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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Article info
Publication history
Published online: December 16, 2019
Identification
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© 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
