{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T00:03:19Z","timestamp":1792886599005,"version":"4.5.0"},"posted":{"date-parts":[[2026,8,13]]},"group-title":"Oncology","reference-count":12,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIH \/ FDA Center for Tobacco Products","award":["U54 CA229974"],"award-info":[{"award-number":["U54 CA229974"]}],"id":[{"id":"https:\/\/ror.org\/04c42gq36","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,10,21]]},"abstract":"Abstract<\/jats:title>\n \n Introduction<\/jats:title>\n A Korean National Health Insurance Service (NHIS) cohort study reported higher lung cancer incidence among former smokers who used e-cigarettes after quitting than among those who quit without them. Interpreting that association requires knowing which product was used and how long ago participants quit; the cohort measured neither directly, but the contemporaneous Korea National Health and Nutrition Examination Survey (KNHANES) did.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n KNHANES 2018, a cross-sectional national survey, used the NHIS umbrella e-cigarette term, a separate heated tobacco product (HTP) item, and months since cessation. Former smokers using either product (n = 43) were compared with those using neither (n = 1,305), with replication in 2019\u20132023.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of adults affirming current umbrella e-cigarette use, 64% also reported HTP use (former smokers, 50%); 79% of product-using former smokers reported HTP use. Median time since cessation was eight months among product users and twelve years among others (Kolmogorov\u2013Smirnov D = 0.76, P < 0.001). The gap was replicated in every wave through 2023 (D = 0.63\u20130.76) and persisted in the long-term quitter stratum (pooled 2019\u20132023 medians, 6 vs 18 years), in Kim et al.\u2019s high-risk subgroup (2 vs 12 years), after age matching (residual 9.0\u201311.0 years) and among umbrella-item respondents only (D = 0.73).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The reported association is consistent with residual confounding by cessation timing and with product misclassification. It also rests on few exposed events: 16 in the long-term stratum, and 31 of 71 retained when exposure was updated at the next screening. Because at most half of the exposure was exclusive liquid e-cigarette use, an e-cigarette-specific estimate would need about four times as many exposed events for the same precision. Repeated-screening designs that update cessation and product use at every screening, already used for cessation in the same database, would retain the full sample and allow more precise, product-specific dose-response estimates.<\/jats:p>\n <\/jats:sec>","DOI":"10.64898\/2026.08.11.26360188","type":"posted-content","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T16:05:16Z","timestamp":1786637116000},"source":"Crossref","is-referenced-by-count":1,"title":["Brief Report: An Eleven-Year Cessation Gap among Korean Former Smokers using Heated Tobacco or E-Cigarettes: Implications for Lung Cancer Risk Estimates"],"prefix":"10.64898","author":[{"given":"S","family":"Cook","sequence":"first","affiliation":[{"name":"University of Michigan, Ann Arbor, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4367-1491","authenticated-orcid":false,"given":"G","family":"Cohen","sequence":"additional","affiliation":[{"name":"Rose Research Center, Raleigh NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7103-7017","authenticated-orcid":false,"given":"KM","family":"Cummings","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina, Charleston, SC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026102404250458000_2026.08.11.26360188v2.1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-026-04469-5"},{"key":"2026102404250458000_2026.08.11.26360188v2.2","doi-asserted-by":"crossref","first-page":"2356","DOI":"10.1038\/s41591-026-04470-y","article-title":"Long-term health risks of e-cigarettes after smoking cessation","volume":"32","year":"2026","journal-title":"Nat Med"},{"key":"2026102404250458000_2026.08.11.26360188v2.3","doi-asserted-by":"crossref","first-page":"111985","DOI":"10.1016\/j.isci.2025.111985","article-title":"Observational studies of exposure to tobacco and nicotine products: Best practices for maximizing statistical precision and accuracy","volume":"28","year":"2025","journal-title":"iScience"},{"key":"2026102404250458000_2026.08.11.26360188v2.4","doi-asserted-by":"publisher","DOI":"10.1038\/s41571-026-01192-5"},{"key":"2026102404250458000_2026.08.11.26360188v2.5","doi-asserted-by":"crossref","first-page":"e2354958","DOI":"10.1001\/jamanetworkopen.2023.54958","article-title":"Cancer Risk Following Smoking Cessation in Korea","volume":"7","year":"2024","journal-title":"JAMA Netw Open"},{"key":"2026102404250458000_2026.08.11.26360188v2.6","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyt228"},{"key":"2026102404250458000_2026.08.11.26360188v2.7","unstructured":"Korea Disease Control and Prevention Agency. KNHANES 2018\u20132023 [public-release SAS data files]. (2026)."},{"key":"2026102404250458000_2026.08.11.26360188v2.8","unstructured":"National Health Insurance Service. Table V-1-5: \u25a1\u25a1\u25a1 \u25a1\u25a1 \uc804\uc790 \u25a1 \u25a1 \u25a1 \u25a1 \u25a1 \u25a1 [E-Cigarette Use Questionnaire Items by Province and Sex]. In 2018 \u25a1\u25a1\u25a1\u25a1 \u25a1 \u25a1 \u25a1 \u25a1 \u25a1 \u25a1 \u25a1 [Guide for the 2018 National Health Screening Statistical Yearbook]. 62 https:\/\/nhiss.nhis.or.kr\/ (2019)."},{"key":"2026102404250458000_2026.08.11.26360188v2.9","doi-asserted-by":"crossref","unstructured":"Kim, S. H. & Cho, H.-J. Prevalence and correlates of current use of heated tobacco products among a nationally representative sample of Korean adults: Results from a cross-sectional study. Tob. Induc. Dis. 18, (2020).","DOI":"10.18332\/tid\/125232"},{"key":"2026102404250458000_2026.08.11.26360188v2.10","first-page":"1","article-title":"Tobacco use trends in South Korea, 2013\u20132023: Persistent disparities and emerging challenges in a repeated cross-sectional study","volume":"24","year":"2026","journal-title":"Tob. Induc. Dis"},{"key":"2026102404250458000_2026.08.11.26360188v2.11","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1186\/s12931-026-03545-1","article-title":"E-cigarette switching in COPD: reduced cardiovascular events without improvement in respiratory outcomes","volume":"27","year":"2026","journal-title":"Respir Res"},{"key":"2026102404250458000_2026.08.11.26360188v2.12","doi-asserted-by":"publisher","DOI":"10.64898\/2026.08.11.26360188"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.64898\/2026.08.11.26360188","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T11:25:14Z","timestamp":1792841114000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.64898\/2026.08.11.26360188"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,13]]},"references-count":12,"URL":"https:\/\/doi.org\/10.64898\/2026.08.11.26360188","relation":{},"subject":[],"published":{"date-parts":[[2026,8,13]]},"subtype":"preprint"}}