Panel Paper: Relative Effectiveness of Smoking Cessation Strategies for Young Adults in a National Population Study

Friday, November 9, 2018
Madison B - Mezz Level (Marriott Wardman Park)

*Names in bold indicate Presenter

Shannon Lea Watkins1, Johannes Thrul2, Wendy Max1 and Pamela Ling1, (1)University of California, San Francisco, (2)Johns Hopkins University

Significance: Recent changes in the tobacco product landscape including rapidly increasing use of e-cigarettes and poly-tobacco use among young adults present new public health challenges. Young adulthood is a key transition time for cigarette use when experimenters either quit or become established users. While much public health attention is paid to preventing young people from starting to smoke (e.g. Tobacco 21 laws), less attention is given to helping young adult tobacco users quit. Our previous findings suggest young adults are just as interested in quitting as older adults but are less likely to use evidence-based cessation strategies (e.g. Nicotine gum) than older adults. We also find a high proportion of both young and older adult smokers report switching to e-cigarettes as an attempt to quit smoking conventional cigarettes. Population studies of the relative effectiveness of these strategies across age groups are needed to inform regulatory and healthcare decisions.

Methods: We used a nationally representative sample of young adults (age 18-24) and older adults (age 25-64) from the Population Assessment of Tobacco and Health (PATH) Study who reported regularly smoking conventional cigarettes at Wave 1 (2013-2014) and reported attempting to quit within the past year at Wave 2 (2014-2015). This paper evaluated the relative effectiveness of three cessation strategies – behavioral therapy, pharmacotherapy, and product substitution (e.g. switching to e-cigarettes) – compared to unassisted cessation attempts for young and older adults. Survey-weighted logistic regression models (Stata 14) estimated associations between smoking cessation strategies and successful quitting, adjusting for socioeconomic characteristics, exposure to smoking in childhood, poly-tobacco use, and smoking intensity.

Results: Preliminary findings reveal that young adults who used product substitution as their only cessation strategy had higher adjusted odds of successful quitting than those who tried to quit unassisted. All other strategies for young adults were not significantly related to cessation. There was no difference in cessation success across strategies for older adults. For older adults, income insecure, less educated, African American, and heavier (more cigarettes per day) smokers were less likely to successfully quit.

Conclusions: Although e-cigarettes cannot legally be marketed as a cigarette cessation device in the United States, in reality, many smokers look to e-cigarettes to try to quit. Our findings suggest that e-cigarettes are not an effective cessation strategy, and that for young adult smokers they are associated with less likelihood of successfully quitting. Findings also reveal no association between using assistance and successful quitting for older adults. Future work should examine whether strategies are more effective for certain subpopulations of smokers and compare projected effects on cessation of various regulatory strategies for e-cigarettes. Reducing cigarette consumption remains a major public health challenge and this study illustrates the continued need for innovation of effective cessation strategies.