Why can’t smokers quit? Longitudinal study of smokers in the US using the Population Assessment of Tobacco and Health (PATH) waves 1 to 5

INTRODUCTION: Most adult cigarette smokers have tried unsuccessfully to quit. We followed participants in the Population Assessment of Tobacco and Health (PATH) study through five waves (2013–2019), comparing smoking, quit behaviors and other characteristics between persistent smokers and those who became and stayed former smokers. METHODS: The main analysis employed treatment effects to estimate mean differences in smoking and quitting behaviors among smoker groups. Logistic models were used to estimate predicted means based on continuing smokers’ demographic characteristics to ensure that any differences in outcomes did not come from differences in demographic characteristics. RESULTS: Among smokers enrolled in PATH Wave 1, 68 % persisted in all subsequent waves. Compared with smokers who quit after Wave 1, persistent smokers had remarkably stable smoking behaviors, including significantly higher proportions of everyday smokers, consuming 10+ cigarettes per day, and smoking within 30 min of waking up. Persistent smokers were also less likely to try to quit completely, and experienced more negative symptoms from nicotine withdrawal. They also showed less interest in quitting and were less confident of being successful than smokers who quit by the next wave. Neither electronic nicotine delivery systems nor menthol played a role in continued smoking or quitting. CONCLUSIONS: The characteristics and behaviors of persistent smokers in this study were stable over five waves of data collection during a six-year period, suggesting that these smokers need new cessation options.