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Association of E-Cigarette Use With Respiratory Disease Among Adults: A Longitudinal Analysis

  • Dharma N. Bhatta
    Affiliations
    Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, California

    Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
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  • Stanton A. Glantz
    Correspondence
    Address correspondence to: Stanton A. Glantz, PhD, Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366, San Francisco CA 94143.
    Affiliations
    Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, California

    Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California

    Department of Medicine (Cardiology), University of California, San Francisco, San Francisco, California

    Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California

    Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California
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Published:December 16, 2019DOI:https://doi.org/10.1016/j.amepre.2019.07.028

      Introduction

      E-cigarettes deliver an aerosol of nicotine by heating a liquid and are promoted as an alternative to combustible tobacco. This study determines the longitudinal associations between e-cigarette use and respiratory disease controlling for combustible tobacco use.

      Methods

      This was a longitudinal analysis of the adult Population Assessment of Tobacco and Health Waves 1, 2, and 3. Multivariable logistic regression was performed to determine the associations between e-cigarette use and respiratory disease, controlling for combustible tobacco smoking, demographic, and clinical variables. Data were collected in 2013–2016 and analyzed in 2018–2019.

      Results

      Among people who did not report respiratory disease (chronic obstructive pulmonary disease, chronic bronchitis, emphysema, or asthma) at Wave 1, the longitudinal analysis revealed statistically significant associations between former e-cigarette use (AOR=1.31, 95% CI=1.07, 1.60) and current e-cigarette use (AOR=1.29, 95% CI=1.03, 1.61) at Wave 1 and having incident respiratory disease at Waves 2 or 3, controlling for combustible tobacco smoking, demographic, and clinical variables. Current combustible tobacco smoking (AOR=2.56, 95% CI=1.92, 3.41) was also significantly associated with having respiratory disease at Waves 2 or 3. Odds of developing respiratory disease for a current dual user (e-cigarette and all combustible tobacco) were 3.30 compared with a never smoker who never used e-cigarettes. Analysis controlling for cigarette smoking alone yielded similar results.

      Conclusions

      Use of e-cigarettes is an independent risk factor for respiratory disease in addition to combustible tobacco smoking. Dual use, the most common use pattern, is riskier than using either product alone.
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