{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T11:51:30Z","timestamp":1787226690005,"version":"build-2736575974"},"reference-count":37,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2023,3,28]],"date-time":"2023-03-28T00:00:00Z","timestamp":1679961600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["U54CA229974"],"award-info":[{"award-number":["U54CA229974"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Tob Control"],"accepted":{"date-parts":[[2023,3,13]]},"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:sec>\n<jats:title>Introduction<\/jats:title>\n<jats:p>It is unknown how recent changes in the tobacco product marketplace have impacted transitions in cigarette and electronic nicotine delivery system (ENDS) use.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>A multistate transition model was applied to 24 242 adults and 12 067 youth in waves 2\u20134 (2015\u20132017) and 28 061 adults and 12 538 youth in waves 4 and 5 (2017\u20132019) of the Population Assessment of Tobacco and Health Study. Transition rates for initiation, cessation and product transitions were estimated in multivariable models, accounting for gender, age group, race\/ethnicity and daily versus non-daily product use.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Changes in ENDS initiation\/relapse rates depended on age, including among adults. Among youth who had never established tobacco use, the 1-year probability of ENDS initiation increased after 2017 from 1.6% (95% CI 1.4% to 1.8%) to 3.8% (95% CI 3.4% to 4.2%). Persistence of ENDS-only use (ie, 1-year probability of continuing to use ENDS only) increased for youth from 40.7% (95% CI 34.4% to 46.9%) to 65.7% (95% CI 60.5% to 71.1%) and for adults from 57.8% (95% CI 54.4% to 61.3%) to 78.2% (95% CI 76.0% to 80.4%). Persistence of dual use similarly increased for youth from 48.3% (95% CI 37.4% to 59.2%) to 60.9% (95% CI 43.0% to 78.8%) and for adults from 40.1% (95% CI 37.0% to 43.2%) to 63.8% (95% CI 59.6% to 67.6%). Youth and young adults who used both products became more likely to transition to ENDS-only use, but middle-aged and older adults did not.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>ENDS-only and dual use became more persistent. Middle-aged and older adults who used both products became less likely to transition to cigarette-only use but not more likely to discontinue cigarettes. Youth and young adults became more likely to transition to ENDS-only use.<\/jats:p>\n<\/jats:sec>","DOI":"10.1136\/tc-2022-057905","type":"journal-article","created":{"date-parts":[[2023,3,28]],"date-time":"2023-03-28T17:29:10Z","timestamp":1680024550000},"page":"570-579","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["Changing patterns of cigarette and ENDS transitions in the USA: a multistate transition analysis of youth and adults in the PATH Study in 2015\u20132017 vs 2017\u20132019"],"prefix":"10.1136","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3779-5287","authenticated-orcid":false,"given":"Andrew F","family":"Brouwer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jihyoun","family":"Jeon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evelyn","family":"Jimenez-Mendoza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie R","family":"Land","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore R","family":"Holford","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2352-8786","authenticated-orcid":false,"given":"Abigail S","family":"Friedman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8353-4259","authenticated-orcid":false,"given":"Jamie","family":"Tam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1514-1466","authenticated-orcid":false,"given":"Ritesh","family":"Mistry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5280-3612","authenticated-orcid":false,"given":"David T","family":"Levy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1076-5037","authenticated-orcid":false,"given":"Rafael","family":"Meza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,3,28]]},"reference":[{"key":"2024092601251511000_33.5.570.1","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2018-054382"},{"key":"2024092601251511000_33.5.570.2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6937e2"},{"key":"2024092601251511000_33.5.570.3","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2020-056371"},{"key":"2024092601251511000_33.5.570.4","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1001\/jamaoto.2019.2410","article-title":"The adolescent vaping epidemic in the United states-how it happened and where we go from here","volume":"145","author":"Farzal","year":"2019","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"key":"2024092601251511000_33.5.570.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61842-5"},{"key":"2024092601251511000_33.5.570.6","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-014-0225-z"},{"key":"2024092601251511000_33.5.570.7","doi-asserted-by":"publisher","DOI":"10.1370\/afm.1962"},{"key":"2024092601251511000_33.5.570.8","article-title":"Electronic cigarettes for smoking cessation","volume":"4","author":"Hartmann-Boyce","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"2024092601251511000_33.5.570.9","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/S2213-2600(15)00521-4","article-title":"E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis","volume":"4","author":"Kalkhoran","year":"2016","journal-title":"Lancet Respir Med"},{"key":"2024092601251511000_33.5.570.10","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.119.012742","article-title":"Is there a role for electronic cigarettes in tobacco cessation?","volume":"8","author":"Bhatnagar","year":"2019","journal-title":"J Am Heart Assoc"},{"key":"2024092601251511000_33.5.570.11","doi-asserted-by":"publisher","DOI":"10.2105\/ajph.2020.305999"},{"key":"2024092601251511000_33.5.570.12","doi-asserted-by":"crossref","unstructured":"Johnston LD , Miech RA , O\u2019Malley PM , et al . 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