# Cigarette smoking abstinence at follow-up at 12 months among US adults who regularly used Electronic Nicotine Delivery Systems and smoked in the past year: A prospective cohort study

## TL;DR

This study found that people who used Juul or Alto e-cigarettes to quit smoking were more likely to remain smoke-free after one year, despite no overall difference between the two brands.

## Contribution

The study identifies specific sociodemographic and behavioral factors associated with smoking abstinence among ENDS users.

## Key findings

- No overall difference in smoking abstinence was found between Juul and Alto users after one year.
- Users who had already quit smoking by baseline were more likely to remain abstinent if they used Juul.
- Younger age, White ethnicity, and using ENDS to quit smoking were associated with higher abstinence rates.

## Abstract

Regular use of electronic nicotine delivery systems (ENDS) by people who smoke cigarettes may impact smoking trajectories. ENDS brands are used by different populations in different ways, but their associations with smoking cessation are not well understood. This study evaluated whether regular use of Juul or Alto ENDS differently impacted smoking abstinence one year later among adults who had smoked cigarettes.

This prospective cohort study surveyed a national sample of US adults who used ENDS in 2022–2023 and again after one year to assess cigarette smoking. Multivariable logistic regression models used data from 237 people who had smoked cigarettes in the past year and regularly used ENDS products Juul or Alto at baseline to examine the characteristics and behaviors associated with abstaining from cigarette smoking at follow-up at 12 months.

Whereas no overall differences in smoking abstinence at follow-up at 12 months were found between adults who used Juul versus adults who used Alto, adults who used Juul and had quit smoking by baseline were more likely than their Alto-using counterparts to remain abstinent at follow-up at 12 months (AOR=7.07). Other characteristics that were associated with abstaining from cigarettes at follow-up included being 18–29 years (vs older) (AOR=3.64), identifying as White, non-Hispanic (vs another race/ethnicity) (AOR=3.03), not currently smoking at baseline (vs currently smoking) (AOR=20.25), using their Juul or Alto product to quit smoking or remain quit (AOR=2.77), and use of menthol cigarette flavors (vs tobacco flavor) (AOR=2.54).

This longitudinal study found limited differences in smoking abstinence after one year between those who regularly used Juul versus Alto. However, people who used ENDS products specifically to quit smoking were more likely to achieve smoking abstinence and there were important sociodemographic differences. Future research is needed to inform interventions to increase the likelihood that people who use ENDS completely stop smoking and eventually quit all consumer nicotine products.