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.
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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.
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