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

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ID: 313604
2026
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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 & 8. We tested an indirect path from w2 ENDS use through w2 CPD reduction to HR, and a direct path from w2 ENDS use to HR, both moderated by w0 CPD. Results Mean age was 45.9 years, and 42.7% smoked ≥20 CPD. ENDS use at w2 significantly increased the odds of HR for all participants (p<0.001), mediated through reductions in w2 CPD. The ENDS direct pathway was moderated by w0 CPD (p<0.001). For the total (direct + indirect) association, greater w2 ENDS use increased chances of HR for individuals with w0 CPD>16, decreased the chances of HR for individuals with w0 CPD<7 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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Authors Mike Stoolmiller, James D. Sargent, Mary F. Brunette, Joelle C. Ferron, Meghan Santos, Sarah I. Pratt
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Journal nicotine & tobacco research : official journal of the society for research on nicotine and tobacco
Year 2026
DOI
10.1093/ntr/ntag107
URL
https://doi.org/10.1093/ntr/ntag107
Keywords Keywords not found

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