{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:57:26Z","timestamp":1790791046993,"version":"4.1.0"},"reference-count":21,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Tob Control"],"accepted":{"date-parts":[[2026,9,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>We investigated the roles of heated tobacco products (HTPs) and electronic cigarettes (ECs) in combustible cigarette (CCs) smoking initiation, relapse and cessation, as well as in all tobacco product discontinuation and transition of dual and triple use of CCs, HTPs and ECs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Researchers analysed data from Korea National Health Insurance Service including 7\u2009260\u2009125 Korean adults who participated in three biennial health screenings between 2019 and 2023. Multivariable logistic regression analyses were performed to investigate the associations of HTPs and ECs use with initiation, relapse and cessation of CCs smoking and discontinuing all tobacco products, and transition probabilities were estimated to characterise changes in tobacco-use patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared with participants who reported never using, those who reported current HTPs and ECs use had higher odds of initiation, relapse and cessation of CCs smoking, but lower odds of discontinuing all tobacco products. Among participants who reported dual use of CCs and HTPs, more than 70% transitioned to CCs\u2019 use. Complete cessation of all tobacco products was less common among dual and triple users of HTPs, ECs and CCs than among exclusive CC users.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Although HTPs and ECs use was associated with increased CCs smoking cessation, these products drive higher rates of CC initiation and relapse and lower rates of complete tobacco cessation. Most users of multiple tobacco products revert to CCs smoking and are less likely to successfully quit all tobacco use. The net public health impact of these evolving tobacco use patterns in Korea remains uncertain.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/tc-2026-060187","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:20:31Z","timestamp":1790788831000},"page":"tc-2026-060187","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Transitions in tobacco product use involving combustible cigarettes, heated tobacco products and electronic cigarettes among 7 million South Korean adults: a prospective cohort study"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8899-9637","authenticated-orcid":false,"given":"Youn","family":"Huh","sequence":"first","affiliation":[{"name":"Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2186-8792","authenticated-orcid":false,"given":"Hae Rim","family":"Kim","sequence":"additional","affiliation":[{"name":"College of Natural Science, School of Statistics, University of Seoul, Seoul, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3125-7805","authenticated-orcid":false,"given":"Jung Ah","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Asan Medical Center,University of Ulsan College of Medicine, Seoul, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong-Jun","family":"Cho","sequence":"additional","affiliation":[{"name":"University of Ulsan College of Medicine, Ulsan, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"2026093010202142000_tc-2026-060187v1.1","doi-asserted-by":"crossref","DOI":"10.3346\/jkms.2024.39.e328","article-title":"Tobacco Use in Korea: Current Epidemiology and Public Health Issues","volume":"39","author":"Park","year":"2024","journal-title":"J Korean Med Sci"},{"key":"2026093010202142000_tc-2026-060187v1.2","unstructured":"National Center for Health Statistics . Korea health statistics 2024: Korea National Health and Nutrition Examination Survey (KNHANES \u2168-3). Korea National Health and Nutrition Examination Survey. Cheongju Korea Disease Control and Prevention Agency."},{"key":"2026093010202142000_tc-2026-060187v1.3","doi-asserted-by":"crossref","first-page":"00946","DOI":"10.1183\/23120541.00976-2020","article-title":"Prospective association between use of electronic cigarettes and use of conventional cigarettes: a systematic review and meta-analysis","volume":"7","author":"Adermark","year":"2021","journal-title":"ERJ Open Res"},{"key":"2026093010202142000_tc-2026-060187v1.4","doi-asserted-by":"publisher","DOI":"10.1136\/tc.2008.027318"},{"key":"2026093010202142000_tc-2026-060187v1.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-020-09055-z","article-title":"The actual and anticipated effects of a menthol cigarette ban: a scoping review","volume":"20","author":"Cadham","year":"2020","journal-title":"BMC Public Health"},{"key":"2026093010202142000_tc-2026-060187v1.6","article-title":"A systematic review investigating the impact of dual use of e-cigarettes and conventional cigarettes on smoking cessation","volume":"11","author":"Hamoud","year":"2025","journal-title":"ERJ Open Res"},{"key":"2026093010202142000_tc-2026-060187v1.7","article-title":"Electronic cigarettes for smoking cessation","volume":"11","author":"Hartmann-Boyce","year":"2022","journal-title":"Cochrane Database Syst Rev"},{"key":"2026093010202142000_tc-2026-060187v1.8","doi-asserted-by":"publisher","DOI":"10.2105\/ajph.2020.305999"},{"key":"2026093010202142000_tc-2026-060187v1.9","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1007\/s00038-020-01436-w","article-title":"Cessation outcomes in adult dual users of e-cigarettes and cigarettes: the Population Assessment of Tobacco and Health cohort study, USA, 2013-2016","volume":"65","author":"Osibogun","year":"2020","journal-title":"Int J Public Health"},{"key":"2026093010202142000_tc-2026-060187v1.10","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s12954-020-00386-z","article-title":"The impact of cigarette and e-cigarette use history on transition patterns: a longitudinal analysis of the population assessment of tobacco and health (PATH) study, 2013\u20132015","volume":"17","author":"Wei","year":"2020","journal-title":"Harm Reduct J"},{"key":"2026093010202142000_tc-2026-060187v1.11","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1080\/10826084.2019.1710211","article-title":"Changes in Nicotine Product Use among Dual Users of Tobacco and Electronic Cigarettes: Findings from the Population Assessment of Tobacco and Health (PATH) Study, 2013-2015","volume":"55","author":"Miller","year":"2020","journal-title":"Subst Use Misuse"},{"key":"2026093010202142000_tc-2026-060187v1.12","first-page":"1","article-title":"E-cigarette use and subsequent tobacco smoking initiation: an umbrella review with Bayesian model meta-analysis","volume":"0","author":"Kaur","year":"2026","journal-title":"Tob Control"},{"key":"2026093010202142000_tc-2026-060187v1.13","doi-asserted-by":"publisher","DOI":"10.1136\/tc-2022-057368"},{"key":"2026093010202142000_tc-2026-060187v1.14","doi-asserted-by":"publisher","DOI":"10.1136\/tc-2022-057613"},{"key":"2026093010202142000_tc-2026-060187v1.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2021.108599"},{"key":"2026093010202142000_tc-2026-060187v1.16","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyw253"},{"key":"2026093010202142000_tc-2026-060187v1.17","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwq433"},{"key":"2026093010202142000_tc-2026-060187v1.18","doi-asserted-by":"publisher","DOI":"10.1136\/tc-2023-058453"},{"key":"2026093010202142000_tc-2026-060187v1.19","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2020-055967"},{"key":"2026093010202142000_tc-2026-060187v1.20","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2012.301070"},{"key":"2026093010202142000_tc-2026-060187v1.21","doi-asserted-by":"crossref","DOI":"10.1056\/EVIDoa2300229","article-title":"Population-Based Disease Odds for E-Cigarettes and Dual Use versus Cigarettes","volume":"3","author":"Glantz","year":"2024","journal-title":"NEJM Evid"}],"container-title":["Tobacco Control"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/tc-2026-060187","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:20:34Z","timestamp":1790788834000},"score":1,"resource":{"primary":{"URL":"https:\/\/tobaccocontrol.bmj.com\/lookup\/doi\/10.1136\/tc-2026-060187"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":21,"alternative-id":["10.1136\/tc-2026-060187"],"URL":"https:\/\/doi.org\/10.1136\/tc-2026-060187","relation":{},"ISSN":["0964-4563","1468-3318"],"issn-type":[{"value":"0964-4563","type":"print"},{"value":"1468-3318","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]}}}