Encouraging adult smokers to transition to potentially less harmful nicotine products, like electronic nicotine delivery systems (ENDS), may positively impact individual and population health. However, there is concern that ENDS use by never smokers might lead to cigarette smoking.

A cross-sectional, online, retrospective survey examined factors associated with ENDS use, combustible cigarette smoking history, and changes in smoking behavior, in 494 adult users of blu PLUS+, blu Disposable, and myblu ENDS in the US. Across all products, current use was reported by 12 never smokers (2.4% of survey population). For myblu and blu Disposable, the majority of current users were former smokers of cigarettes, while for blu PLUS+ the majority of current users were established smokers. Of those myblu users who were current cigarette smokers at first use of myblu, 52.5% are now former smokers; similar values of 52.1% and 52.2% were found for blu PLUS+ and blu Disposable, respectively. Of those who were former smokers at first use of myblu, 9.1% are now relapsed smokers; similar values of 8.0% and 7.3% were found for blu PLUS+ and blu Disposable, respectively. Finally, 1 never smoker initiated cigarette smoking subsequent to first use of blu Disposable. No never smokers initiated cigarette smoking subsequent to first use of either myblu or blu Plus+.

Our findings suggest that blu and myblu ENDS are predominantly used by those with a smoking history, and that their use supports adult smokers transitioning away from combustible cigarettes. Furthermore, blu and myblu use is associated with a low level of relapse among former smokers and of cigarette smoking initiation among never smokers. These data support a positive role for blu and myblu ENDS in tobacco harm reduction.