Association of Electronic Cigarette Use with Respiratory Symptom Development among U.S. Young Adults

Abstract

Rationale: Electronic cigarette (e-cigarette) use is highly prevalent among young adults. However, longitudinal data assessing the association between e-cigarette use and respiratory symptoms are lacking. Objectives: To determine whether e-cigarette use is associated with the development of respiratory symptoms in young adults. Methods: Data are derived from the PATH (Population Assessment of Tobacco and Health) study waves 2 (2014-2015), 3 (2015-2016), 4 (2016-2018), and 5 (2018-2019). Young adults aged 18-24 years at baseline with no prevalent respiratory disease or symptoms were included in the analyses. Binary logistic regression models with a generalized estimating equation were used to estimate time-varying and time-lagged associations of e-cigarette use during waves 2-4, with respiratory symptom development approximately 12 months later at waves 3-5. Measurements and Main Results: The per-wave prevalence of former and current e-cigarette use was 15.2% and 5.6%, respectively. Former e-cigarette use was associated with higher odds of developing any respiratory symptom (adjusted odds ratio [aOR], 1.20; 95% confidence interval [CI], 1.04-1.39) and wheezing in the chest (aOR, 1.41; 95% CI, 1.08-1.83) in multivariable adjusted models. Current e-cigarette use was associated with higher odds for any respiratory symptom (aOR, 1.32; 95% CI, 1.06-1.65) and wheezing in the chest (aOR, 1.51; 95% CI, 1.06-2.14). Associations persisted among participants who never smoked combustible cigarettes. Conclusions: In this nationally representative cohort of young adults, former and current e-cigarette use was associated with higher odds of developing wheezing-related respiratory symptoms, after accounting for cigarette smoking and other combustible tobacco product use.

Keywords: electronic cigarette use; respiratory signs and symptoms; tobacco use in young adults.

Figure 1.

Multivariable-adjusted association of electronic cigarette (e-cigarette) use with respiratory symptom development among U.S. young adults. The association was adjusted for age, sex, race, current use of other tobacco product (cigar, cigarillo, filtered cigar, pipe, or hookah), marijuana use, other recreational drug use, secondhand smoke exposure, and body mass index (<18.5, 18.5–24.9, 25.0–29.9, or ⩾30.0 kg/m²). Further adjusted for cigarette smoking status (never, former, current some days, or current every day) for entire sample. aOR = adjusted odds ratio; CI = confidence interval; ref. = reference.

Figure 2.

Multivariable-adjusted association of electronic cigarette (e-cigarette) use and cigarette smoking patterns with respiratory symptom development among U.S. young adults. The association was adjusted for age, sex, race, current use of other tobacco product (cigar, cigarillo, filtered cigar, pipe, hookah, smokeless, or snus), marijuana use, other recreational drug use, secondhand smoke exposure, and body mass index (<18.5, 18.5–24.9, 25.0–29.9, or ⩾30.0 kg/m²). (A) Any respiratory sypmtom. (B) Wheezing in the chest. (C) Wheezing during exercise. (D) Dry cough at night. aOR = adjusted odds ratio; Cig = combustible cigarette use; EC = current e-cigarette use; No EC = noncurrent e-cigarette use.