Research ArticleAssociation of E-Cigarette Use With Respiratory Disease Among Adults: A Longitudinal Analysis
Section snippets
INTRODUCTION
Respiratory diseases are leading causes of morbidity and mortality in the U.S.1,2 Smoking is a major cause3 and, like combustible tobacco products, e-cigarettes expose users to nicotine, ultrafine particles, and other toxicants.4 Some pulmonary toxicants are in e-cigarette aerosol at higher levels than combusted cigarettes, including propylene glycol,5 diacetyl6,7 (butter flavor), cinnamaldehyde8 (cinnamon), benzaldehyde (cherry), and metals.9,10
Animal studies found that e-cigarettes increase
METHODS
Data were collected in 2013–2016 and analyzed in 2018–2019.
RESULTS
Table 1 shows baseline descriptive statistics and Appendix Table 1, available online, shows the relationships between e-cigarette use and combusted tobacco and cigarette smoking. A total of 5,466 (15.1%) adults reported that they had respiratory disease at baseline. Table 2 shows the descriptive statistics stratified by respiratory disease at Wave 1 and combined Waves 2 and 3. Appendix Table 2, available online, reports detailed information by specific diagnosis.
Among people who did not report
DISCUSSION
This study is the first population-based longitudinal analysis of the association between e-cigarette use and incident respiratory disease, with current e-cigarette use elevating the odds of developing incident respiratory disease by a factor of 1.29 (95% CI=1.03, 1.61) in the longitudinal sample. The risk of respiratory disease is independent of, and in addition to, the risks associated with current combustible tobacco smoking (AOR=2.56, 95% CI=1.92, 3.41), as well as cigarettes alone. This
CONCLUSIONS
Current use of e-cigarettes appears to be an independent risk factor for respiratory disease in addition to all combustible tobacco smoking. Although switching from combustible tobacco, including cigarettes, to e-cigarettes theoretically could reduce the risk of developing respiratory disease, current evidence indicates a high prevalence of dual use, which is associated with increased risk beyond combustible tobacco use. In addition, for most smokers, using an e-cigarette is associated with
ACKNOWLEDGMENTS
This work was supported by grants R01DA043950 from the National Institute on Drug Abuse; P50CA180890 from the National Cancer Institute and the U.S. Food and Drug Administration Center for Tobacco Products; U54HL147127 from the National Heart, Lung, and Blood Institute and the Food and Drug Administration Center for Tobacco Products; and the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center Global Cancer Program. The content is solely the responsibility of
REFERENCES (36)
- et al.
E-cigarette use and respiratory disorder in an adult sample
Drug Alcohol Depend
(2019) - et al.
Cardiovascular disease in COPD: mechanisms
Chest
(2013) - et al.
Increased risk of respiratory diseases in adults with Type 1 and Type 2 diabetes
Diabetes Res Clin Pract
(2018) - et al.
Validation of self-reported chronic obstructive pulmonary disease among patients in the ED
Am J Emerg Med
(2009) - et al.
Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure
J Clin Epidemiol
(2004) - et al.
E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis
Lancet Respir Med
(2016) - et al.
Deaths: final data for 2015
Natl Vital Stat Rep
(2017) World health statistics 2008
(Published 2008)Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015
Lancet Respir Med
(2017)- et al.
E-cigarettes: use, effects on smoking, risks, and policy implications
Annu Rev Public Health
(2018)
Experimental exposure to propylene glycol mist in aviation emergency training: acute ocular and respiratory effects
Occup Environ Med
Clinical bronchiolitis obliterans in workers at a microwave-popcorn plant
N Engl J Med
Evaluation of electronic cigarette liquids and aerosol for the presence of selected inhalation toxins
Nicotine Tob Res
Distribution, quantification and toxicity of cinnamaldehyde in electronic cigarette refill fluids and aerosols
Tob Control
Metal concentrations in e-cigarette liquid and aerosol samples: the contribution of metallic coils
Environ Health Perspect
Metal and silicate particles including nanoparticles are present in electronic cigarette cartomizer fluid and aerosol
PLOS ONE
Pulmonary toxicity of e-cigarettes
Am J Physiol Lung Cell Mol Physiol
Acrolein effects in pulmonary cells: relevance to chronic obstructive pulmonary disease
Ann N Y Acad Sci
Cited by (174)
ENDS, Cigarettes, and Respiratory Illness: Longitudinal Associations Among U.S. Youth
2024, American Journal of Preventive MedicineElectronic cigarette use and respiratory symptoms in the French population-based Constances cohort
2024, Respiratory MedicineEffects of cannabis smoking on the respiratory system: A state-of-the-art review
2024, Respiratory MedicineCigarettes, ENDS Use, and Chronic Obstructive Pulmonary Disease Incidence: A Prospective Longitudinal Study
2023, American Journal of Preventive MedicineComprehensive review of the national surveys that assess E-cigarette use domains among youth and adults in the United States
2023, Lancet Regional Health - Americas