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It means the cumulative exposure equals smoking one pack (20 cigarettes) daily for 30 years, or two packs daily for 15 years, or any combination where packs years = 30

Abbreviations AHR: Adjusted hazard rate ASH: Action on Smoking and Health AOR: Adjusted odds ratio ARR: Adjusted risk ratio CI: Confidence interval COPD: Chronic obstructive pulmonary disease EC: Electronic cigarette eCO: Expired carbon monoxide eNO: Expired nitric oxide EPA: Environmental Protection Agency HRCT: High-resolution computed tomography NHIS: National Health Interview Survey PATH: Population Assessment of Tobacco and Health PICO: Population, intervention, comparator, outcomes PRISMA: Preferred Reported Items for Systematic Reviews and Meta-Analyses RCT: Randomized controlled trial VERITAS Study: The Vaping Effects: Real-World International Surveillance Study WHO: World Health Organization References National Academies of Sciences E, Medicine (2018) Public health consequences of E-cigarettes

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