Switching Away From Smoking and Reduction in Cigarette Consumption among US Adult Purchasers of the JUUL System across 24 Months Including Diverse Subpopulations Disproportionately Affected by Cigarette Smoking

OBJECTIVES: Electronic nicotine delivery systems (ENDS) can reduce tobacco-related risks for adults who smoke cigarettes (AWS) by facilitating complete switching away from combustible cigarettes. However, little is known about ENDS use and switching among subpopulations that have been disproportionately affected by smoking, which could contribute to reducing tobacco-related disparities. METHODS: AWS (age≥21 years) were recruited following their first purchase of a JUUL Starter Kit in 2018. Participants self-reported switching (no past-30-day cigarette smoking) at 1-, 2-, 3-, 6-, 9-, 12-, 15-, 18-, 21-, and 24-months follow-up assessments. Percent switched and percent with a substantial smoking reduction from baseline (≥50% decrease in cigarettes/day among those who continued smoking) were analyzed. Analyses focused on racial/ethnic minorities, persons with low income and education levels, sexual minorities, and those with mental and physical health conditions. RESULTS: Overall rates of switching away from cigarettes increased across follow-ups to 51.2% at Month 12 and 58.6% at Month 24. Among those who continued to smoke, 45.4% reported a substantial smoking reduction in Month 24. Rates of switching and substantial smoking reduction were similar between subgroups disproportionately affected by cigarette smoking and their referent counterparts, except for lower switch rates in individuals with physical health conditions. CONCLUSIONS: AWS demonstrated progressively increasing switching rates over two years after purchasing JUUL products. A similar trend was also observed across populations disproportionately affected by smoking. ENDS products such as JUUL may provide an opportunity to benefit population health and reduce tobacco-related disparities among AWS.