{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T18:13:19Z","timestamp":1788199999877,"version":"build-2803163510"},"reference-count":33,"publisher":"BMJ","funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["R21DA058328"],"award-info":[{"award-number":["R21DA058328"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Tob Control"],"accepted":{"date-parts":[[2026,6,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>E-cigarette nicotine concentration level is critical to tobacco regulation. This study seeks to examine whether nicotine level is associated with transitions in tobacco use status such as exclusive cigarette, exclusive electronic (e-)cigarette, dual and no use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using a large, nationally representative cohort from the Population Assessment of Tobacco and Health (PATH) study in the USA, we compared changes in the prevalence of tobacco use status at 1-year follow-up (Wave 7) based on level of e-cigarette nicotine exposure at baseline (Wave 6). Self-reported nicotine concentration was categorised into high (5.0% or more), moderate (1.8\u20134.9%), low (0.1\u20131.7%), 0% and \u2018I don\u2019t know\u2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among those using e-cigarettes at baseline, those using products containing nicotine (\u22650.1%) were more likely to continue exclusive e-cigarette use at follow-up than those using 0% or unknown nicotine content. Among those reporting dual use at baseline, nearly half continued dual use at follow-up regardless of nicotine concentration. However, those using higher nicotine concentrations (\u22651.8%) were more likely to either switch to exclusive e-cigarettes or quit entirely indicating greater harm reduction than those using low-nicotine or no-nicotine products. In contrast, nearly half with baseline dual use and 0% nicotine transitioned to exclusive cigarette smoking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These findings highlight the complex relationship between e-cigarette nicotine concentration and tobacco use transitions. Regulatory and public health approaches may benefit from balancing the potential harm reduction role of nicotine-containing e-cigarettes for adults who smoke with concerns regarding sustained nicotine dependence and long-term e-cigarette use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/tc-2026-060086","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T17:20:15Z","timestamp":1782753615000},"page":"tc-2026-060086","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Role of e-cigarette nicotine concentration in longitudinal transitions between cigarette, e-cigarette and dual use"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1395-7904","authenticated-orcid":false,"given":"Hongying Daisy","family":"Dai","sequence":"first","affiliation":[{"name":"Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Nebraska, USA"},{"name":"Department of Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abraham","family":"Degarege","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2711-8615","authenticated-orcid":false,"given":"Paula R","family":"Guastello","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Nebraska, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"2026083110201234000_tc-2026-060086v2.1","unstructured":"Centers for Disease Control . Burden of cigarette use in the U.S."},{"key":"2026083110201234000_tc-2026-060086v2.2","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1007\/s40429-020-00340-w","article-title":"Electronic Cigarette Use Among Youth: Understanding Unique Risks in a Vulnerable Population","volume":"7","author":"Trucco","year":"2020","journal-title":"Curr Addict Rep"},{"key":"2026083110201234000_tc-2026-060086v2.3","article-title":"Electronic cigarettes for smoking cessation","volume":"4","author":"Hartmann-Boyce","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"2026083110201234000_tc-2026-060086v2.4","doi-asserted-by":"crossref","unstructured":"Feeney S , Rossetti V , Terrien J . E-Cigarettes-a review of the evidence-harm versus harm reduction. Tob Use Insights 2022;15. doi:10.1177\/1179173X221087524","DOI":"10.1177\/1179173X221087524"},{"key":"2026083110201234000_tc-2026-060086v2.5","doi-asserted-by":"crossref","DOI":"10.3389\/adar.2023.11345","article-title":"E-cigarettes may serve as a gateway to conventional cigarettes and other addictive drugs","volume":"3","author":"Chen","year":"2023","journal-title":"Adv Drug Alcohol Res"},{"key":"2026083110201234000_tc-2026-060086v2.6","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1007\/s40429-022-00448-1","article-title":"Dual Use of Combustible Cigarettes and E-cigarettes: a Narrative Review of Current Evidence","volume":"9","author":"Coleman","year":"2022","journal-title":"Curr Addict Rep"},{"key":"2026083110201234000_tc-2026-060086v2.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2019.05.029"},{"key":"2026083110201234000_tc-2026-060086v2.8","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2019-055485"},{"key":"2026083110201234000_tc-2026-060086v2.9","doi-asserted-by":"publisher","DOI":"10.2174\/1570159X15666171016164430"},{"key":"2026083110201234000_tc-2026-060086v2.10","unstructured":"Food and Drug Administration . 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Regulation of electronic nicotine delivery systems (ENDS): background and selected policy."},{"key":"2026083110201234000_tc-2026-060086v2.15","unstructured":"United States Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, Food and Drug Administration, Center for Tobacco Products . Population assessment of tobacco and health (PATH) study [United States] public-use files (ICPSR 36498). Inter-university consortium for political and social research [distributor]. n.d. Available: https:\/\/www.icpsr.umich.edu\/web\/NAHDAP\/studies\/36498"},{"key":"2026083110201234000_tc-2026-060086v2.16","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2018.5937","article-title":"Comparison of Nicotine and Toxicant Exposure in Users of Electronic Cigarettes and Combustible Cigarettes","volume":"1","author":"Goniewicz","year":"2018","journal-title":"JAMA Netw Open"},{"key":"2026083110201234000_tc-2026-060086v2.17","unstructured":"McCarthy PJ . Pseudoreplication: further evaluation and applications of the balanced half-sample technique. 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Overview of legislation and regulation on e-cigarettes. In: E-cigarettes: risks, research and challenges. 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