Abstract
INTRODUCTIONFlavors other than tobacco flavor have been identified as a major reason for electronic nicotine delivery system (ENDS) initiation in youth and are thought to contribute to the continued use of ENDS in users of all ages. Our previous research showed a significant association between overall ENDS use and COPD. This study aims to identify the association of ENDS flavor categories with self-reported COPD.METHODSThe data analysis included 4909 adults from Population Assessment of Tobacco and Health (PATH) Wave 4 data who were ever established ENDS users and responded to an item about diagnosis of COPD. Weighted multivariable logistic regression models were used to examine the association between different ENDS flavors and self-reported COPD considering complex sampling design.RESULTSAmong 4909 ever established ENDS users, 418 adults (weighted percentage 9.8%) had self-reported COPD. Self-reported COPD prevalence differed between different ENDS flavor categories, with the highest (weighted percentage 19.9%) occurring among tobacco flavor users. Compared to non-tobacco flavor categories, tobacco flavor category showed significantly higher association with self-reported COPD (AOR=2.05; 95% CI: 1.20–3.53), after adjusting for potential confounding variables. No significant associations with self-reported COPD were found for other examined ENDS flavor categories including menthol/mint, fruit, candy/ desserts/other-sweets, and other flavors, compared to their corresponding non-users.CONCLUSIONSTobacco flavored ENDS use was significantly associated with self-reported COPD. Future studies are needed to confirm the biological and epidemiological association of flavored ENDS use with COPD.
Highlights
Flavors other than tobacco flavor have been identified as a major reason for electronic nicotine delivery system (ENDS) initiation in youth and are thought to contribute to the continued use of ENDS in users of all ages
This study aims to identify the association of ENDS flavor categories with self-reported chronic obstructive pulmonary disease (COPD) by analyzing the Population Assessment of Tobacco and Health (PATH) Study Wave 4 data
Among these ENDS users, 20.6% reported tobacco flavor use, 21.6% reported menthol/mint flavor use, 45.0% reported fruit flavor use, 30.7% reported candy/deserts/sweets flavor use, and 13.6% reported other flavors use
Summary
Flavors other than tobacco flavor have been identified as a major reason for electronic nicotine delivery system (ENDS) initiation in youth and are thought to contribute to the continued use of ENDS in users of all ages. This study aims to identify the association of ENDS flavor categories with self-reported COPD. Flavors other than tobacco have been identified as a major reason for ENDS initiation in youth and are thought to contribute to the continued use in users of all ages[3,4]. The recent multi-state outbreak of ‘e-cigarette or vaping product use-associated lung injury (EVALI)’ involved more than 2600 cases (as of January 2020) and raised national concern about the acute harmful effects of ENDS12. According to the US Centers for Disease Control and Prevention (CDC), tetrahydrocannabinol (THC, the psychoactive ingredient in cannabis or marijuana) delivered with Vitamin E acetate in ENDS has been linked to many of the EVALI documented cases[13]
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