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Methods US Adults Used to Stop Smoking, 2021–2022
RESEARCH BRIEF — Volume 21 — July 3, 2024
Floe Foxon, BSc (Hons)1; Ray Niaura, PhD2 (View author affiliations)
Suggested citation for this article: Foxon F, Niaura R. Methods US Adults Used to Stop Smoking, 2021–2022. Prev Chronic Dis 2024;21:240032. DOI: http://dx.doi.org/10.5888/pcd21.240032.
PEER REVIEWED
What is already known on this topic?
The most popular methods to stop smoking used by US adults from 2014 through 2016 were giving up cigarettes all at once, gradually cutting back on cigarettes, and substituting e-cigarettes for some regular cigarettes.
What is added by this report?
We used the latest available nationally representative data to determine which subpopulations of US adults stopped smoking and the methods they used, from 2021 through 2022.
What are the implications for public health practice?
Nicotine-containing methods such as e-cigarettes, gums or lozenges, patches, and nasal sprays or inhalers are the most popular methods US adults used to stop smoking.
Abstract
We used nationally representative CDC (Centers for Disease Control and Prevention) survey data to identify which subpopulations of US adults had stopped smoking cigarettes for 6 months or longer in the last year and the methods they used. From 2021 through 2022, 2.9 million adults stopped smoking. Most of these were male, non-Hispanic White, aged less than 55 years, college educated, and identified as straight. The most popular method used was nicotine products (53.9%; 1.5 million adults), especially e-cigarettes in combination with other methods (40.8%; 1.2 million) and e-cigarettes alone (26.0%; 0.7 million). The data suggest that interventions to reduce smoking could focus on subpopulations that stopped smoking the least and encourage use of evidence-based methods.
Objective
Although considerable progress has been made in the last decade in the US to reduce prevalence of combustible cigarette smoking (1), smoking continues as one of the leading causes of chronic disease (2). Thus, further reductions in smoking prevalence are crucial to preventing or reducing the effects of chronic disease in the US. A previous study identified giving up cigarettes all at once, gradually cutting back on cigarettes, and substituting some cigarettes with e-cigarettes as the most commonly reported stop-smoking methods during quit attempts from 2014 through 2016 (3). More recent data are needed to understand who stopped smoking since 2016 and how they did it. Therefore, the objectives of our study were to identify which subpopulations stopped smoking completely (reported having stopped smoking for ≥6 months in the past year as defined in previous research) (4) or tried to stop smoking, and to quantify the methods they used by using the most recent CDC National Health Interview Survey (NHIS) data (5).
Methods
We used data on methods used to stop smoking from CDC’s latest NHIS. These data are nationally representative and have low bias (5). The 2022 NHIS (fielded January–December 2022) asked respondents who had stopped smoking in the past 2 years which methods they used to stop smoking completely. We focused on those respondents who had stopped smoking in the last year (2021 through 2022) and who had stopped smoking for 6 months or longer at the time of the survey. The survey also asked respondents who were still smoking but had tried to stop in the past year which methods they used when they tried. Full details of questionnaire wording are available in online supplemental materials (https://doi.org/10.17605/osf.io/HGMN6). The prevalence of each stop-smoking method was calculated with NHIS sampling weights to provide nationally representative population estimates. NHIS stratum and cluster variables were also used to provide 95% CIs. Demographic characteristics of the sample of adults who stopped smoking or tried to stop (sex, race or ethnicity, age, education, and sexual orientation) were derived from standard NHIS questions, similar to other CDC NHIS publications (6,7).
Only publicly available, de-identified survey data were used; therefore, our study was exempt from NIH human subjects research under NIH exemption 4 and did not require institutional review board review.
Results
Overall, 2.9 million US adults stopped smoking from 2021 through 2022 and had been stopped for 6 months or longer at the time of the survey. In the same period, 13.1 million tried to stop but were unsuccessful. Slightly more men stopped smoking than women (1.6 million vs 1.3 million); most were non-Hispanic White adults, most were aged younger than 55 years, most had at least some college education, and most self-identified as straight (Table 1). Among those who stopped smoking for 6 months or longer, the most commonly reported methods used were nicotine products (53.9%, 1.5 million US adults), primarily e-cigarettes used alone or in combination with other methods (40.8%, 1.2 million US adults) (Table 2). The least commonly reported methods were nonnicotine, nonprescription drug methods (including a quit line, counseling or clinic, class, or group) (6.3%, 0.2 million US adults). Of the listed methods, the most commonly reported exclusive method selected was e-cigarettes; 26.0% (0.7 million US adults) of adults who stopped smoking from 2021 through 2022 for 6 months or longer selected e-cigarettes as their only listed method.
Discussion
We identified subpopulations of US adults in NHIS 2022 who stopped or tried to stop smoking and the methods they used. We found that smaller proportions of all adults who stopped smoking from 2021 through 2022 were women, Hispanic and non-Hispanic non-White, older (aged ≥55 y), had lower educational attainment (less than some college education), and were nonheterosexual. This may be explained simply by relative subpopulation size (ie, the US adult population comprises fewer nonheterosexual than heterosexual adults and more males who smoke than females) (8). Nevertheless, we must ensure that specific subpopulations do not get left behind in efforts to curb smoking.
Approximately 40% of adults surveyed in NHIS did not report using any of the surveyed evidence-based methods to stop smoking. Methods containing nicotine, primarily e-cigarettes, were the most commonly reported methods that were explicitly surveyed. This may provide support for FDA’s “nicotine-focused framework for public health” (9), which describes noncombustible nicotine products as “a promising foundation for a comprehensive approach to tobacco harm reduction,” FDA’s efforts to authorize certain e-cigarette products as “appropriate for the protection of public health” (10), and CDC’s statement that “[e]-cigarettes have the potential to benefit adults who smoke . . . if used as a complete substitute for regular cigarettes,” (11) while necessarily preventing access to nicotine products by nonsmoking subpopulations, such as adolescents.
Our study’s strengths include use of a large, nationally representative survey with low bias administered by CDC. NHIS results are thought to be generalizable to the entire US population, because that is the purpose of its sample design by CDC’s National Center for Health Statistics (5,12). Another strength is the direct measures of stopping smoking (ie, survey questions answered by adults who actually stopped smoking) as opposed to indirect measures of stopping smoking (eg, models).
Our study had limitations. First was our inability to parse out individual methods in the “none of the above” category, which is an unavoidable limitation of the NHIS questionnaire design. Because “none of the above” was inferred from respondents who stopped or tried but who did not select any of the surveyed items, the “none of the above” category may be underrepresented in these analyses. Furthermore, the questionnaire did not ask respondents about the duration of treatment use. Future questionnaires should ask respondents for these details. Recall bias may also limit the accuracy of our findings (13).
Efforts to reduce smoking among US adults should focus on the subpopulations that stopped smoking the least and encourage use of evidence-based methods.
Acknowledgments
The authors thank 2 anonymous reviewers and participants in the 2024 Society for Research on Nicotine and Tobacco conference for their helpful comments and suggestions. The authors declare the following potential conflicts of interests: F.F. provides consulting services through Pinney Associates on tobacco harm reduction on an exclusive basis to Juul Labs Inc, which had no involvement in this article. During the past 3 years, R.N. received grant and contractual funding from the National Institutes of Health and the Food and Drug Administration, neither of which supported the work reported here. R.N. is not affiliated with Pinney Associates or Juul. The authors received no external financial support and declared no other potential conflicts of interest with respect to the research, authorship, or publication of this article. No copyrighted materials were used in this article.
Author Information
Corresponding Author: Floe Foxon, Department of Data Management and Statistical Analysis,
Pinney Associates, 201 North Craig St, Ste 320, Pittsburgh, PA 15213 (ffoxon@pinneyassociates.com).
Author Affiliations: 1Department of Data Management and Statistical Analysis, Pinney Associates, Pittsburgh, Pennsylvania. 2Department of Epidemiology, School of Global Public Health, New York University, New York, New York.
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Tables
| Characteristic | Stopped smoking completelyb, weighted % (95% CI) (weighted N, millions) | Tried to stop smoking but did not stop smoking, weighted % (95% CI) (weighted N, millions) |
|---|---|---|
| All adults | 100 (2.9) | 100 (13.1) |
| Sex | ||
| Female | 45.3 (39.3–51.4) (1.3) | 44.2 (41.1–47.2) (5.8) |
| Male | 54.7 (48.6–60.7 (1.6) | 55.8 (52.8–58.9) (7.3) |
| Race or ethnicity | ||
| Hispanic | 15.2 (10.8–20.6) (0.4) | 12.0 (9.9–14.4) (1.6) |
| Non-Hispanic Black | 11.2 (7.5–15.9) (0.3) | 16.1 (13.7–18.6) (2.1) |
| Non-Hispanic White | 67.3 (60.8–73.2) (1.9) | 65.1 (62.1–68.0) (8.5) |
| Non-Hispanic Other | 6.3 (3.5–10.3) (0.2) | 6.8 (5.4–8.6) (0.9) |
| Age, y | ||
| 18–34 | 41.9 (35.4–48.7) (1.2) | 24.7 (21.9–27.6) (3.2) |
| 35–54 | 34.2 (27.9–40.9) (1.0) | 39.6 (36.4–42.8) (5.2) |
| 55 or older | 23.9 (19.0–29.3) (0.7) | 35.7 (33.0–38.6) (4.7) |
| Education | ||
| ≤12 years (no diploma) | 9.4 (5.8–14.2) (0.3) | 18.5 (16.0–21.3) (2.4) |
| GED certificate or high school diploma | 34.4 (28.7–40.5) (1.0) | 38.5 (35.5–41.7) (5.0) |
| Some college (no degree) | 18.8 (14.4–23.9) (0.5) | 17.1 (15.1–19.3) (2.2) |
| Associate, undergraduate, or graduate degree | 37.3 (31.3–43.8) (1.1) | 25.8 (23.2–28.5) (3.4) |
| Sexual orientation | ||
| Gay/lesbian/bisexual | 12.8 (8.6–18.0) (0.4) | 5.8 (4.5–7.4) (0.8) |
| Straight | 82.8 (76.7–87.9) (2.4) | 90.0 (88.1–91.7) (11.8) |
| Other | 4.4 (1.8–8.8) (0.1) | 4.1 (3.0–5.6) (0.5) |
a Following Cornelius et al (8), modified Clopper-Pearson confidence limits were calculated by using the Korn and Graubard method.
b Reported having stopped smoking for 6 months or longer in the past year, as defined in previous research (4).
| Method(s) | Stopped smoking completelyb, weighted % (95% CI) (weighted N, millions) | Tried to stop smoking but did not stop smoking, weighted % (95% CI) (weighted N, millions) |
|---|---|---|
| Any method | 100 (2.9) | 100 (13.1) |
| Nicotine products | ||
| E-cigarettes | 40.8 (34.4–47.5) (1.2) | 20.7 (18.1–23.4) (2.7) |
| Exclusivelyc | 26.0 (20.6–32.0) (0.7) | 11.2 (9.3–13.3) (1.5) |
| Nicotine gum/lozenge | 18.8 (14.1–24.4) (0.5) | 19.0 (16.7–21.4) (2.5) |
| Exclusivelyc | —d | 4.8 (3.7–6.2) (0.6) |
| Nicotine patch | 15.4 (11.1–20.6) (0.4) | 22.1 (19.7–24.6) (2.9) |
| Exclusivelyc | 5.4 (2.8–9.5) (0.2) | 7.4 (6.1–9.0) (1.0) |
| Nicotine nasal spray/inhaler | —d | 0.9 (0.5–1.7) (0.1) |
| Exclusivelyc | —d | —d |
| One or more of the above | 53.9 (47.4–60.3) (1.5) | 45.1 (42.0–48.2) (5.9) |
| Prescription drug products | ||
| Varenicline | 5.1 (2.9–8.2) (0.1) | 11.3 (9.5–13.3) (1.5) |
| Exclusivelyc | —d | 3.0 (2.1–4.2) (0.4) |
| Bupropion | 4.7 (2.6–7.7) (0.1) | 7.4 (5.9–9.0) (1.0) |
| Exclusivelyc | —d | 1.7 (1.0–2.7) (0.2) |
| One or more of the above | 8.1 (5.3–11.8) (0.2) | 16.2 (14.2–18.5) (2.1) |
| One or more pharmacotherapy (nicotine product incl. e-cigarettes or prescription drug product) | 56.6 (49.9–63.1) (1.6) | 51.1 (47.9–54.3) (6.7) |
| Non-nicotine, non-prescription drug methods | ||
| Quit line | 3.1 (1.4–5.7) (0.1) | 4.3 (3.2–5.7) (0.6) |
| Exclusivelyc | 3.1 (1.4–5.7) (0.1) | —d |
| Counseling | 3.1 (1.5–5.7) (0.1) | 4.8 (3.6–6.2) (0.6) |
| Exclusivelyc | —d | 0.6 (0.3–1.2) (0.1) |
| Clinic/class/group | —d | 2.5 (1.7–3.5) (0.3) |
| Exclusivelyc | —d | —d |
| One or more of the above | 6.3 (3.9–9.7) (0.2) | 7.9 (6.4–9.7) (1.0) |
| Any of the abovee | 57.5 (50.8–63.9) (1.6) | 52.5 (49.2–55.7) (6.9) |
| None of the abovef | 42.5 (36.1–49.2) (1.2) | 47.5 (44.3–50.8) (6.2) |
a Following Cornelius et al (8), modified Clopper-Pearson confidence limits were calculated by using the Korn and Graubard method.
b Reported having stopped smoking for 6 months or longer in the past year, as defined in previous research (4) .
c Exclusive percentages are expressed among all adults who stopped or tried to stop smoking, not as a percentage of those adults who used the particular method (eg, 26.0% of all adults who stopped smoking used e-cigarettes exclusively). Exclusive means the respondent selected that particular method but did not select the other methods listed on the questionnaire (eg, exclusive e-cigarette means reported using e-cigarettes but not nicotine gum or lozenge, nicotine patch, nicotine, nasal spray/inhaler, varenicline, bupropion, a quit line, or counseling).
d Estimates with an unweighted denominator or numerator less than 10, relative 95% CI width >160%, or degrees of freedom less than 8 are suppressed, consistent with the latest 2023 National Center for Health Statistics standards for rates and counts (https://www.cdc.gov/nchs/data/series/sr_02/sr02-200.pdf).
e Stopped smoking “completely” from 2021 through 2022 or tried from 2021 through 2022 and reported using any of e-cigarettes, nicotine gum/lozenge, nicotine patch, nicotine nasal spray/inhaler, varenicline, bupropion, quit line, counseling, or clinic/class/group.
f Stopped smoking “completely” from 2021 through 2022 or tried from 2021 through 2022 but did not report using any of e-cigarettes, nicotine gum/lozenge, nicotine patch, nicotine nasal spray/inhaler, varenicline, bupropion, quit line, counseling, or clinic/class/group.
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