The Effect of Alternative Tobacco Product Use On Smoking Cessation Outcomes Among Participants in An Online Cessation Intervention

Theoretical Background and research questions/hypothesis: As restrictions and taxes on cigarettes increase and indoor smoking laws become ubiquitous, non-cigarette, alternative tobacco products may become a larger part of the U.S. tobacco market. A growing percentage of U.S. smokers are using alternative tobacco products, which may make smoking cessation harder for those trying to quit. This study will examine the impact of alternative tobacco product use on cessation outcomes among a population of adult smokers who are enrolled in an online smoking cessation program.

Methods: This study uses data from a sample of current smokers who were new registrants to a web-based smoking cessation intervention, BecomeAnEX.org, and followed for 6 months (n=556). Alternative tobacco product use was defined as past 30 day use of any of the following tobacco products: cigars, cigarillos or little cigars, e-cigarettes, snus, dissolvables, or chewing tobacco, snuff or dip. Logistic regression was used to determine the association between alternative tobacco product use, and cessation outcomes at 6 months. Logistic regression was used to determine the association between alternative tobacco product use, and cessation outcomes at 6 months.

Results: A total of 25.2% of the sample had used any alternative tobacco product in the past 30 days. The products most often used were e-cigarettes (12.2%) and cigars, cigarillos or little cigars (10.6%). Past 30 day users of an alternative tobacco product were mostly male (60.7%), ages 25-44 (56.5%), White, non-Hispanic (66.0%), had completed some college (49.3%) and were employed (63.3%). Controlling for covariates, those who had used an alternative product in the past 30 days were less likely than those who hadn’t used an alternative product to be have reported 7- or 30-day abstinence at 6 months (OR 0.14, p≤.0001 and OR=0.12, p≤.0001, respectively).

Conclusions: Past 30 day use of alternative products was associated with a decreased likelihood of abstinence among smokers seeking treatment in an online smoking cessation intervention.

Implications for research and/or practice: Including content that addresses alternative tobacco product use on such sites, along with other resources and support, may improve smoking cessation outcomes in such interventions.