{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T17:20:21Z","timestamp":1793380821664,"version":"4.5.0"},"reference-count":33,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Electronic cigarettes (EC) have been shown to expose users to fewer tobacco-related toxicants compared with combustible cigarettes. The current generation of ECs has rapidly shifted toward pod-based nicotine salt formulation ECs, and more research is needed to understand the impacts of using these EC products among those who smoke.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine the short-term effects of switching from cigarettes to a pod-based 5% nicotine EC, compared with a 0% nicotine EC.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This double-blind, parallel-arm, randomized, placebo-controlled trial with follow-up at 6 weeks (randomized phase) and 10 weeks (postrandomized phase) was conducted at a single-site academic medical center in Pennsylvania from April 22, 2022, to December 12, 2023. Participants included adults who smoked more than 4 cigarettes per day (CPD) and expressed interest in switching completely to an EC. Data were analyzed from August 23, 2024, to December 1, 2025.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Participants were allocated 1:1 to the standardized research EC (SREC) with 5% nicotine or 0% nicotine for 6 weeks.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was concentration of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) in urine corrected for creatinine level at 6 weeks. Secondary outcomes included exhaled carbon monoxide (CO), cotinine level, CPD, CO-verified cigarette abstinence, and levels of volatile organic compounds.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 104 participants (52 per group) were randomized, of whom 68 (65.4%) were female, with a mean (SD) age of 50.9 (10.0) years. At 6 weeks, the 5% SREC group did not have significantly lower NNAL levels (mean difference [MD], \u2212116.6 [95% CI, \u2212245.4 to 12.2] pg\/mg;\n P<\/jats:italic>\n \u2009=\u2009.08). However, a greater proportion of participants in the 5% SREC group were abstinent from cigarettes (19 of 52 [36.5%] vs 6 of 52 [11.5%];\n P<\/jats:italic>\n \u2009=\u2009.005), compared with the 0% SREC group. The 5% SREC group had greater cotinine levels (MD, 2367.8 [95% CI, 407.5-4328.2] ng\/mg;\n P<\/jats:italic>\n \u2009=\u2009.02); however, there were no differences in CPD (MD, \u22120.9 [95% CI, \u22123.9 to 2.1] CPD;\n P<\/jats:italic>\n \u2009=\u2009.55) or exhaled CO levels (MD, \u22125.1 [95% CI, \u221212.9 to 2.6] ppm;\n P<\/jats:italic>\n \u2009=\u2009.19) between groups. Levels of cyanoethyl mercapturic acid (CYMA) (MD, \u221249.0 [95% CI, \u221290.4 to \u22127.6] ng\/mg;\n P<\/jats:italic>\n \u2009=\u2009.02) and 3-hydroxypropyl mercapturic acid (3HPMA) (MD, \u2212290.8 [95% CI, \u2212514.0 to \u221267.6] ng\/mg;\n P<\/jats:italic>\n \u2009=\u2009.01), biomarkers of acrylonitrile (a carcinogen) and acrolein (a cardiac toxicant) exposure (both of which are respiratory toxicants), were lower in the 5% SREC group compared with the 0% SREC group.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this randomized clinical trial of adults who smoke, switching from cigarettes to a 5% SREC vs a 0% SREC resulted in reduced exposure to some toxicants delivered by cigarette smoking and an increased rate of smoking cessation. ECs that deliver nicotine like a cigarette may have an important role in reducing the harmful toxicant exposure caused by cigarette smoking.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT03625986<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.13292","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T15:00:29Z","timestamp":1779202829000},"page":"e2613292","source":"Crossref","is-referenced-by-count":2,"title":["Toxicant Exposures After Switching From Cigarettes to a Pod-Based Electronic Cigarette"],"prefix":"10.1001","volume":"9","author":[{"given":"Jessica M.","family":"Yingst","sequence":"first","affiliation":[{"name":"Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolle 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