Switching Away From Smoking and Reduction in Cigarette Consumption Among U.S. Adult Purchasers of the JUUL System Across 24 Months Including Diverse Subpopulations Disproportionately Affected by Cigarette Smoking

INTRODUCTION: Electronic nicotine-delivery systems (ENDS) can reduce tobacco-related health risks for adults who smoke cigarettes (AWS) by facilitating complete switching away from cigarettes. However, little is known about ENDS use and switching among subpopulations that have been disproportionately affected by smoking. AIMS AND METHODS: AWS (age ≥ 21 years) were recruited following their first purchase of a JUUL Starter Kit in 2018. Participants who self-reported switching (no past-30-day cigarette smoking) at 1-, 2-, 3-, 6-, 9-, 12-, 15-, 18-, 21-, and 24-month follow-ups. Percent switched and percent with substantial smoking reduction (≥50% decrease in cigarettes per day among those who continued smoking) were calculated. Analyses focused on racial and 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% (month-12) to 58.6% (month-24, 87% of whom used ENDS). Among those who continued to smoke at 24 months, 45.4% reduced cigarettes per day by ≥ 50%. Rates of switching and substantial smoking reduction were largely similar across subgroups, with some statistically significant, but small, differences in month-24 switching rates (eg, education, mental and physical health conditions; switch rate range: 42%-57%). CONCLUSIONS: AWS demonstrated progressively increasing switching rates over 2 years after purchasing JUUL products. Similar trends in switching and smoking reduction were observed across populations disproportionately affected by smoking. By facilitating switching and smoking reduction, ENDS products such as JUUL may provide an opportunity to reduce smoking-related harm among some populations disproportionately affected by smoking, potentially reducing tobacco-related health disparities. IMPLICATIONS: ENDS have the potential to benefit population health if they can replace cigarettes. This benefit must extend to populations disproportionately affected by smoking. In this real-world study, 59% of JUUL purchasers reported complete switching 2 years later (no past-30-day smoking, with most continuing to use ENDS). Furthermore, 45% of those who continued to smoke reduced cigarette consumption by at least half. These rates of switching and smoking reduction were largely comparable across populations disproportionately affected by smoking (defined, eg, by ethnicity and income). ENDS can serve as an effective harm reduction strategy to complement current efforts to reduce tobacco-related disparities.