E-cigarette use linked to asthma among adolescents with no other smoking history
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Key takeaways:
- E-cigarette use was linked to asthma among youth with no previous combustible product use across the U.S.
- Male sex, previous combustible and substance use, and depression were associated with e-cigarette use.
Vaping increased the risk for asthma among adolescents in Texas and across the United States who had never smoked conventional tobacco products, according to a study published in Preventive Medicine.
These findings highlight the need for public health strategies to tackle increases in e-cigarette use among adolescents, Taehyun Roh, PhD, assistant professor in the department of epidemiology and biostatistics at the School of Public Health of Texas A&M University, and colleagues wrote.
“There has been a significant increase in vaping among middle and high school students in the U.S., prompting our interest in exploring its health impacts, including its association with conditions such as asthma,” Roh told Healio.
Roh also said that the investigation was particularly relevant due to the extensive, 12-year research in asthma conducted by coauthor Genny Carrillo, MD, ScD, MPH, director of the Program on Asthma and Research Education and associate professor in the department of environmental and occupational health at the School of Public Health of Texas A&M University.
Study design, results
The researchers examined data from 3,042 adolescents in Texas and 32,885 adolescents in the United States, aged 13 to 17 years, collected between 2015 and 2019 as part of the CDC’s Youth Risk Behavior Surveillance System (YRBSS).
Among other questions, the YRBSS asked participants if they have ever used an electronic vapor product, how many days out of the previous 30 included electronic vapor product use, and if a doctor or nurse has ever told them that they have asthma.
In the Texas cohort, 44% of adolescents (n = 1,304; 44.6% girls; mean age, 15.9 years) reported ever e-cigarette use, and 13.4% (n = 323; 14.9% girls; mean age, 15.9 years) reported current e-cigarette use.
Analyses adjusted for covariates showed Hispanic adolescents had lower odds for ever (adjusted OR = 0.61; 95% CI, 0.52-0.72) and current (aOR = 0.36; 95% CI, 0.22-0.58) e-cigarette use compared with white adolescents in Texas, with Black adolescents also showing less current use (aOR = 0.33; 95% CI, 0.19-0.6).
Also, ever e-cigarette use among adolescents in Texas was significantly associated with older age (aOR = 1.1; 95% CI, 1.02-1.19), combustible substance use (aOR = 6.45; 95% CI, 4.66-8.93), other substance use (aOR = 2.96; 95% CI, 2.38) and depression (aOR = 1.52; 95% CI, 1.21-1.91), with previous use of combustible products (aOR = 8.91; 95% CI, 5.84-13.6) and other substances (aOR = 6.19; 95% CI, 4.57-8.37) also linked to current use. Current e-cigarette used appeared less common among male adolescents (aOR = 0.66; 95% CI, 0.53-0.83).
From the U.S. cohort, 60.6% (n = 19,893; 60.4% girls; mean age, 15.8 years) reported ever e-cigarette use, and 17.2% (n = 5,390; 16.5% girls; mean age, 15.9 years) reported current e-cigarette use.
Significantly higher odds for ever use in the United States were associated with male sex (aOR = 1.19; 95% CI, 1.07-1.32), previous use of combustible smoking products (aOR = 14.1; 95% CI, 11.3-17.7) or other substances (aOR = 1.3; 95% CI, 1.05-1.61), and depression (aOR = 2.12.; 95% CI, 1.8-2.49). Obesity was associated with significantly lower odds for ever use (aOR = 0.86; 95% CI, 0.76-0.98).
Also, there were significantly higher odds for current use among older adolescents (aOR = 1.09; 95% CI, 1-1.15) as well as among adolescents who were overweight (aOR = 1.28; 95% CI, 1.1-1.49) and who had previously used combustible products (aOR = 3.92; 95% CI, 3.1-4.97) and other substances (aOR = 3.09; 95% CI, 2.63-3.64). Ever use appeared less likely among Black (aOR = 0.43; 95% CI, 0.34-0.54) and Hispanic (aOR = 0.56; 95% CI, 0.41-0.77) adolescents compared with white adolescents.
The YRBSS data also indicated that 23.5% of adolescents from the U.S. cohort and 23% from the Texas cohort had been diagnosed with asthma. Although ever e-cigarette use was significantly associated with asthma among Texas adolescents (aOR = 1.25; 95% CI, 1.01-1.55), the trend did not persist in the U.S. cohort (aOR = 0.99; 95% CI, 0.9-1.1).
When the researchers stratified analysis by previous combustible use, they found no association between e-cigarette use and asthma among adolescents who had previously used combustible products in the U.S. (aOR = 0.9; 95% CI, 0.78-1.04) and Texas (aOR = 1.08; 95% CI, 0.73-1.61) cohorts.
However, among adolescents who had never used combustible products, there were significant positive relationships between e-cigarette use and asthma in Texas (aOR = 1.32; 95% CI, 1.06-1.66) and in the United States (aOR = 1.18; 95% CI, 1.02-1.37).
Conclusions, next steps
“The study identified an association between e-cigarette use and asthma in adolescents who had never smoked conventional tobacco products,” Roh said. “This demonstrates that e-cigarette use increases the risk of asthma independently from conventional tobacco product use in adolescents.”
Based on these findings, the researchers called for further research into the cultural protective factors associated with the reduced use of e-cigarettes among Hispanic youth, the relationship between body weight and e-cigarette use, and causality between these associations.
For now, the researchers continued, these findings may inform more targeted public health interventions focused on reducing the use of e-cigarettes and, subsequently, the burden of asthma.
These interventions may include raising awareness, stricter regulations and alternative coping mechanisms for mental health, the researchers wrote, with increased knowledge about the negative impacts of e-cigarette use enabling individuals to make informed decisions and discourage adolescents from initiating or continuing their use.
“Individually, physicians can educate their patients, but as members of the American Medical Association, they can also lobby Congress,” Roh said.
For example, Roh said, physicians can call on Congress to ban vaping in all public places, prevent the proliferation of vape flavors that appeal to minors and young adults, and launch extensive public awareness campaigns highlighting the significant health risks associated with vaping, both for the individuals who vape and for those exposed to secondhand vaping.
Meanwhile, the researchers are continuing their work with a pilot study on a vaping prevention intervention at the Texas A&M main campus to identify students’ beliefs and knowledge regarding vaping.
“Our objective is to enhance their intention to quit vaping or dissuade them from starting,” Roh said. “We intend to submit an NIH proposal to expand our intervention study to the entire campus.”
Reference:
- Researchers find association between vaping and asthma among US adolescents. https://today.tamu.edu/2023/09/18/researchers-find-association-between-vaping-and-asthma-among-us-adolescents/. Published Sept. 18, 2023. Accessed Sept. 19, 2023.
For more information:
Taehyun Roh, PhD, can be reached at taehyunroh@exchange.tamu.edu.
Perspective
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It is critical for health care providers to see vaping for what it is — an epidemic that has introduced a new generation to nicotine and nicotine addiction. Youth vaping is a serious health issue. There are overwhelming data that vaping leads to an increase in asthma diagnosis and, for those with existing asthma, increased exacerbations, emergent and urgent care visits and an increase in medication use such as oral corticosteroids.
The study showed that vaping was significantly associated with asthma in youth who had never smoked cigarettes, clearly linking vaping with asthma independent of other tobacco products.
In the past 10 years, vaping has increased among all age groups and is now more popular than traditional cigarettes among middle school and high school students. In the 2019 CDC National Youth Tobacco Survey, 28% of high school students and 11% of middle school students reported using e-cigarettes in the previous 30 days. That amounts to more than 5 million young people vaping in the month preceding this survey. Of those, 1.6 million vaped more than 20 times during this period.
We also need to have a consistent message for all our patients — vaping is never safe. In addition to aerosolized lung-toxic compounds such as solvents, flavorings, carbonyl compounds and nitrosamines, vaping introduces the lungs to heavy metals such as chromium, nickel and lead, which can result in neurotoxicity and cardiovascular disease in addition to effects on asthma.
Medical providers need to encourage parents to keep the lines of communication open with their teens and pre-teens. It can be difficult to bring up sensitive topics, but we know that young people do listen to parents and health care providers.
When parents have open discussions about the dangers of all forms of nicotine, vaping declines. The American Lung Association has a wonderful program called “Do the Vape Talk” that provides resources for parents to help facilitate communication.
Another important talking point for health professionals to remember is that no tobacco product is “approved” by the FDA. As of late 2021, the FDA did allow vaping products to be sold in the U.S., but this does not imply that these are safe. The FDA statement of vaping notes that “All tobacco products are potentially harmful and addictive and those who do not use tobacco products should continue not to.”
References:
FDA permits sale of IQOS Tobacco Heating System through premarket tobacco product application pathway. Available at: https://www.fda.gov/news-events/press-announcements/fda-permits-sale-iqos-tobacco-heating-system-through-premarket-tobacco-product-application-pathway. Published April 30, 2019. Accessed Oct. 4, 2023.
Wang TW, et al. MMWR Surveill Summ. 2019;doi: 10.15585/mmwr.ss6812a1.
Perspective
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The findings are not surprising, because I see more and more youth vaping out in public, and the e-cigarette companies do a lot of advertising targeting youth. I always ask any of my patients aged older than 12 years about cigarette or vaping use. They always respond no, but I think it is because of the parent being in the room.
E-cigarette use among adolescents is an epidemic that is only going to get worse with time. The e-cigarette companies are after a new market, and it is our adolescents. E-cigarette use is dangerous because of the different chemicals and metals associated with vaping. It also is dangerous because of the risk for asthma and because studies show that e-cigarettes will lead to future cigarette smoking and nicotine dependence among the youth.
We can make adolescents aware of the dangers associated with e-cigarette use and how it can progress to long-term nicotine dependence. We also need to ask about depression because so many e-cigarette users suffer from it.
Several policy actions can be taken to reduce youth e-cigarette use. First, the FDA must finalize its review of all premarket tobacco products. The FDA and Department of Justice must also act to remove all illegal tobacco products from the marketplace.
In March 2022, Congress closed the Puff Bar loophole when it passed a law requiring the FDA to regulate tobacco products made with synthetic nicotine. As a result, all synthetic nicotine products on the market, such as Puff Bar, are now illegal, yet they are still being sold in the U.S.
In addition, the Biden administration must swiftly finalize two rules that will remove all menthol cigarettes and flavored cigars from the marketplace.
Lastly, Congress must increase federal funding for the CDC’s Office on Smoking and Health to help states combat the youth e-cigarette epidemic.
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