In Reply In their letter in response to our Original Investigation,1 He and Niu suggest that the association between frequency of electronic cigarette (EC) use and smoking level may be dose dependent, which our study did not investigate. This is a valid point, as frequency of EC use, and therefore the nicotine dose received, might be relevant with regard to smoking cessation. Unfortunately, such measures are difficult to obtain in large cohort studies such as CONSTANCES (Consultants des Centres d’Examens de Santé). Some vapers take a few puffs several times a day, while others use their ECs less frequently but take more puffs each time.2 Additionally, other factors might also influence frequency of EC use, such nicotine dependency, nicotine dose in the e-liquid used, lengths and strength of puffs, as well as context and location of use (eg, festive, social, work, home). Prior studies of smoking cessation have considered daily EC use to be intensive,3,4 yet future research will need to yield more detailed information about the relationship between the level of use and smoking patterns in large community-based samples.
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Gomajee R, El-Khoury F, Melchior M. More Explorations Needed on Association of Electronic Cigarette Use and Smoking Reduction—Reply. JAMA Intern Med. 2020;180(1):160–161. doi:10.1001/jamainternmed.2019.5275
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