Article Text

Download PDFPDF
Original research
Prospective study of e-cigarette use and respiratory symptoms in adolescents and young adults
  1. Alayna P Tackett1,
  2. Robert Urman2,
  3. Jessica Barrington-Trimis2,
  4. Feifei Liu2,
  5. Hanna Hong3,
  6. Mary Ann Pentz2,
  7. Talat S Islam2,
  8. Sandrah P Eckel2,
  9. Meghan Rebuli4,
  10. Adam Leventhal2,
  11. Jonathan M Samet5,
  12. Kiros Berhane6,
  13. Rob McConnell2
  1. 1 Department of Internal Medicine, Division of Medical Oncology, Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
  2. 2 Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
  3. 3 Division of Pulmonology, Children's Hospital of Orange County, Orange, California, USA
  4. 4 Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
  5. 5 Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
  6. 6 Department of Biostatistics, Columbia University, New York, New York, USA
  1. Correspondence to Dr Rob McConnell, Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, CA 20089, USA; rmcconne{at}


Rationale Electronic cigarette (e-cigarette) aerosol contains volatile aldehydes, including flavourings and oxidant metals with known pulmonary toxicity.

Objectives To evaluate the associations of e-cigarette use with symptoms of wheeze, bronchitic symptoms and shortness of breath (SOB) across 4 years of prospective data.

Methods Participants completed questionnaires on respiratory symptoms and past 30-day e-cigarette, cigarette and cannabis use in 2014 (wave 1; N=2094; mean age 17.3 years, SD=0.6 years). Follow-up information was collected in 2015 (wave 2; n=1609), 2017 (wave 3; n=1502) and 2018 (wave 4; n=1637) using online surveys. Mixed-effects logistic regression models evaluated associations of e-cigarette use with respiratory symptoms.

Measurements and main results Participants were mostly Hispanic white (51.8%) and evenly representative by sex (49.6% female; 50.4% male). Compared with never e-cigarette users, past 30-day e-cigarette users reported increased odds of wheeze (OR 1.81; 95% CI 1.28, 2.56), bronchitic symptoms (OR 2.06; 95% CI 1.58, 2.69) and SOB (OR 1.78; 95% CI 1.23, 2.57), adjusting for study wave, age, sex, race, lifetime asthma diagnosis and parental education. Effect estimates were attenuated (wheeze (OR 1.41; 95% CI 0.99, 2.01), bronchitic symptoms (OR 1.55; 95% CI 1.18, 2.05), SOB (OR 1.48; 95% CI 1.01, 2.18)), after adjusting additionally for current cigarette use, cannabis use and secondhand exposure to e-cigarettes/cigarettes/cannabis.

Conclusions E-cigarette use in young adults was associated with respiratory symptoms, independent of combustible cannabis and cigarette exposures.

  • Tobacco and the lung

Data availability statement

Data are available upon reasonable request.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available upon reasonable request.

View Full Text


  • Twitter @meradfor

  • Correction notice This article has been corrected since it was published Online First. It was noted that the estimates in the results section of the abstract were different from the results section of the text. These have been amended and do not change the overall conclusions of the article.

  • Contributors Conception and design: RM, RU, JB-T. Analysis and interpretation: APT, RM, RU, JB-T, SPE, FL. Drafting and revising the manuscript for important intellectual content: APT, RU, JB-T, FL, HH, MAP, TSI, SPE, MR, AL, JMS, KB, RM. Guarantor, RM.

  • Funding This reported research was supported by NIH (grant numbers: P50CA180905, R21HD084812, K01DA042950, K01HL148907, P30ES007048, P2CES033433) and the Hastings Foundation.

  • Disclaimer The funders had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; or decision to submit the manuscript for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Linked Articles