Trends and Correlates of E-Cigarette Use for Cigarette Cessation Among U.S. Adults: Evidence from the Population Assessment of Tobacco and Health Study (PATH) Waves 5-7 (2018-2023)

ABSTRACT Introduction We describe trends in the prevalence of e-cigarette use for cigarette smoking cessation among U.S. adults who smoke, and identify social, cognitive, and behavioral correlates of e-cigarette use for cigarette cessation over time. Methods We analyzed cross-sectional data from Waves 5 (2018-2019), 6 (2021), and 7 (2022-2023) of the Population Assessment of Tobacco and Health (PATH) Study among adults with current established cigarette smoking who reported a past-year quit attempt (2018-2019: n=3,074; 2021: n=1,944; and 2022-2023: n=1,678). Weighted prevalence estimates with 95% confidence intervals (CIs) summarized the proportion of respondents who reported using e-cigarettes for smoking cessation. Wave-specific multivariable logistic regression models estimated adjusted odds ratios (AORs) for demographic, social, cognitive, and behavioral correlates. Results The weighted prevalence of e-cigarette use for cigarette cessation was 20.0% (95% CI: 18.3-21.8) in 2018-2019, declined to 15.4% (13.5-17.5) in 2021, and increased to 19.6% (17.4-22.0) in 2022-2023. Perception of e-cigarettes as less harmful than cigarettes was associated with higher odds of using e-cigarettes for cessation at all waves (AORs: 2.24–4.17; p<0.05). Reporting that important peers used e-cigarettes (“social exposure”) was also a consistent correlate (AORs: 2.03–2.76; p<0.05). Extreme interest in quitting cigarettes was associated with e-cigarette use for cessation only in 2018-2019 (AOR:2.31; p<0.05) and not in later years. Conclusion Use of e-cigarettes for smoking cessation remained common from 2018 to 2023. Perceived lower harm and social exposure were consistently associated with this behavior, highlighting the influence of cognitive and social factors on cessation-related decisions among adults who smoke cigarettes.