quit completely.” At the W3-W5 interviews, respondents who were current established tobacco users were asked: “In the past 12 months, have you tried to quit [product/tobacco] completely?” Three cessation behavior measures were defined at follow-up wave of each wave pair:

  • Discontinuing past 30-day use. For each type of tobacco product, among those who were past 30-day users of the product at the baseline wave, we defined discontinuing past 30-day use as no past 30-day use of the product at follow-up (versus past 30-day use of the product at follow-up). Also, among those who used any tobacco product in the past 30 days at baseline, we defined discontinuing past 30-day use as no past 30-day use of any tobacco product at follow-up (versus past 30-day use of any tobacco product at follow-up).

  • Making a quit attempt. For each type of tobacco product, among those who were current established users of the product at the baseline wave, we defined making a quit attempt as either having tried to quit completely in the past 12 months at follow-up or as not using the product at all at follow-up (versus not having tried to quit completely in the past 12 months at follow-up).

  • Quitting among attempters. For each type of tobacco product, among those who were current established users of the product at the baseline wave and who made a quit attempt at follow-up, we defined quitting as no every day or someday use of the product at follow-up (versus every day or someday use of the product at follow-up).

Statistical analyses

First, for each type of tobacco product and each cessation behavior outcome, we determined annual cessation rates between W1-W2, W2-W3, and W3-W4, overall and stratified by age group at the baseline wave of each wave pair (i.e., 18–20, 21–24, 25–39, 40–54, 55–69, 70+ years at baseline wave [missing data on age were imputed at W1 as described in the PATH Study Restricted Use Files User Guide (http://doiorg/10.3886/Series606]). That is, for annual cessation rates, W1 served as the baseline wave to follow-up W2, W2 served as the baseline wave to follow-up W3, and W3 served as the baseline wave to follow-up W4. Annual cessation rates were each weighted using the single-wave or all-waves weights as appropriate and available for longitudinal analyses as described in Supplemental Table 1a (including full-sample and 100 replicate weights) such that all those eligible to participate in any annual wave pair were included in analyses and estimates represent cessation rates in the population at the time of the follow-up wave for those who were in the population at the time of W1 or W4 (Supplemental Table 1a).

Next, for each type of tobacco product and each cessation behavior outcome, we determined biennial cessation rates between W1-W3, W2-W4, and W4-W5, overall and stratified by age group at the baseline wave of each wave pair (same age groups as for annual cessation rates). For biennial rates, W1 served as the baseline wave to follow-up W3, W2 served as the baseline wave to follow-up W4, and W4 served as the baseline wave to follow-up W5. Biennial cessation rates were each weighted using the single-wave or all-waves weights as appropriate and available for longitudinal analyses as described in Supplemental Table 1a (including full-sample and 100 replicate weights) such that all those eligible to participate in any biennial wave pair were included in analyses and estimates represent cessation behavior rates in the population at the time of the follow-up wave for those who were in the population at the time of W1 or W4 (Supplemental Table 1a).

Last, for each type of tobacco product and each cessation behavior outcome, we used generalized estimating equations (GEEs) logistic regression analyses to evaluate annual linear and non-linear trends across W1-W4 (i.e., time as measured by wave was entered as a continuous variable to assess linear trends and a quadratic term was entered for non-linear trends, please see Supplemental Table 1b for more details about sample sizes), weighted using the W4 all-waves weights for the W1 cohort (including full-sample and 100 replicate weights); only those who participated in all four waves were included in analyses and estimates represent cessation rates in the population at the time of the follow-up wave for those who were in the population at the time of W1 (respondents who were recruited into the PATH Study at Wave 4 were excluded from this analysis). Then, for each type of tobacco product and each cessation behavior outcome, we used GEEs to evaluate biennial linear and non-linear trends across W1-W5 (i.e., time as measured by wave was entered as a continuous variable to assess linear trends and a quadratic term was entered for non-linear trends, please see Supplemental Table 1b for more details about sample sizes), weighted using the W5 all-waves weights for the W1 cohort (including full-sample and 100 replicate weights); only those who participated in all five waves were included in analyses and estimates represent cessation rates in the population at the time of the follow-up wave for those who were in the population at the time of W1 (respondents who were recruited into the PATH Study from Wave 4 were excluded from this analysis). GEE allows for inclusion of multiple wave pair observations in a single analysis while statistically controlling for interdependence among observations contributed by the same individuals.23–24 For all GEE trend analyses, we specified the unstructured covariance and within-person correlation matrices and the binomial distribution of the dependent variable using the logit link function; however, in instances where we were unable to obtain estimates using unstructured correlations, we specified autocorrelation matricesii, and estimates obtained using these alternate matrices are indicated in the tables.

For all weighted analyses, variances were computed using the balanced repeated replication method25 with Fay’s adjustment set to 0.3 to increase estimate stability.26 The Wilson method was used to calculate 95% confidence intervals (CIs). All analyses were conducted using SAS 9.4 software (SAS Institute, Cary, North Carolina, USA). The SAS macro code used to run weighted GEE analyses and calculate adjusted odds ratios (aORs) and CIs has been published elsewhere.14 Analyses were run on the W1–W5 Restricted Use Files (https://doi.org/10.3886/ICPSR36231). Estimates with a relative standard error >30% or with a denominator <50 are flagged since these estimates may provide unreliable precision, and estimates with unweighted sample size <3 (i.e., any numerator) are collapsed to protect respondent confidentiality.

RESULTS

Discontinuing past 30-day use: Annual and biennial rates

The PATH Study national annual and biennial rates of discontinuing past 30-day tobacco product use, by product type, for adults in the U.S. between 2013–2019 are shown in Figures 1a and 1b. Supplemental Table 2a and 2b shows these rates stratified by age group and provides additional information on Ns, measures of variance, and correlation matrices used for each trend analysis.

Figure 1a.

Figure 1a.

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Discontinuing Past 30-day Use: PATH Study Annual Rates 2013/14–2016/17

Figure 1b.

Figure 1b.

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Discontinuing Past 30-day Use: PATH Study Biennial Rates 2013/14–2018/19

Across 2013–2017, annual rates of discontinuing past 30-day tobacco product use were consistently lowest for cigarettes (always below 15%) and were consistently highest for hookah (always above 58%, Figure 1a). Among the subset of respondents who participated in all four waves, there were statistically significant positive linear trends in discontinuing past 30-day tobacco product use for any tobacco (OR=1.18, 95%CI: 1.12–1.24), cigarettes (OR=1.11, 95%CI: 1.05–1.18), ENDS (OR=1.18, 95%CI: 1.10–1.27), and cigars (OR=1.96, 95%CI: 1.63–2.35), which also had a statistically significant negative nonlinear trend (OR=0.81, 95%CI: 0.75–0.89). That is, rates of discontinuing past 30-day tobacco product use significantly increased across the analysis period for any tobacco, cigarettes, ENDS, and cigars, though the rate for cigars decreased at the end of the analysis period. For smokeless tobacco, there was a statistically significant positive nonlinear trend iii ([OR=1.18, 95%CI: 1.02–1.37], Supplemental Table 2a). That is, the rate of discontinuing past 30-day smokeless tobacco use significantly increased at a higher rate at the end of the analysis period than at the beginning of the analysis period.

Across 2013–2019, biennial rates of discontinuing past 30-day tobacco product use were again consistently lowest for cigarettes (always below 19%) and were again consistently highest for hookah (always above 69%, Figure 1b). Among the subset of respondents who participated in all five wavesiv, there were statistically significant positive linear trends in discontinuing past 30-day tobacco product use for any tobacco (OR=1.56, 95%CI: 1.37–1.79), which also had a statistically significant negative nonlinear trend (OR= 0.84. 95%CI: 0.79– 0.90), and cigarettes (OR= 1.12, 95%CI: 1.07–1.17). There was a statistically significant positive nonlinear trend for cigars (OR=1.15, 95%CI: 1.05–1.25) and for smokeless tobacco ([OR=1.19, 95%CI: 1.06–1 .M], Supplemental Table 2b).

Making a quit attempt: Annual and biennial rates

The PATH Study national annual and biennial rates of making a quit attempt, by product type, for adults in the U.S. between 2013–2019 are shown in Figures 2a and 2b. Supplemental Table 3a and 3b shows these rates stratified by age group and provides additional information on Ns, measures of variance, and correlation matrices used for each trend analysis.

Figure 2a.

Figure 2a.

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Making a Quit Attempt: PATH Study Annual Rates 2013/14–2016/17

Figure 2b.

Figure 2b.

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Making a Quit Attempt: PATH Study Biennial Rates 2013/14–2018/19

Across 2013–2017, annual rates of making a quit attempt were generally lowest for cigarettes (always below 42%) and were consistently highest for hookah (always above 60%, Figure 2a). Among the subset of respondents who participated in all four waves, there were statistically significant positive linear trends in making a quit attempt for cigarettes (OR= 2.58, 95%CI: 2.27–2.93), which also had a statistically significant negative nonlinear trend (OR= 0.71, 95%CI: 0.67–0.76), ENDS (OR=1.38, 95%CI: 1.23–1.54), cigars (OR=1.20, 95%CI: 1.06–1.37), and smokeless tobacco ([OR= 1.19, 95%CI: 1.09–1.31], Supplemental Table 3a).

Across 2013–2019, biennial rates of making a quit attempt were generally similar among cigarettes, ENDS, and smokeless tobacco, and were again consistently highest for hookah (Figure 2b). Among the subset of respondents who participated in all five waves, there were statistically significant negative linear trends in making a quit attempt for cigarettes (OR=0.80, 95%CI: 0.70–0.91), which also had a statistically significant positive nonlinear trend (OR=1.17, 95%CI: 1.10–1.25), ENDS (OR=0.59, 95%CI: 0.39–0.89), which also had a statistically significant positive nonlinear trend (OR=1.39, 95%CI: 1.16–1.68), and smokeless tobacco (OR=0.68, 95%CI: 0.50–0.93), which also had a statistically significant positive nonlinear trend (OR=1.38, 95%CI: 1.18–1.60). There was a statistically significant positive nonlinear trend for cigars (OR=1.29, 95%CI: 1.10–1.52) and for hookah ([OR=1.47, 95%CI: 1.02–2.13], Supplemental Table 3b).

Quitting among attempters: Annual and biennial rates

The PATH Study national annual and biennial rates of quitting among attempters, by product type, for adults in the U.S. between 2013–2019 are shown in Figures 3a and 3b. Supplemental Table 4a and 4b shows these rates stratified by age group and provides additional information on Ns, measures of variance, and correlation matrices used for each trend analysis.

Figure 3a.

Figure 3a.

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Quitting Among Attempters: PATH Study Biennial Rates 2013–2017

Figure 3b.

Figure 3b.

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Quitting Among Attempters: PATH Study Biennial Rates 2013–2019

Across 2013–2017, annual rates of quitting among attempters were consistently lowest for cigarettes (always below 39%) and were similarly highest for ENDS (always above 82%) and hookah (always above 82%, Figure 3a). Among the subset of respondents who participated in all four waves, there were statistically significant negative linear trends in quitting among attempters for cigarettes (OR= 0.64, 95%CI: 0.51–0.80), which also had a statistically significant positive nonlinear trend (OR=1.15, 95%CI: 1.03–1.29) and for smokeless tobacco (OR= 0.41, 95%CI: 0.24–0.72), which also had a statistically significant positive nonlinear trend ([OR=1.56, 95%CI: 1.23–1.99], Supplemental Table 4a).

Across 2013–2019, biennial rates of quitting among attempters were consistently lowest for cigarettes (always below 35%) and were again similarly highest for ENDS (always above 79%) and hookah (always above 73%, Figure 3b). Among the subset of respondents who participated in all five waves, there was a statistically significant negative linear trend in quitting among attempters for cigarettes (OR=0.52, 95%CI: 0.38–0.72), which also had a statistically significant positive nonlinear trend (OR=1.62, 95%CI: 1.38–1.89); there was a statistically significant positive linear trend in quitting among attempters for smokeless tobacco (OR=1.76, 95%CI: 1.51–2.05), and there was a statistically significant positive nonlinear trend for cigars ([OR=1.57, 95%CI: 1.19–2.09], Supplemental Table 4b).

DISCUSSION

U.S. nationally representative, longitudinal data from the PATH Study between 2013–2019 show that rates of discontinuing past 30-day cigarette smoking among adult smokers remain low relative to rates of discontinuing past 30-day use for other tobacco products, although rates of discontinuing cigarette smoking did slowly increase across the study period. Our definition of discontinuing use intentionally encompasses the full range of any past 30-day use, meaning that it includes discontinuing use among long-term daily users, for example, as well as among those who may have only tried a product once in the past 30 days. This definition enables us to capture any recent use, though we also evaluate making a quit attempt and quitting among those who made a quit attempt, both of which are limited to those who used the product fairly regularly. Rates of making a quit attempt and quitting among attempters increased for cigarette smokers between 2016/17–2018/19, which is generally consistent with similarly-defined cross-sectional estimates from the National Health Interview Survey.27

Dissimilar from cigarettes, though, we found that rates of discontinuing past 30-day ENDS use sharply declined between 2016/17–2018/19 relative to prior years, which corresponds to the advent of nicotine salt-based e-liquid formulations becoming available in the U.S., with JUUL entering the market in 2016.28 Nicotine salts are believed to be more effective at delivering nicotine to the user, which may result in increased nicotine exposure29–30 and associated abuse liability31 and in turn could account for population-level decreases in the rates of discontinuing ENDS use. Further, the decrease in rates of discontinuing ENDS use coincided with a period of higher rates of discontinuing cigarette use, although additional research would be needed to determine whether ENDS use is displacing cigarette smoking in the population.

Importantly, the cessation rate data that we report on here can serve as ‘pre-policy’ data for evaluating the impacts of recent federal tobacco control actions that have taken place in the U.S. (e.g., federal Tobacco 21,32 FDA’s ENDS enforcement priorities33) as well as potential future policies that may be implemented such as banning menthol as a characterizing flavor in cigarettes34 or the issuance of Premarket Tobacco Product Application marketing authorizations for ENDS.35

Further, although our results are specific to the U.S., they have relevance to policymakers and researchers outside of the U.S. when considered in the context of similarities/differences in tobacco product regulatory environments among different countries. For example, during our analysis period, several states in the U.S. adopted ‘Tobacco 21’ policies (T21), which raised the legal age for sale of tobacco products from 18 years to 21 years.17,18 Those in other countries/jurisdictions that are considering adopting such a policy may be keen to consult our age-stratified tobacco product use discontinuation rates. For example, we report that cigarette discontinuation rates among those aged 18–20 years (i.e., the age group newly impacted by T21) increased from ~30% to ~37% across the analysis period, whereas cigarette discontinuation rates among those aged 40–54 years only increased by ~1% (Supplemental Table 2b).

Limitations

We reported on population-level cessation rates using wave pair designs and we conducted two sets of longitudinal trend analyses (annual and biennial), which enabled us to utilize all available data given the most appropriate and available longitudinal weights in the PATH Study data, with details on sample sizes provided in supplemental tables that can serve as a reference to others. However, some GEE trend analyses did not run through with replicate weights after specifying unstructured or autocorrelation working correlation matrices, and thus are not reported. Nonetheless, we further examined cessation rates using wave pairs among the same subsets of observations that were included in GEE trend analyses (regardless of whether GEE trend analyses yielded results) and confirmed consistency in rate estimates regardless of approach.

It should also be noted that while the biennial assessment timepoints span two years, the timeframe for reporting having made a quit attempt is only 12 months (i.e., the PATH Study only queried the last 12 months of the approximately 24-month timespan between W4 and W5). Additionally, as with any retrospective estimates of recalled quit attempts, and by extension estimates of quitting among those who recall quit attempts, our findings likely underestimate to some degree the proportion of people who attempt to quit, as recall of quit attempts is known to be reduced for quit attempts that ended longer ago, lasted for only a short time, or were unaided.36,37

Further, there were some changes in the way in which ENDS questions were asked in W1 versus other waves and some changes in the way in which quit attempt questions were asked in W2 versus other waves (see Methods section), and thus, some differences in estimates across the analysis period may be due in some part to instrument changes. We also combined different types of ENDS into a single ENDS category, and we combined different types of cigars into a single cigar category, which are notably broad categories and subsequent work – perhaps focused on a single class of products such as cigars – can report on disaggregated product types if sample sizes allow, as well as further details of product characteristics and how they relate to cessation behaviors.

Conclusions

Findings show that tobacco product cessation rates have been changing in recent years in the U.S. alongside the changing tobacco product marketplace and regulatory environment, though rates of quitting cigarette smoking remain low. Findings can serve as a benchmark against which future cessation rates can be compared to evaluate the impacts of future tobacco regulatory policies.

Supplementary Material

Supp1

What this paper adds:

• What is already known on this topic –

Tobacco product transition behaviors from the Population Assessment of Tobacco and Health (PATH) Study in the United States (U.S.) covering 2013–2016 were previously published. Since then, the tobacco product marketplace has expanded, and new tobacco regulatory actions have been implemented.

• What this study adds –

Rates of discontinuing cigarette smoking among adults in the (U.S.) increased between 2013–2019, with there being increases in both cigarette quit attempt rates and rates of quitting among attempters, while rates of discontinuing ENDS use among adults decreased across this same time period.

• How this study might affect research, practice or policy –

Findings show that tobacco product cessation rates by product type have been changing in recent years in the U.S. alongside the changing tobacco product marketplace and regulatory environment, though rates of discontinuing cigarette smoking remain low. Findings can serve as a benchmark against which future cessation rates can be compared to evaluate the impact of future tobacco regulatory policies.

Funding/Support:

This manuscript is supported with Federal funds from the National Institute on Drug Abuse, National Institutes of Health, and the Center for Tobacco Products, Food and Drug Administration, Department of Health and Human Services, under contract to Westat (Contract Nos. HHSN271201100027C and HHSN271201600001C).

Role of the Funder/Sponsor: Representatives from the National Institute on Drug Abuse and the U.S. Food and Drug Administration contributed to the interpretation of the data and participated in the preparation, review, and approval of the manuscript.

Footnotes

Conflicts of interest disclosures: The authors declare no conflicts of interest.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the U.S. Department of Health and Human Services or any of its affiliated institutions or agencies.

i

For each type of tobacco product, respondents who were current established users of that product at follow-up and were current established users of any non-ENDS product at follow-up, or were current established users of that tobacco product at follow-up and were current established users of ENDS and at least one other tobacco product at follow-up, were asked about making an attempt to quit using tobacco generally at follow-up rather than specifically about making an attempt to quit use of the given tobacco product at follow-up. Due to these differences in instrument ask specifications when ascertaining making a quit attempt among those who were previously current established users of a given tobacco product, and likewise when ascertaining quitting among attempters among those who were previously current established users of a given tobacco product, these two outcomes were evaluated only for use of each type of tobacco product rather than for use of any tobacco product as was done for the quitting past 30-day use outcome.

ii

Although exchangeable correlation structure may be further specified in GEE trend analyses, it is a fairly restrictive option (i.e., it would constrain correlations among repeated observations to a single one correlation estimate) and therefore we did not use this correlation structure.

iii

For quadratic models, a significant nonlinear trend term generally depicts the overall shape of the figure. Specifically, a significant positive quadratic trend suggests an accelerating increase trend (e.g., for smokeless tobacco, compared with the increase in annual rates of quitting from W1-W2 to W2-W3, the increase in annual rates were larger from W2-W3 to W3-W4). Similarly, a significant negative quadratic trend suggests an accelerating decrease trend. Further, a significant linear term adjusts the level of nonlinear acceleration, and the combination of quadratic and linear terms including their directions and relative values eventually determine the nonlinear shape of the predicted trend based on data.

iv

Trend analyses for biennial rates included an additional 133 respondents who were not in the W4 cohort for the W4-W5 wave pair but were in the W1 cohort and were interviewed in all 5 waves.

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