ENDS, Cigarettes, and Respiratory Illness: Longitudinal Associations Among U.S. Youth

Abstract

Introduction: Electronic nicotine delivery system (ENDS) use is highly prevalent among U.S. youth, and there is concern about its respiratory health effects. However, evidence from nationally representative longitudinal data is limited. MethodsUsing youth data (ages 12-17) from waves 1-5 (2013-2019) of the Population Assessment of Tobacco and Health (PATH) Study, multilevel Poisson regression models were estimated to examine the association between ENDS use, cigarettes, and diagnosed bronchitis, pneumonia, or chronic cough. Current product use was lagged by one wave and categorized as: (a) never/non-current use; (b) exclusive cigarette use; (c) exclusive ENDS use; and (d) dual ENDS/cigarette use. Multivariable models adjusted for age, sex, race and ethnicity, parental educational, asthma, body mass index, cannabis use, secondhand smoke exposure, and household use of combustible products. Data analysis was conducted in 2022–2023. Results7.4% of respondents were diagnosed with bronchitis, pneumonia, or chronic cough at follow-up. In the multivariable model, exclusive cigarette use (IRR = 1.85; 95% CI 1.29-2.65), exclusive ENDS use (IRR = 1.49; 95% CI 1.06-2.08), and dual use (IRR = 2.70, 95% CI 1.61-3.50) were associated with a higher risk of diagnosed bronchitis, pneumonia, or chronic cough, compared to never/non-current use. ConclusionsThese results suggest that ENDS and cigarettes, used exclusively or jointly, increased the risk of diagnosed bronchitis, pneumonia, or chronic cough among U.S. youth. However, dual use was associated with the highest risk. Targeted policies aimed at continuing to reduce cigarette smoking and ENDS use among youth, especially among those with dual use, are needed.