Exclusive Insights from Cheryl K. Olson Sc.D.

“It’s remarkable how little we know about how people stop smoking in everyday life,” says McKinney RSA advisor Cheryl K. Olson, Sc.D.  Olson’s latest article in Tobacco Reporter shares some of what we do know. As a behavioral scientist who does survey research, she also sheds light on why seemingly simple information can be hard to get.   

Nationally representative surveys often ask people whether they smoke cigarettes, but rarely ask how they quit. As her TR article notes, the US National Health Interview Survey does ask—but only during certain years. (In 2024, for example, the survey asks instead about whether “a doctor, dentist, or other health professional advised you about ways to stop smoking or prescribed medication to help you quit.” ) And the answer choices they give change year to year, making comparisons impossible.  

Olson talked with Ray Niaura, professor at the New York University School of Global Public Health. He and statistician Floe Foxon recently analyzed the NHIS data from 2022. “We were working with NHIS data already looking at some other things,” he says. “So it wasn’t a heavy lift to look at the questions related to methods that smokers have used to try to quit or to quit completely.”  

That year, the survey asked specifically whether respondents had tried to quit using specific nicotine products, including switching to electronic or e-cigarettes. Frustratingly, for space reasons, it did not ask about other non-medicinal reduced-harm alternatives—nothing on heated tobacco, snus, or nicotine pouches. It even omitted the classic option of “going cold turkey.” So we can’t accurately estimate how many of the 7.5 million Americans who quit between 2020-2022 might have used those methods.  

The results for e-cigarettes? “It was the number one method used to quit smoking,” says Niaura. “That caught me a little by surprise.” These results hint at a quiet revolution. E-cigarettes may be playing a larger role than popularly assumed, in both attempted and successful quitting.   

In addition to e-cigarettes, the analysis of NHIS data found high endorsement of over-the-counter and prescription nicotine replacement products [NRTs]. “So in a way, it’s like e-cigarettes are—or could be or should be thought of in that way,” says Niaura. “That’s what they are [i.e., NRTs]. It’s just another way of delivering nicotine. And just maybe consumers have figured that out.” 

You can see Niaura and Foxon’s findings in a poster they presented recently to the Society for Research on Nicotine and Tobacco. And watch for their updated, expanded results in the CDC journal Preventing Chronic Disease.  

To complement the academic perspective, Olson talked with Skip Murray, harm reduction advocate and former vape shop owner. In addition to her comments in the article, Murray shared this plea to make options available for people who smoke:  

“We must remember that quitting smoking is only half the story. Lots of people quit, but few remain quit. It becomes an endless cycle for some. It is more important that they quit smoking than it is to push them to quit nicotine. Some people like what nicotine does to their bodies, and it is important that those people have access to less harmful options than smoking. Those alternative products can break the cycle of smoking, quitting, and returning to smoking–and help them remain smoke-free.”