{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:59:18Z","timestamp":1785113958116,"version":"3.55.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"United States National Cancer Institute"},{"name":"United States Food and Drug Administration\u2019s Center for Tobacco","award":["P01CA200512"],"award-info":[{"award-number":["P01CA200512"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>As tobacco use patterns shift toward non-combustible tobacco products such as electronic cigarettes (ECs) and nicotine pouches, dual use with combustible products may undermine potential public health benefits. Herein we describe adult trends in exclusive and dual use of combustible and non-combustible products in the United States between 2015 and 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed annual National Health and Interview Survey data including all adults with valid data on tobacco use, age, and sex. Joinpoint regression estimated annual percentage change (APC) and 95% CIs overall and by age group and sex. All tests were 2-tailed (P\u2009&amp;lt;\u2009.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Exclusive combustible use remained 2-3 times higher than exclusive non-combustible use or dual use across all years. From 2015 and 2023, combustible use declined in both sexes, with the steepest drops in younger adults after 2020. Exclusive non-combustible use increased in all age groups after 2017, especially among younger adults and females. The most common dual use pattern was cigarettes plus ECs, which was stable over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Exclusive use of combustible tobacco, primarily cigarettes, is declining but remains the most common pattern, especially in older adults. In contrast, exclusive EC use is displacing combustible use among younger adults. Dual use patterns were low overall and stable across the study period.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jncics\/pkag062","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T16:35:12Z","timestamp":1781627712000},"source":"Crossref","is-referenced-by-count":0,"title":["Trends in adult exclusive and dual use of combustible and non-combustible tobacco products in the United States"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7103-7017","authenticated-orcid":false,"given":"Kenneth Michael","family":"Cummings","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina , Charleston, SC,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avery","family":"Roberson","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina , Charleston, SC,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin W","family":"Randol","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina , Charleston, SC,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracy T","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina , Charleston, SC,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David T","family":"Levy","sequence":"additional","affiliation":[{"name":"Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University , Washington, DC,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4807-4415","authenticated-orcid":false,"given":"Yoonseo","family":"Mok","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Michigan , Ann Arbor, MI,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve","family":"Cook","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Michigan , Ann Arbor, MI,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1076-5037","authenticated-orcid":false,"given":"Rafael","family":"Meza","sequence":"additional","affiliation":[{"name":"Rutgers Cancer Institute, Rutgers University, New Bunswick, NJ, United States"},{"name":"Population Health Sciences, BC Cancer Research Institute, Vancouver, British Columbia, Canada"},{"name":"School of Population and Public Health, University of British Columbia, Vancouver , British Columbia,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"2026072620025166900_pkag062-B1","doi-asserted-by":"publisher","DOI":"10.17226\/10029","volume-title":"Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction","author":"Institute of Medicine","year":"2001"},{"key":"2026072620025166900_pkag062-B2","doi-asserted-by":"publisher","DOI":"10.17226\/24952","volume-title":"Public Health Consequences of E-Cigarettes","author":"National Academies of Sciences, Engineering, and Medicine","year":"2018"},{"key":"2026072620025166900_pkag062-B3","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1056\/NEJMp1707409","article-title":"A nicotine-focused framework for public health","volume":"377","author":"Gottlieb","year":"2017","journal-title":"N Engl J 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