Electronic Nicotine Delivery Systems Users Research Articles

Effectiveness of ENDS, NRT and medication for smoking cessation among cigarette-only users: a longitudinal analysis of PATH Study wave 3 (2015–2016) and 4 (2016–2017), adult data

BackgroundResearch is inconclusive on the effectiveness of electronic nicotine delivery systems (ENDS) as cigarette cessation aids compared with nicotine replacement therapy (NRT) or non-NRT medication. This study compared the cigarette...

An association between electronic nicotine delivery systems use and a history of stroke using the 2016 behavioral risk factor surveillance system.

Electronic nicotine delivery systems (ENDS) are growing in use and many of the health implications with these devices remain unknown. This study aims to assess, using a survey representative of the USA general population, if an association exists between a history of ENDS use and a history of stroke.This cross-sectional study was a secondary data analysis using the 2016 behavioral risk factor surveillance system survey. The main exposure variable of the study was a self-reported history of ENDS use. The main outcome was a self-reported history of stroke. Covariates included sex, race, traditional cigarette use, smokeless tobacco use, chronic kidney disease, diabetes, myocardial infarction, and coronary artery disease. Unadjusted and adjusted logistic regression analyses were done. Adjusted odds ratios (AOR) and their corresponding 95% confidence intervals (CI) were calculated.Of the 486,303 total behavioral risk factor surveillance system survey participants, 465,594 met the inclusion criteria for this study of ENDS use and stroke. This study shows that current ENDS use was positively associated with a history of stroke. AOR of some daily ENDS use with stroke was 1.28 (95% CI: 1.02–1.61) and AOR of current daily ENDS use with stroke was 1.62 (95% CI: 1.18–2.31). The majority (55.9%) of current daily ENDS users reported former traditional cigarette smoking. Female sex, non-white ethnicity, elderly age, chronic kidney disease, coronary artery disease, diabetes, and traditional cigarette use characteristics were all also associated with increased odds of reporting a stroke.This study found a statistically significant and positive association between ENDS use and a history of stroke. Further research is warranted to investigate the reproducibility and temporality of this association. Nevertheless, this study contributes to the growing body of knowledge about the potential cardiovascular concerns related to ENDS use and the need for large cohort studies.

Factors associated with past-year attempts to quit e-cigarettes among current users: Findings from the Population Assessment of Tobacco and Health Wave 4 (2017–2018)

Over 10 million adults report use of electronic nicotine delivery systems (ENDS), with approximately 3.6 million reporting daily use. Even as the popularity of ENDS has increased, both as an available nicotine delivery system and an alternative to combustible cigarette smoking, few studies to date have examined ENDS cessation interest and related behaviors among ENDS users. The current study aimed to describe past year attempts to quit ENDS among current users and to investigate ENDS use / user characteristics associated with unsuccessful attempts to quit in the past year among adult, current, established ENDS users using data from the Population Assessment of Tobacco and Health (PATH) Study Wave 4. Over 10 % of ENDS users reported an attempt to quit completely in the past year, and 60 % indicated future intention to quit completely. Higher nicotine dependence, lower-frequency ENDS use, and higher interest in quitting were associated with past year attempts to quit ENDS. The current study adds support to claims that many ENDS users plan to quit using ENDS someday and highlights the need for continued research on ENDS cessation.

Psychological and Demographic Predictors of Vaping and Vaping Susceptibility in Young Adults.

BackgroundThe use of electronic nicotine delivery systems (ENDS), also known as vaping, is becoming popular among young adults. Few studies have explored the psychological factors that predict ENDS use and susceptibility in young adults, in addition to known demographic predictors.MethodIn a cross-sectional survey design, 521 young adults (37% male), ages 18–25 from the United States, were recruited via Amazon’s Mechanical Turk (MTurk) in 2019, to answer an online survey measuring demographic characteristics and psychological characteristics related to mental health and the Big Five personality traits. The survey also included measures of ENDS ever-use, current use, and susceptibility (never users open to trying ENDS), which we predicted from the demographic and psychological measures using independent and multiple binary logistic regression analyses.ResultsOf those surveyed (n = 521), 282 (54.1%) were ENDS ever-users, 93 (17.9%) were current ENDS users, and 61 (11.7%) were ENDS susceptible; 62 (11.9%) were current smokers. Demographically, young adults lower in adulthood socioeconomic-status (SES), not pursuing education further than high school, and current smokers were more likely to be ENDS users. Psychologically, young adults higher in anxiety and lower in conscientiousness more likely to have ever-used ENDS. Lower conscientiousness further predicted current ENDS use and ENDS susceptibility.ConclusionIn this sample of MTurk workers, young adults with experience in vaping were more demographically and psychologically vulnerable than young adults with no experience in vaping. Young adults interested in vaping, but without prior experience, were less conscientious than their non-interested peers. Interventions to target vaping use should focus on economically disadvantaged young adults and those lower in conscientiousness.

Identification of newly formed toxic chemicals in E-cigarette aerosols with Orbitrap mass spectrometry and implications on E-cigarette control.

The increasing use of electronic nicotine delivery systems (ENDS) is of concern due to multiple emerging adverse health effects. Most analyses of the harmful chemicals of ENDS have targeted metals or carbonyls generated by thermal decomposition of carrier liquids such as propylene glycol. However, new complex compounds not routinely identified and with unknown health consequences could be formed. ENDS aerosol samples were collected by the direct aerosol droplet deposition method. Untargeted analysis was performed using Orbitrap mass spectrometry with high mass accuracy. We identified more than 30 "features" in the aerosol characterized by pairs of the mass-to-charge ratio "m/z" of the compound and the retention time. We identified several compounds containing nicotine and propylene glycol (NIC-PG), whose abundance relative to nicotine increased along with vaping power used. On the basis of the prediction by the Environmental Protection Agency Toxicity Estimation Software Tool, these compounds exert developmental toxicity. In addition, a nitrogen-containing compound, likely tributylamine (a known lung irritant), was identified based on the molecular weight. This compound has not been previously identified in ENDS e-liquids and aerosols. ENDS produce not only small toxic compounds such as aldehydes, but also large complex toxic compounds such as NIC-PG. Predicted development toxicity for NIC-PG is concerning for fetal development in pregnant women who use ENDS, children exposed to secondhand or thirdhand ENDS aerosols, and teenage ENDS users whose brains are still developing. The strong positive association between NIC-PG levels and ENDS power output supports regulating high-powered ENDS.

Electronic nicotine delivery systems (ENDS) cue reactivity in dual users: A combined analysis

BackgroundCigarette smokers report increases in smoking urge in response to exposure to electronic nicotine delivery systems (ENDS) and dual users, i.e. smokers who also vape ENDS, may exhibit greater cue reactivity than exclusive smokers. The current investigation examined reactivity to a variety of ENDS cues across a large sample of cigarette smokers and dual ENDS users. MethodsYoung adult smokers (N = 345; >5 cigarettes per day) were recruited between 2013–2019 for participation in a series of within-subjects laboratory-based studies. Participants completed surveys before and after exposure to a confederate-delivered control cue (water) and an active cue, including cigarette or ENDS cues ranging from first generation “cigalikes” to a fourth generation “pod-mod”. Main outcomes were post-cue changes in desire for combustible cigarettes and e-cigarettes, and smoking behavior as determined by the smoking latency portion of the Smoking Lapse Paradigm after cue exposure. ResultsRelative to smokers who do not use ENDS, dual users demonstrated higher baseline desire for ENDS and greater ENDS cue reactivity (across product types) in terms of post-cue increases in smoking urge and shorter latency to smoking choice. In contrast, reactivity to the cigarette cue was similar across groups. ConclusionsDual users show heightened ENDS cue reactivity on smoking urge and behavior relative to never users of ENDS, regardless of the type of ENDS cue. Given their reactivity to both cigarette and ENDS cues, it may be difficult for dual users to transition to exclusive vaping or quit tobacco product use altogether.

Cannabis use and electronic cigarette use: The role of dual use on use frequency and related problems

Despite high rates of use of both cannabis and electronic nicotine delivery systems (ENDS), little is known about the role of cannabis use among ENDS users and of ENDS use among cannabis users. This study tested whether dual use was related to more frequent use, use-related problems, and negative affect. Among cannabis users (n=315), ENDS was associated with more frequent cannabis use, cannabis-related problems, anxiety, and depression. Among ENDS users (n=156), cannabis was associated with more frequent ENDS use, ENDS-related problems, and anxiety. Overall, ENDS use is common among cannabis users and cannabis use is common among ENDS users. Further, use of both of these substances is related to more use, use-related problems, and negative affect, especially anxiety.

The Influence of Friends on Teen Vaping: A Mixed-Methods Approach.

Vaping is popular among adolescents. Previous research has explored sources of information and influence on youth vaping, including marketing, ads, family, peers, social media, and the internet. This research endeavors to expand understanding of peer influence. Our hypothesis is that friends’ influence on teen vapers’ first electronic nicotine delivery systems (ENDS) use varies by demographic variables and awareness of ENDS advertising. In August–October 2017, youth (n = 3174) aged 13–18 completed an online survey to quantify ENDS behaviors and attitudes and were invited to participate in follow-up online research in November-December 2017 to probe qualitative context around perceptions and motivations (n = 76). This analysis focused on the ENDS users, defined as having ever tried any ENDS product, from the survey (n = 1549) and the follow-up research (n = 39). Among survey respondents, friends were the most common source of vapers’ first ENDS product (60%). Most survey respondents tried their first ENDS product while “hanging out with friends” (54%). Among follow-up research participants, the theme of socializing was also prominent. ENDS advertising and marketing through social media had a strong association with friend networks; in fact, the odds of friends as source of the first vaping experience were 2 times higher for those who had seen ENDS ads on social media compared with other types of media. The influence of friends is particularly evident among non-Hispanic Whites, Hispanics/Latinos, those living in urban areas, those living in high-income households, those with higher self-esteem, and those who experiment with vaping. These findings support the premise that peer influence is a primary social influencer and reinforcer for vaping. Being included in a popular activity appears to be a strong driving force.

Respiratory and Cardiovascular Health Effects of e-Cigarette Substitution: Protocol for Two Living Systematic Reviews.

BackgroundDespite the clear risks of tobacco use, millions of people continue to smoke. Electronic nicotine delivery systems (ENDS), commonly called e-cigarettes, have been proposed as a substitute for those who are unwilling or unable to quit. Current systematic and narrative reviews on the health effects of ENDS use, particularly respiratory and cardiovascular effects, have come to differing conclusions.ObjectiveWe conducted two systematic reviews to critically assess and synthesize available human studies on the respiratory and cardiovascular health effects of ENDS substitution for people who smoke. The primary goal is to provide clinicians with evidence on the health effects of ENDS substitution to inform their treatment recommendations and plans. The twin goal of the reviews is to promote health literacy in ENDS users with facts on the health effects of ENDS.MethodsThese two reviews will be living systematic reviews. The systematic reviews will be initiated through a baseline review. Studies will be evaluated using the JBI quality assessment tools and a checklist of biases drawn from the Centre for Evidence Based Medicine Catalogue of Bias. A narrative synthesis is planned because of the heterogeneity of data. A search for recently published studies will be conducted every 3 months, and an updated review will be published every 6 months for the duration of the project or possibly longer.ResultsThe baseline and updated reviews will be published in a peer-reviewed journal. The findings of the reviews will be reported in a white paper for clinicians and a fact sheet for people who use ENDS.ConclusionsThe substitution of ENDS for cigarettes is one way to potentially reduce the risks of smoking. Clinicians and their patients need to understand the potential benefits and possible risks of substituting ENDS for cigarettes. Our living systematic reviews seek to highlight the best and most up-to-date evidence in this highly contentious and fast-moving field of research.Trial RegistrationPROSPERO CRD42021239094; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=239094International Registered Report Identifier (IRRID)DERR1-10.2196/29084

Associations between electronic nicotine delivery systems and birth outcomes

Objectives Nicotine crosses the placenta and is a known teratogen. The use of electronic nicotine delivery systems (ENDS) has increased among pregnant women in the US, but there is limited knowledge about their effects on birth outcomes. We examined the associations between ENDS and cigarette use during pregnancy with birth outcomes. Methods We conducted a cross-sectional analysis of 57,046 respondents from 32 US states in the 2016–2017 Pregnancy Risk Assessment Monitoring System. Respondents self-reported use of ENDS and cigarettes during the last 3 months of pregnancy; this was linked with birth outcomes documented on the birth certificate, including birth weight, gestational age, small-for-gestational age, and preterm birth. Results During the last 3 months of pregnancy, 0.5% of women used ENDS only, 0.8% were dual users of ENDS and cigarettes, and 8.0% used cigarettes only. In adjusted models, infants of women who used ENDS only weighed 57.8 grams less (95% CI −134.2, 18.6; p = .14) and were born 0.21 weeks earlier (95% CI −0.45, 0.03; p = .09) than infants of non-users. Infants born to dual users were 193.9 grams less (95% CI −274.9, −112.8; p < .01) and had a 1.93 higher odds of being born small-for-gestational age (95% CI 1.31, 2.83; p < .01) than infants of non-users. Conclusions Our results provide some indication that prenatal ENDS use may adversely affect birth outcomes by reducing birth weight and gestational age. Estimates were imprecise, suggesting that larger samples of ENDS users with more detailed information about patterns of use are needed.

Use of Electronic Nicotine Delivery Systems (ENDS) in Colombia

Background and Aims: The use of Electronic Nicotine Delivery Systems (ENDS) in Colombia is a new phenomenon. However, there has been an increase in recent years and without any apparent explanation, is necessary to understand the characteristics of the use of ENDS in Colombia. Methods: This research is a secondary analysis study based on data from the 2020 National Study of Psychoactive Substance Use in the Colombian territory, which uses a household survey methodology. The study sample includes 49,756 people (48.3% male, 51.8% female), between 12 and 65 years old, distributed in the 32 departments of the country. Results: Five percent of Colombians between 12 and 65 years of age have used ENDS at some time in their life (67.8% male). The 12- to 17-year-old group started at 14.6 years average and exists a higher proportion of tobacco smokers among ENDS users in all prevalence. Conclusions: The use of ENDS is growing probably because of new marketing strategies that involve novel details and that generate curiosity, especially in the youngest. Some of these are technological designs, pleasant smells and flavors or absence of them and how easy it can be to hide them and consume them in places where it is forbidden to do. So, many young people and adolescents who had not used nicotine before, now do. There is a knowledge gap about ENDS, therefore they can affect the work has been done for decades in reducing nicotine consumption among young people and be the gateway to the consumption of cigarettes or other substances (marijuana).

Longitudinal Examination of Prenatal Tobacco Switching Behaviors and Birth Outcomes, Including Electronic Nicotine Delivery System (ENDS) and Dual Use.

In the US, approximately 8% of pregnant women smoke, and 5-11.9% currently use ENDS products. The health effects of ENDS use are debated; however, most contain nicotine which is known to cause adverse perinatal outcomes. Studies have shown adult ENDS users significantly alter use behaviors over time (switch to conventional cigarettes-only or dual use) thus complicating efforts to examine health effects of ENDS use. The purpose of this study was to describe switching behaviors and associated birth outcomes among infants of women using conventional cigarettes only, ENDS-only, or both. This was a multisite, longitudinal study of biologically confirmed perinatal tobacco users, with nicotine product use assessed each trimester. For the purpose of analysis, participants were defined as switchers, no-switchers, or quitters. Birth outcomes were abstracted from electronic medical records. Analysis included descriptive statistics, linear and multivariate logistic regression adjusted for age, preterm birth, smoking behavior in the first trimester, and an interaction between smoking switching behavior and smoking behavior in the first trimester. Analysis was conducted using SAS v9.4 with significance determined as p < 0.05. At enrollment, 48.6% of participants used only conventional cigarettes, 41.7% were dual users, and 10% used ENDS-only. While almost two-thirds of participants used the same tobacco product throughout pregnancy, 26% reported switching behaviors that were complex and not easily clustered. No differences were found in birth outcomes between switchers and no-switchers; however, a difference emerged in birth weight between no-switchers and quitters. Given the limited data on health effects of ENDS use, and the known harmful consequences of perinatal nicotine use, capturing and classifying product switching behaviors is imperative to inform public health, and remains a challenge requiring further research.

Acute Exposure to E‐Cigarette Vapor Promotes Neutrophil‐Platelet Aggregation in Murine Pulmonary Microvasculature

More than 1 in 4 high school students use electronic nicotine delivery systems (ENDS) in the United States, with usage rising over 130% since 2017. It is well known that smoking can cause cardiovascular disease and thrombosis; however, few studies have investigated the adverse effects of ENDS use on the cardiovascular system, especially in the lungs. Neutrophils and platelets are known to undergo activation and proinflammatory phenotypic changes when exposed to ENDS vapor, and their aggregation could promote vascular occlusion and further inflammation. We hypothesize that platelet and neutrophil recruitment will be increased in mice exposed to ENDS vapor, and that higher rates of aggregate formation will be observed in the pulmonary vasculature of these subjects. To investigate lung vascular pathology following ENDS use, we have applied an innovative spinning disk confocal microscopy approach to visualize real-time interactions of blood cells in the lungs of live mice. Identifying the presence of platelet-neutrophil aggregates in the lung due to ENDS vapor exposure would suggest that ENDS users may be at higher risk of atherosclerotic and thrombotic complications that with chronic use could eventually result in respiratory disease. Mice were subjected to 3 consecutive days of ENDS vapor inhalation using a Juul device with Virginia Classic Tobacco e-liquid (5% nicotine) for 3 hours each day. Mice subjected to room air sham inhalation constituted the control group. 24 hours after completion of the inhalation course, mice were anesthetized to facilitate microsurgery enabling fluorescence microscopy of the living lung. Neutrophils and platelets were labeled with fluorescently tagged antibodies to compare overall presence and aggregation within the lung microvasculature (Fig. 1). Preliminary data suggest significant (p<0.01) increases (Fig. 2) in platelet (2.59-fold), neutrophil (2.06-fold), and platelet-neutrophil aggregate (2.02-fold) presence in mice exposed to ENDS vapor compared to untreated mice. Collectively, this illustrates that ENDS vapor induces a pro-inflammatory state in the pulmonary vasculature in as little as one day after limited exposure. These findings will prove useful in future studies seeking to model the consequences of long-term ENDS use, which will ultimately enhance both clinician monitoring of patients at risk of such complications and public awareness of the potential consequences of ENDS use.

Variations in Electronic Nicotine Delivery System (ENDS) device types and association with cigarette quit attempts

This study examined electronic nicotine delivery systems (ENDS) devices classified as disposable, non-refillable cartridge, refillable cartridge, refillable tank, and refillable mod systems and examined if cigarette quit attempts varied by device type among daily and non-daily ENDS users. Data from Wave 3 (2015–16) of the Population Assessment of Tobacco and Health Study, a nationally representative study in the U.S. was used to explore ENDS device types among past 12 month adult cigarette and ENDS users (n = 4952). Multivariate models were fitted to predict cigarette quit attempts among daily (n = 474) and nondaily (n = 1074) ENDS users by ENDS device types. Analyses were conducted in April 2020.Refillable tank system (38.5%) was the most prevalent and refillable cartridge was the least prevalent (3.3%) device type among past 12 month cigarette and ENDS users. Adults who used disposable ENDS were least likely to use ENDS as “an alternative to quitting all tobacco” (p < 0.001) or “as a way of cutting down on smoking” (p < 0.001). The odds of attempting to quit smoking were higher among daily ENDS users who used non-refillable cartridge (AOR = 7.3, 95% CI: 1.5–34.9), refillable tank (AOR = 5.3, 95% CI: 1.5–19.3) or refillable mod systems (AOR = 5.9, 95% CI: 1.2–30.1) compared to those who used disposables adjusting for age group, gender, race, ethnicity, and nicotine dependence. The likelihood of quit attempt among non-daily ENDS users did not differ by device type. Better understanding of ENDS device types and their use in smoking cessation is needed to inform health interventions.

Use of electronic nicotine delivery systems (ENDS) among U.S. women of reproductive age: Prevalence, reported reasons for use, and toxin exposure

Given the rapidly expanding marketplace for Electronic Nicotine Delivery Systems (ENDS), it is important to monitor patterns of use, particularly among vulnerable populations. This study examined ENDS prevalence, reasons for use (i.e., to help quit smoking and for appealing flavors), and toxin exposure among U.S. women of reproductive age using data from the Population Assessment of Tobacco and Health (PATH) Study (2013–17). Exclusive ENDS users, dual users of ENDS and cigarettes, and exclusive cigarette smokers were compared within and between pregnant and not-pregnant women. Among pregnant women, prevalence of exclusive ENDS and dual use was similar (0.8%; 95%CI = 0.4–1.2% vs. 1.4%; 95%CI = 0.9–2.0%, respectively), but exclusive ENDS use was less prevalent than dual use among not-pregnant women (1.1%; 95%CI = 0.9–1.4% vs. 3.7%; 95%CI = 3.3–4.0%, respectively). Most women reported ENDs were used to help quit smoking (66.5–90.0%) and for appealing flavors (57.6–87.4%), and endorsement rates did not differ by use pattern or pregnancy status. Except for metals, toxin exposure was substantially lower for exclusive ENDS users relative to dual users and exclusive cigarette smokers regardless of pregnancy status. Pregnant and not-pregnant U.S. women regularly report using ENDS for help with quitting smoking and for appealing flavors. Although no type or pattern of tobacco/nicotine use is safe, especially during pregnancy, using ENDS exclusively is consistent with lower overall toxin exposure for pregnant and not-pregnant women. This study advances understanding of ENDS use and toxin exposure in women of reproductive age, a population highly vulnerable to the effects of nicotine/tobacco consumption.

Multi-level drivers of tobacco use and purchasing behaviors during COVID-19 "lockdown": A qualitative study in the United States.

BackgroundThe COVID-19 pandemic and associated public health prevention measures (e.g., “stay at home” orders) may impact tobacco supply and demand among consumers. This qualitative study identified multi-level drivers of shifts in inhaled tobacco product use and access patterns during the initial COVID-19 “lockdown” period in the United States.MethodsBetween April and May 2020, we conducted semi-structured telephone interviews (n = 44) with adults who use cigarettes and/or electronic nicotine delivery systems (ENDS). Transcripts were thematically analyzed using a socioecological framework.ResultsNearly all participants reported changes in their product use during lockdown, though patterns varied. Increased use was most common and was predominantly driven by individual-level factors: pandemic-related anxiety, boredom, and irregular routines. Decreased use was common among social users who cited fewer interpersonal interactions and fear of sharing products. At the community level, retail access impacted cigarette and ENDS use differently. While cigarettes were universally accessible, ENDS access was more limited, driving some to purchase products online. Delayed deliveries led some ENDS users to compensate with readily-available cigarettes.ConclusionTo mitigate ways that the COVID-19 pandemic may exacerbate an existing public health crisis, multi-level policy strategies, such as expanded virtual cessation services and implementation and enforcement of smoke-free home rules, can better support population health during this critical period. Policies that facilitate access to lower risk products can help minimize harm among those who cannot or do not want to quit smoking.

Combatting the Epidemic of E-cigarette Use and Vaping among Students and Transitional-age Youth

Background: Over the past decade, the use of electronic nicotine delivery system (ENDS) devices such as e-cigarettes has increased dramatically, particularly among students and other transitional- age youth. Societal norms and the variety of ENDS devices available have also evolved dramatically in recent years. Objective: This article provides a comprehensive review and synthesis of contemporary literature, as it relates to ENDS use among transitional-age youth. Methods: Over 125 peer-reviewed studies, literature syntheses, legal reports and contemporary media works focused on ENDS use and vaping were reviewed. Results: Marketing strategies for ENDS devices have primarily targeted teens and young adults. Though ENDS devices are advertised as a safer alternative to cigarettes, accumulating data demonstrate significant health risks and consequences associated with use. The long-term health effects remain largely unknown; however, detrimental acute effects are apparent. Furthermore, rather than aiding in tobacco cessation efforts, the use of ENDS by transitional-age youth is correlated with the increased use of conventional tobacco products and other substances of abuse. Students appear to be ill-informed regarding the dangers of using ENDS products. Conclusion: Given the rapid increase in ENDS users each year, and accumulating concerns about health risks associated with use, university student health services must be prepared to address this growing problem. As clinical practice guidelines do not yet exist to encourage ENDS-product cessation, the use of the evidence-based strategies developed for tobacco cessation is advised. More research is needed to determine the most effective methods to prevent the initiation of ENDS use within this population.

Cross-Sectional Association Between Exclusive and Concurrent Use of Cigarettes, ENDS, and Cigars, the Three Most Popular Tobacco Products, and Wheezing Symptoms Among U.S. Adults.

IntroductionThis study assessed the association of exclusive and concurrent use of cigarettes, electronic nicotine delivery systems (ENDS), and cigars with ever and past 12-month wheezing symptoms among a nationally representative sample of US adult current tobacco users.MethodsCross-sectional data from the Population Assessment of Tobacco and Health (PATH) Study Wave 3 (W3) were used. The weighted prevalence of self-reported ever and past 12-month wheezing symptoms for noncurrent users compared with users of cigarettes, ENDS, cigars, and any combination of these products (polytobacco use of these tobacco products) were presented for 28 082 adults. The cross-sectional association of tobacco use with self-reported wheezing symptoms was assessed using weighted multivariable and ordinal logistic regression with consideration of complex sampling design.ResultsSignificantly higher odds of ever had wheezing or whistling in the chest at any time in the past were observed among current cigarette (adjusted odds ratio: 2.62, 95% confidence intervals [CI]: 2.35, 2.91), ENDS (1.49, 95% CI: 1.14, 1.95), and polytobacco users (2.67, 95% CI: 2.26, 3.16) compared with noncurrent users. No associations were seen for cigar use. Polytobacco use was associated with a higher odds of ever wheezing when compared with exclusive ENDS (1.61, 95% CI: 1.19, 2.17) and exclusive cigar use (2.87, 95% CI: 1.93, 4.26), but not exclusive use of cigarettes.ConclusionsEver wheezing is associated with the use of cigarettes, ENDS, and polytobacco use of cigarettes, ENDS, and/or cigars, but not cigar use. The association of polytobacco use and wheezing appears to be driven by cigarette use.ImplicationsCross-sectional associations with ever and past 12-month wheezing symptoms were found to be the strongest among cigarette users, exclusively or in combination. Future longitudinal research is needed to better understand how cigarette use interacts with other tobacco and nicotine products and contributes to respiratory symptoms.

Abstract 16156: Association of Electronic Nicotine Delivery Systems (ENDS) Usage and EVALI-like Symptoms

Introduction: Comprehensive studies regarding clinical symptoms related to electronic nicotine delivery systems (ENDS) usage are sparse. Methods: The sample included 1,432 current ENDS users, ages 18-64, drawn from a national online survey conducted in 2016. A quota sampling method was used for key demographic characteristics such as age, gender, and race/ethnicity. ENDS use included types of devices, flavors, and knowledge of e-liquid used. Outcomes included any E-cigarette or Vaping use-Associated Lung Injury (EVALI)-like symptoms (e.g., cough, shortness of breath, nausea) and any clinical symptoms (see Table footnotes). Results: Of the sample, 50% were female, 23% non-Hispanic (NH) White, 23% NH Black, 54% Hispanic, 18% aged 18-24, 17% LGBTQ, 41% with &lt;$50K income, 55% 1+ any symptoms, and 33% 1+ any EVALI-like symptoms. Cough and nausea were most prevalent among EVALI-like symptoms (27% and 7.3%, respectively). The proportion of having any EVALI-like symptoms was higher in the following groups: younger, Hispanic, current smokers, and current other product users. With multiple adjustments (see Table footnotes), those who used refillable devices, varied nicotine content, flavored products or made their own e-liquids were more likely to have clinical symptoms than their counterparts. For example, the odds (95% CI) of having 1+ EVALI-like symptoms in those who used refillable devices with e-liquid pour or with e-liquid cartridge replacement were 1.70 (1.13, 2.56) and 1.95 (1.27, 2.99), respectively, compared to the non-refillable group (see Table). It should be noted that those who used non-refillable devices were also more likely not to know the nicotine content in their e-liquid. However, their use pattern seemed stable: They tended to use only one brand, one type of device, and non-flavored e-liquid (results not tabulated). Conclusions: ENDS use was significantly associated with the odds of having clinical symptoms, including EVALI-like symptoms.

Transitions between cigarette, ENDS and dual use in adults in the PATH study (waves 1–4): multistate transition modelling accounting for complex survey design

IntroductionEven prior to 2018, electronic nicotine delivery systems (ENDS) began to dramatically change the landscape of tobacco products and product use patterns in the USA.MethodsUsing a Markov multistate transition model...