What question did this study set out to answer?

To assess how early use of electronic nicotine delivery systems (ENDS) relates to harm reduction in adult smokers.

May 17, 2026

Relationship Between Early Product Substitution and Harm Reduction in an ENDS Switching Trial for Adults who Smoke

Key Points

To assess how early use of electronic nicotine delivery systems (ENDS) relates to harm reduction in adult smokers.
Longitudinal study with 120 participants receiving disposable ENDS for 8 weeks, assessed every 2 weeks.
Analyzed the relationship between w2 ENDS sessions per day and harm reduction, with w0 cigarettes per day as a moderating factor.
Used structural equation modeling to test indirect and direct pathways to harm reduction.
ENDs use at week 2 significantly improved the odds of harm reduction (p<0.001), mediated by reduced cigarette use at week 2.
For participants with higher initial smoking rates (w0 >16 CPD), increased ENDS use correlated with higher harm reduction chances, while lower smoking rates (w0 <7) showed decreased harm reduction chances.
Overall predictors accounted for 66% of the variance in harm reduction outcomes.

Abstract

Abstract Introduction To examine the relationship between early product substitution and harm reduction (HR) in an ENDS switching trial for adults who smoke. Methods We conducted a longitudinal structural equation analysis of 120 treatment participants who received disposable ENDS for 8 weeks and were assessed every 2weeks. The predictor was w2 ENDS sessions/day. The HR latent construct included 4 binary indicators: cigarettes/day (CPD) ≤5 and carbon monoxide (CO) 10ppm at weeks 6 0.001), mediated through reductions in w2 CPD. The ENDS direct pathway was moderated by w0 CPD (p0.001). For the total (direct + indirect) association, greater w2 ENDS use increased chances of HR for individuals with w0 CPD16, decreased the chances of HR for individuals with w0 CPD7 and had no impact on those in the w0 CPD 7-15. All predictors combined explained 66% of the variance in HR. Conclusions In this study, early ENDS use predicted short-term HR, but only for individuals who smoked more heavily. For those with low smoking intensity, early ENDS use predicted decreased short-term chances of HR and increased dual product use. This is a novel finding limited to a small sample of persons with severe mental illness. Implications If replicated and extended to later HR outcomes, the finding supports a focus on early ENDS use as an intermediate outcome for phase 2 trials of ENDS products, and adaptive treatment designs aimed at early non responders, with a particular focus on persons who smoke heavily.

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