Wednesday, November 15, 2023

Why Can’t Smokers Quit: Part I


Along with my research colleague Nantaporn Plurphanswat, I recently published a study entitled “Why can’t smokers quit? Longitudinal study of smokers in the US using the Population Assessment of Tobacco and Health (PATH) waves 1 to 5.”  It was published in Addictive Behaviors Reports.

We attempted to determine the factors that may be associated with persistent smoking.  There have been many other studies of this subject, but most have only involved a single cross-sectional survey.  The FDA’s PATH survey is different, because it has followed thousands of people for several years.  We started with 5,860 current (C) smokers enrolled in the PATH study (i.e. Wave 1) in 2013-14 who had follow-up smoking information in the next four waves, or six years.  Almost 4,000 smokers continued to smoke (designated CCCCC), while others became former (F) smokers and and stayed quit in subsequent waves (CFFFF, CCFFF, CCCFF, and CCCCF).  Our analysis focused on differences between persistent smokers and quitters.  We made sure that we adjusted our results for differences in demographic factors such as age, sex, race/ethnicity, education, marital status and where they lived.

This was a big effort, so it will take more than one blog post to describe our results.  In this post I’ll provide results for two hot topics, menthol cigarettes and vaping.

Everyone knows about the FDA’s intention to ban menthol flavored cigarettes, which the agency says lures teens into smoking.  Our goal was to determine whether menthol was associated with persistent smoking or less quitting, because previous studies have produced mixed results (here, here, here, here).

We found that 39–45 % of all smoker groups reported that they had initiated with menthol or mint flavored cigarettes, and 36–48 % currently used menthol or mint flavor in all waves.  Furthermore, among smokers who initiated with menthol, 53–66 % continued to smoke them in all waves. However, we found no statistically significant differences between persistent smokers and quitters with respect to initiation with or current menthol smoking.

In general, vaping produced mixed results. First, the bad news was that the proportions of everyday vape use among persistent smokers were relatively stable throughout all five waves, and the percentage of former vaping grew. However, quitters had higher current vaping in the wave they became former smokers, and smokers who quit in the next wave tended to increase the percentage of everyday vaping at that wave. Our findings are consistent with other PATH studies revealing that vaping has helped some smokers to quit (here, here and here).  We also found that CFFFF who quit after Wave 1 and continued to vape did not return to smoking.

In summary, menthol didn’t play a role in persistent smoking or quitting in the first five waves of the PATH survey.  But there wasn’t a lot of evidence that vaping played a major role.  Stay tuned for more results.


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