Abstract
INTRODUCTION: Reducing the disease burden from tobacco smoking may encompass switching to noncombustible (NCs), along with cessation. This study evaluates factors associated with switching to NCs (e-cigarettes, smokeless, and snus) versus continued smoking, complete cessation, or dual use. AIMS AND METHODS: Population Assessment of Tobacco and Health adult data were analyzed in three 2-year wave pairs across 2013-2019 to assess product transitions among people who exclusively smoked tobacco. Generalized estimating equations examined demographics, smoking characteristics, perceptions, and messaging exposure as predictors of transitions from cigarette smoking. RESULTS: Ages 18-44 years (ref = 65+; aORs = 3.79-5.92), males (aOR = 1.18, 95% CI [1.01, 1.37]), and perceiving NCs as less harmful than smoking (ref = not; aOR = 1.47, 95% CI [1.28, 1.69]) were positively associated with switching to NCs versus continued smoking, while being Black (ref = White; aOR = 0.36, 95% CI [0.26, 0.48]) or Hispanic (ref = non-Hispanic; aOR = 0.59, 95% CI [0.45, 0.78]) were negatively associated. Ages 18-64 years (aORs = 2.49-5.89), noticing promotional ads (ref = not; aOR = 1.34, 95% CI [1.14, 1.58]), daily light or heavy smoking (ref = nondaily; aORs = 2.33-3.72), and smoking within 30 minutes of waking (ref=>30 minutes; aOR = 1.47, 95% CI [1.18, 1.85]) were positively associated with switching to NCs versus cessation, while being Black (aOR = 0.55, 95% CI [0.38, 0.74]) or Hispanic (aOR = 0.52, 95% CI [0.38, 0.71]) were negatively associated. Incomes of $10 000-≥$100 000 (ref ≤ $10 000; aORs = 2.08-3.13) and daily heavy smoking (aOR = 1.96, 95% CI [1.11, 3.48]) were positively associated with switching to NCs versus dual use, while being male (aOR = 0.44, 95% CI [0.29, 0.65]) was negatively associated. CONCLUSIONS: Transitioning to NCs was unequally distributed among sociodemographic groups and smoking characteristics. The mere availability of NCs may not promote health equity. Continued market and regulatory efforts that promote both smoking cessation and transitioning to NCs among various populations may promote public health gains. IMPLICATIONS: This study examines factors associated with transitioning from smoking to noncombustible tobacco product use. We examined three different product use scenarios that may be associated with varied levels of exposure to harm. We observed that younger ages and perceiving NCs as less harmful than cigarettes were more likely to transition to NCs as compared to continued smoking and cessation, while Black or Hispanic individuals were less likely to transition to NCs. This highlights the need for more focused harm reduction efforts for racial and ethnic minority populations as a complementary strategy to cessation to reduce health disparities from smoking.