Exclusive E-cigarette Use Research Articles

The effects of electronic cigarette use patterns on health-related symptom burden and quality of life: analysis of US prospective longitudinal cohort study data

ObjectiveThis study aimed to examine the association between e-cigarette (EC) use patterns and health-related symptoms (fatigue, pain, and emotional problems) as well as general quality of life (QoL).MethodsData were analyzed from 7,225 adults across Waves 1–6 of the US Population Assessment of Tobacco and Health (PATH) study. Current combustible cigarette (CC) or EC use patterns included dual CC/EC use, exclusive EC use, non-current use of CC or EC, and exclusive CC smoking. Multivariate linear mixed-effects models were used to investigate longitudinal associations between EC use patterns, and symptom burdens/QoL scores.ResultsThose who were not currently smoking or vaping reported the lowest fatigue, pain, and emotional problems, and the best QoL, among the four groups (all p < 0.001). Compared to exclusive CC smoking, exclusive EC use was associated with a significant decrease of 0.065 units in average fatigue (95% confidence interval [CI]: −0.121, −0.009), of 0.206 units in average pain (95% CI: −0.355, −0.058), and of 0.103 units in average QoL scores (95% CI: −0.155, −0.051), with emotional problems similar over time.ConclusionExclusive EC users had less health-related symptoms and better QoL than those who were exclusive CC smokers. This should be taken into account when assessing the harm reduction potential of ECs.

Association of Cigarette–E-Cigarette Transitions With Respiratory Symptom Resolution

Abstract Introduction Adults increasingly use e-cigarettes for cigarette cessation because of the perceived reduced risk. While e-cigarette use is associated with reduced toxicant exposure compared with smoking, it is unclear whether transitioning from cigarettes to e-cigarettes is associated with resolution of respiratory symptoms. Methods Data were obtained from the Population Assessment of Tobacco and Health (PATH) study waves 1–5. US adult participants were separated into observations with cigarette–e-cigarette exposure intervals determined from PATH waves 1–2, 2–3, and 3–4. Observations were included if the participant reported exclusively smoking at baseline and reported a baseline cough or wheeze. Mixed-effect Poisson models measured the association between cigarette–e-cigarette transitions over the two-wave exposure interval (from smoking to nonuse, exclusive e-cigarette use, continued smoking, or dual use) and the reported resolution of the participant’s cough or wheeze. Results Among 5210 (3362 unique) observations, transitioning from cigarettes to e-cigarettes was associated with increased rates of wheeze resolution (incidence rate ratio [IRR] = 1.33; 95% confidence interval [CI] = 1.01 to 1.75) but not cough resolution (IRR = 1.18; 95% CI = 0.93 to 1.50) compared with persistent smoking. Cigarette to dual-use transitions were not associated with improvements in symptom resolution, and those who switched to dual use and maintained or increased their smoking intensity had 15% decreased rates of respiratory symptom resolution compared with persistent smoking. Discussion E-cigarette-assisted smoking cessation may increase rates of respiratory symptoms resolution among smokers who completely transition to e-cigarettes; however, there is risk for additional harm among those who initiate e-cigarette use without decreasing their smoking intensity. Implications Government agencies are increasingly weighing the risks and benefits of e-cigarette-assisted cigarette cessation given the reduced harm associated with e-cigarette use. This study provides novel evidence that completely transitioning from cigarettes to e-cigarettes is associated with increased rates of resolution from self-reported wheeze symptoms. However, risk exists in e-cigarette-assisted cigarette cessation, as those who transitioned from exclusive cigarette smoking to dual use and did not reduce their cigarette smoking intensity had decreased rates of respiratory symptom resolution compared with persistent smokers.

Exclusive and dual use of electronic cigarettes among European youth in 32 countries with different regulatory landscapes

BackgroundThe Tobacco Products Directive (2014/40/EU) partially harmonised the regulation of electronic cigarettes (e-cigarettes) in Europe, but individual countries maintain jurisdiction over bans on use in public places, domestic advertising, taxation...

To use or not to use electronic cigarettes? Reasons for use, stopping use and their behavioural sequelae among Mexicans who smoke

IntroductionReasons for using and stopping the use of e-cigarettes and their associations with transitions in nicotine product use are relatively unknown in countries with e-cigarette bans, such as Mexico.MethodsData comes...

Using Biomarker Ratios to Distinguish Between Exclusive and Dual Use of Cigarettes, Smokeless Tobacco, and e-Cigarettes

Using Biomarker Ratios to Distinguish Between Exclusive and Dual Use of Cigarettes, Smokeless Tobacco, and e-Cigarettes

Prevalence of Cigarette Smoking, E-cigarette Use, and Dual Use Among Urban and Rural Women During the Peripartum Period, PRAMS 2015-2020.

Evidence has emerged on the health dangers of electronic cigarette (e-cigarette) use among pregnant women and neonates. We examined whether rural residence is a risk factor for smoking and e-cigarette use among women during the peripartum period in the United States. This study was based on pooled cross-sectional 2015-2020 data from the Pregnancy Risk Assessment Monitoring System. The outcome was exclusive smoking, exclusive e-cigarette use, and use of both products (ie, dual use) versus use of neither tobacco product by women with live infants aged 2 to 6 months. We examined rural-urban differences in outcome by using univariate and multivariable multinomial logistic regressions with post hoc contrasts and marginal analyses, adjusting for complex survey design and nonresponse. During the peripartum period, 5.0% of women were smoking combustible cigarettes, 5.0% were using e-cigarettes, and 1.9% were using both tobacco products. The crude prevalence of e-cigarette use was 1.1 percentage point higher, and the adjusted prevalence was 0.8 percentage points lower for rural versus urban women (P < .001 for both). Among rural women, 6.7% (95% CI, 6.3%-7.1%) smoked combustible cigarettes exclusively and 2.6% (95% CI, 2.3%-2.8%) used both products, as compared with 4.5% (95% CI, 4.4%-4.8%) and 1.7% (95% CI, 1.6%-1.8%) of urban women, respectively, adjusting for sociodemographic and health-related characteristics. Maternal sociodemographic and health-related characteristics differed by combustible smoking versus e-cigarette use during the peripartum period. The effect of residence on e-cigarette use was significantly confounded by sociodemographic and health-related characteristics, resulting in clinically comparable prevalence of e-cigarette use in rural and urban mothers with live infants aged 2 to 6 months.

Development and Psychometric Evaluation of a Novel Measure of Nicotine E-cigarette Withdrawal for use with Adolescents and Young Adults.

Nicotine withdrawal is a well-established construct that prompts continued nicotine product use and contributes to failed cessation efforts. Despite ongoing public health concerns about nicotine e-cigarette use in adolescents and young adults (AYAs), no psychometrically-sound measure of nicotine e-cigarette withdrawal exists for this population. A mixed methods approach comprising a literature review to identify existing nicotine withdrawal items; subject matter expert feedback on existing items and novel item generation; cognitive interviews assessing the measure's instructions, items, and response options; and a large quantitative validation survey (N = 997) was employed to develop the novel retrospective measure of nicotine e-cigarette withdrawal. A 25-item solution comprising four subscales - Negative Affect, Negative Physical Symptoms, Craving, and Appetite/Food - and an Overall Withdrawal score was supported. Internal reliability was excellent (mean alpha = 0.91), and scalar measurement invariance was reached for all subgroups tested (e.g., sex, age, exclusive e-cigarette use versus dual tobacco product use, daily versus non-daily nicotine vaping). Overall Withdrawal and its subscales evidenced concurrent validity with time to first vape in the morning, e-cigarette dependence, and previous vaping cessation attempts, although not each subscale was associated with each outcome. Importantly, cross-sectional incremental validity analyses indicated that retrospective withdrawal accounted for variance in each outcome above and beyond e-cigarette dependence. The novel retrospective AYA Nicotine E-cigarette Withdrawal Scale (AYA NEWS) evidenced strong psychometric properties for use in this population. Future research can determine whether the AYA NEWS can be used to assess acute e-cigarette nicotine withdrawal. While e-cigarette use remains the most prevalent form of nicotine product use among adolescents and young adults, there are limited options for psychometrically-sound measures of e-cigarette-related constructs in this population. Withdrawal from nicotine is associated with failed cessation attempts and continued use of nicotine-containing products, making it a critical construct within tobacco-related research. This study outlines the development and preliminary psychometric evaluation of a novel, retrospective measure of nicotine e-cigarette withdrawal. Study findings support using the Adolescent and Young Adult Nicotine E-cigarette Withdrawal Scale (AYA NEWS) to assess retrospective withdrawal from nicotine e-cigarettes in young people.

Eating Disorder Symptomatology Among Young Adult Cigarette and E-Cigarette Users

Objective: Tobacco use is elevated among individuals with eating disorders (EDs). Yet, further research is needed to understand associations between cigarette and e-cigarette use patterns and ED symptomatology. To gain a more comprehensive understanding of tobacco use and EDs, this study characterized ED symptomatology and tobacco use patterns, including exclusive cigarette use, e-cigarette use, dual use, and nonuse. Method: Young adults aged 18-24 years who self-reported exclusive cigarette, e-cigarette, dual, or nonuse (N = 2500) were recruited via Lucid, an online survey management company. Participants completed questionnaires assessing body dissatisfaction, global ED psychopathology, binge eating and self-induced vomiting frequency, and demographics. ED diagnostic groups included: anorexia nervosa (AN), bulimia spectrum eating disorders (BSED), atypical AN, and night eating syndrome (NES). Results: Multinomial logistic models revealed those with AN were more likely to be dual users, those with atypical AN were more likely to be exclusive e-cigarette users, and participants with a BSED or NES were more likely to be exclusive e-cigarette or dual users, compared to those without an ED. General linear models suggested body dissatisfaction and global ED psychopathology were higher among exclusive e-cigarette and dual users, while binge eating and self-induced vomiting frequencies were greater among all tobacco use groups compared to nonusers. Discussion: Our findings suggest young adults with ED symptomatology were more likely to be users of e-cigarettes exclusively or dual users. It will be necessary to examine how these associations manifest using longitudinal and clinical populations in future research.

Time to first report of signs of nicotine dependence among youth who use e-cigarettes and cigarettes in the United States: A nationally representative cohort study, findings from the Population Assessment of Tobacco and Health, 2013–2019

ObjectiveTo determine the time to first report of signs of nicotine dependence among youth exclusive e-cigarette users and compare this time to that for exclusive cigarette users. MethodsSecondary analysis of data (Waves 1–5; 2013–2019) from the Population Assessment of Tobacco and Health was conducted. Youth never tobacco users in the United States who reported exclusive past-30-day (P30D) e-cigarette or cigarette use (n = 2940, N = 5,391,642) in at least one wave were included in the current analysis. Survival analysis was used to estimate the time to the first report of three nicotine dependence indicators (i.e., “use within 30 minutes of waking”; “cravings” and “really needing to use”) following the first report of P30D use. Multivariable Cox proportional hazard models were used to estimate adjusted hazard ratios (aHR). ResultsThere were no significant differences in the time to first report of “use within 30 minutes of waking” (aHR = 1.1, 95% CI = 0.87–1.40) and “cravings” (aHR = 1.09, 95% CI = 0.81–1.47) between exclusive P30D e-cigarette use and exclusive P30D cigarette use. However, compared to exclusive P30D e-cigarette use, the hazard of first reporting “really needing to use” tobacco was 39% (aHR 1.39; 95% CI: 1.05–1.84) times higher for those who reported exclusive P30D cigarette use after controlling for covariates. ConclusionCompared to exclusive P30D cigarette use, no differences in the time to first report of signs of nicotine dependence (“use within 30 minutes” and “cravings”) were observed among exclusive P30D e-cigarette users. Policymakers and regulatory agencies should consider this evidence when assessing the abuse liability of e-cigarette products.

Correlates of using E-cigarettes with high nicotine concentrations among U.S. adults who exclusively vape E-cigarettes or dual use with cigarettes

BackgroundIdentifying the correlates of using e-cigarettes with high nicotine concentrations in exclusive and dual-using vapers can elucidate which subpopulations might be most impacted by e-cigarette regulatory activities related to nicotine concentration. MethodsData are drawn from Wave 5 (December 2018-November 2019) of the Population Assessment of Tobacco and Health (PATH) study. Self-reported nicotine concentration was grouped as high (5.0 %+), moderate (1.8–4.9 %), low (0.1–1.7 %), 0 %, and “I don’t know.” Multivariable logistic regressions estimated associations of sociodemographic factors, tobacco use status, and e-cigarette use patterns of high nicotine concentration vs. other nicotine levels, stratified by current exclusive e-cigarette use and dual use of e-cigarettes and cigarettes. ResultsIn the study samples (exclusive e-cigarette use [n = 1,755], dual-use [n = 1,200]), higher proportions of exclusive e-cigarette users reported using high nicotine concentrations than dual users (18.3 % vs. 8.6 %). Among exclusive e-cigarette users, never vs. former smokers and daily (vs. someday) e-cigarette users were more likely to use high vs. low nicotine. In both exclusive and dual users, younger (vs. older) adults were more likely to report using high nicotine concentration e-cigarettes than most other nicotine levels. Current dual users who did vs. did not report using e-cigarettes to quit smoking had higher odds of using high vs. 0 % nicotine concentrations. ConclusionsHigh-nicotine e-cigarette use might be elevated in subpopulations that face greater risks for vaping (e.g., never smokers, young adults) than groups who benefit from the potential harm reduction. Regulatory restrictions on high-nicotine products may selectively affect some subgroups adversely impacted by vaping.

Intended and unintended effects of e-cigarettes in clinical studies: a plea for (more) transparency

E-cigarettes are used in clinical trials to facilitate smoking cessation. Due to the health risks associated with the use of e-cigarettes, the results of clinical trials should be fully reported, including continued exclusive use and dual use of tobacco and e-cigarettes. Nicotine cessation outcomes should be reported as the primary endpoint as well as the analysis of tobacco cessation alone. As there is currently no robust evidence that reducing cigarette consumption provides substantial health benefits, cigarette consumption reduction should not be used as a health outcome in clinical trials. Continued nicotine dependence should be included as an "adverse event" in the reporting of trial results.

Electronic cigarette use and chest pain in US adults: Evidence from the PATH study.

Electronic cigarettes (e-cigarette) were introduced for smoking cessation/reduction but have also become popular among the youth. Although e-cigarettes contain fewer toxins than combustible cigarettes, their long-term cardiovascular and pulmonary effects remain unknown. We aimed to assess the association between self-reported chest pain and e-cigarette use. We analyzed data from the PATH (Population Assessment of Tobacco and Health) study wave 4 (2016-2018) and wave 5 (2018-2019). Based on questionnaires from wave 4, we categorized tobacco use as: 1) non-use, 2) exclusive e-cigarette use, 3) combustible cigarette use, and 4) dual use. Presence of established cardiovascular disease was examined at wave 4, and participants aged >40 years were asked about chest pain during wave 5. We used binary logistic regression models to determine the association between tobacco exposures and self-reported chest pain. We evaluated a total of 11254 adults. The rates of chest pain were 1518 out of 7055 non-users, 49 from 208 exclusive e-cigarette users, 1192 from 3722 combustible cigarette users, and 99 out of 269 dual users. In the multivariable models adjusted for relevant covariates, combustible cigarette users (adjusted odds ratio, AOR=1.77; 95% CI: 1.56-2.01) and dual users (AOR=2.22; 95% CI: 1.61-3.05) had higher odds of reporting ever having chest pain, as well as having chest pain in the past 30 days. Conversely, exclusive e-cigarette users had similar odds of reporting chest pain compared to non-users (AOR=1.03; 95% CI: 0.69-1.54) and lower odds than combustible and dual users. In sensitivity analyses, categorizing individuals based on their reported history of cardiovascular disease, overall findings were similar. Exclusive e-cigarette use is associated with a lower rate of chest pain compared to combustible cigarette use and dual use.

Immigration status-related exclusive e-cigarette use and cannabis use and their dual use disparities associated with mental health disorder symptoms

IntroductionE-cigarette and cannabis use has been linked to various health risks, including respiratory and cardiovascular conditions. Yet, extant knowledge about the risk factors for exclusive and dual use of e-cigarettes and cannabis is limited, especially among immigrants. We examined exclusive e-cigarette and cannabis use and their dual use associated with mental health disorders among immigrants and U.S.-born. MethodsWe analyzed national cross-sectional data collected between May 13, 2021, and January 9, 2022, among adults aged >18 years (n= 4766) living in U.S. Multinomial logistic regression analyses were conducted to model the associations of exclusivity and dual-use (reference group= non-use) with anxiety/depression. ResultsThe dual-use prevalence was higher than exclusive e-cigarette and cannabis use, especially among U.S.-born (dual use= 14.79% vs. cannabis use= 13.53% vs. e-cigarette use= 7.11%) compared to immigrants (dual use= 8.23% vs. cannabis use= 5.03% vs. e-cigarette use= 6.31%). Immigrants had lower risks of exclusive cannabis and dual use compared to U.S.-born. Anxiety/depression was associated with higher risks of exclusive cannabis use and dual use across immigration status, but was associated with exclusive e-cigarette use among only immigrants. While effect sizes of dual-use associated with anxiety/depression were higher among U.S.-born, the effect sizes of exclusive e-cigarette and cannabis use associated with anxiety/depression were higher among immigrants. ConclusionsThe findings revealed significant mental health risks for e-cigarette, cannabis, and their dual use among immigrants and U.S.-born, especially among U.S.-born. These findings highlight the need for public health research and interventions to consider immigration status-related disparities in substance use.

The impact of chronic electronic cigarette use on endothelial dysfunction measured by flow-mediated vasodilation: A systematic review and meta-analysis.

Despite electronic cigarettes (e-cigarettes) being marketed as a safer alternative to combustible cigarettes, the effects of chronic e-cigarette use on vascular health remain uncertain. Our meta-analysis aimed to assess the health implications of chronic exclusive e-cigarette use on endothelial dysfunction, as measured by flow-mediated vasodilation (FMD). PubMed, Embase and Scopus were searched for studies from 1 January 2004 to 31 March 2024. Four cross-sectional studies (n=769) were pooled using a random-effects model. The mean differences (MD) of FMD were reported by comparing exclusive e-cigarette use versus non-use; exclusive e-cigarette use versus combustible cigarette use; and combustible cigarette use versus non-use. A non-significant reduction in FMD in exclusive e-cigarette use compared to non-use was reported (MD of FMD: -1.47%; 95% CI: -3.96 - 1.02; I2= 84%). Similar MD of FMD in exclusive e-cigarette use and exclusive combustible cigarette use (vs non-use) suggested that both of these products might have comparable adverse influences on endothelial health. The limited availability of studies assessing the chronic impact of e-cigarette use restricted our ability to provide definitive findings. We emphasize the importance of additional research that explores the long-term impact of e-cigarette use on endothelial dysfunction, and identify key areas and give suggestions for further study.

Predictors of Quitting Dual Use of Electronic Cigarettes and Cigarettes During Pregnancy.

Background and Aims: There is limited research surrounding dual maternal use of cigarettes and electronic cigarettes (e-cigarettes). We aimed to assess predictors of maternal quitting of cigarettes, e-cigarettes, and both during late pregnancy. Materials and Methods: We analyzed dual use (n = 4,006) and exclusive e-cigarette use (n = 1,685) among mothers using data from the 2016 to 2019 phase of the Pregnancy Risk Assessment Monitoring Systems (PRAMS), a nationally representative sample of the United States. Dual use and exclusive e-cigarette use were defined based on use reported during the 3 months before pregnancy and quitting was assessed during the last 3 months of pregnancy. Multinomial and binomial logistic regression models estimated the odds ratios and 95% confidence intervals for predictors of quitting status among mothers who reported dual use and exclusive e-cigarette use, respectively. Separate predictor analyses were conducted in the dual and exclusive e-cigarette use groups to see predictors of quitting e-cigarettes, cigarettes, or both. Results: The highest proportion of mothers who used cigarettes and e-cigarettes before pregnancy quit both during late pregnancy (46.2%), followed by those who quit e-cigarette use only (26.5%) and those who quit cigarette use only (6.6%). Among mothers who reported dual use, those who were African American or Asian, of Hispanic ethnicity, consumed alcohol before pregnancy, had higher education, were married, had diabetes, had higher annual household income, had nongovernmental health insurance, had more prenatal care visits, had a higher frequency of e-cigarette use before pregnancy, had a lower frequency of cigarette use before pregnancy, and smoked hookah around pregnancy had a higher likelihood of quitting both cigarette and e-cigarette use during late pregnancy. Conclusions: Quitting use of cigarettes and/or e-cigarettes was fairly common among mothers who reported dual use or e-cigarette use only. Sociodemographics, pregnancy characteristics, and use of other tobacco products predicted quitting use of both cigarettes and e-cigarettes during late pregnancy.

Symptoms of nicotine dependence by e-cigarette and cigarette use behavior and brand: A population-based, nationally representative cross-sectional study

BackgroundMany modern e-cigarette brands contain equivalent or higher nicotine levels than traditional cigarettes. ObjectiveTo examine differences in four nicotine dependence indicators (i.e., use within 30minutes of waking, cravings, needing to use, and frequent use) among adolescents (aged 12–17 years) with past 30-day (P30D) exclusive use of e-cigarettes, cigarettes, or dual use of both. MethodsData were from Wave 5 (2018–2019) of the Population Assessment of Tobacco and Health (PATH) study (n=1060; N=2053,659). Multivariable logistic regression was performed to determine differences in indicators by P30D e-cigarette and cigarette use behavior (exclusive vs. dual use) and brand (e-cigarette use: JUUL vs. non-JUUL vs. Unknown). ResultsThe odds of frequent use among adolescents with JUUL (AOR: 2.11; 95% CI=1.02–4.37) and non-JUUL (AOR: 2.12; 95% CI=0.95–4.77) use were similar and paralleled that for dual use (AOR: 3.50; 95% CI=1.46–8.43) but were stronger (JUUL only) than exclusive cigarette use. The odds of using within 30minutes of waking for adolescents with JUUL (AOR: 2.23; 95% CI=0.80–6.25) and non-JUUL (AOR:1.42; 95% CI=0.47–4.32) use were similar and paralleled that for both dual (AOR=3.00; 95% CI=1.01–8.88) and exclusive cigarette use. For adolescents who used unknown brands, the odds of all indicators paralleled exclusive cigarette use but were lower than JUUL, non-JUUL, and dual use. ConclusionCompared to exclusive cigarette use, symptoms of nicotine dependence are similar for adolescents with exclusive e-cigarette use, irrespective of brand. Symptoms of nicotine dependence for JUUL and non-JUUL use parallel dual use. Tobacco regulation should consider these findings when assessing the abuse liability of e-cigarettes.

Use of E-Cigarettes and Cigarettes During Late Pregnancy Among Adolescents

Pregnant adolescents sometimes use cigarettes; however, little is known about e-cigarette use among pregnant adolescents, a population with increased health vulnerability. To examine yearly trends, sociodemographic and pregnancy-related determinants, and the association with small-for-gestational-age (SGA) birth of e-cigarette and/or cigarette use during late pregnancy among adolescents. This cohort study used existing data from the 2016-2021 Pregnancy Risk Assessment Monitoring System on 10 428 US adolescents aged 10 to 19 years who had a singleton birth with complete data on e-cigarette or cigarette use and SGA birth. Adolescents reported e-cigarette and cigarette use during the last 3 months of pregnancy. SGA birth (birth weight below the 10th percentile for the same sex and gestational duration) was determined from birth certificates. Multivariable logistic regression was used to compare the odds of SGA birth across pregnant adolescents who exclusively used e-cigarettes, exclusively used cigarettes, used e-cigarettes and cigarettes, or did not use either. Of the 10 428 pregnant adolescents, 72.7% were aged 18 or 19 years; 58.9% self-identified as White and 23.3% as Black; and 69.8% were non-Hispanic. The weighted prevalence of exclusive e-cigarette use during late pregnancy increased from 0.8% in 2016 to 4.1% in 2021, while the prevalence of exclusive cigarette use decreased from 9.2% in 2017 to 3.2% in 2021. The prevalence of dual use fluctuated, ranging from 0.6% to 1.6%. White pregnant adolescents were more likely than those who self-identified as another race and ethnicity to use e-cigarettes (2.7% vs 1.0% for American Indian or Alaska Native adolescents, 0.8% for Asian or other race adolescents, 0.6% for Black adolescents, and 0.7% for multiracial adolescents). Compared with those who did not use either product, adolescents who exclusively used e-cigarettes (16.8% vs 12.9%; confounder-adjusted odds ratio [AOR], 1.68 [95% CI, 0.89-3.18]) or who used cigarettes and e-cigarettes (17.6% vs 12.9%; AOR, 1.68 [95% CI, 0.79-3.53]) had no statistically significant difference in risk of SGA birth. However, adolescents who exclusively used cigarettes had a more than 2-fold higher risk of SGA birth (24.6% vs 12.9%; AOR, 2.51 [95% CI, 1.79-3.52]). This cohort study suggests that pregnant adolescents increasingly used e-cigarettes, with the highest use among White adolescents. Results from this analysis found that, unlike cigarette use, e-cigarette use during late pregnancy was not statistically significantly associated with an increased risk of SGA birth among adolescents. Due to the uncertainty of this nonsignificant association, future research could benefit from a larger sample size.

E-cigarette cessation interest and quit attempts among young adults reporting exclusive e-cigarette use or dual use with other tobacco products: How can we reach them?

There is limited evidence to inform e-cigarette quitting interventions. This mixed-methods study examined: 1) e-cigarette and other tobacco product perceptions and cessation-related factors; and 2) potential behavioral intervention strategies among young adults reporting exclusive e-cigarette use or dual use with other tobacco products. We analyzed Fall 2020 survey data from 726 participants reporting past 6-month e-cigarette use (mean age=24.15 years, 51.1% female, 38.5% racial/ethnic minority) from 6 US metropolitan areas and Spring 2021 qualitative interview data from a subset (n=40), comparing tobacco-related perceptions and cessation-related factors among those reporting exclusive use versus dual use. Among survey participants (35.5% exclusive e-cigarette use, 64.5% dual use), those reporting dual use indicated greater importance of quitting all tobacco or nicotine products (mean=5.28, SD=3.44 vs mean=4.65, SD=3.75, p=0.033), whereas those reporting exclusive use expressed greater confidence in quitting e-cigarettes (mean=7.59, SD=3.06 vs mean=7.08, SD=3.01, p=0.029) and all tobacco and nicotine products (mean=7.00, SD=3.16 vs mean=6.31, SD=3.13, p=0.008), as well as less favorable perceptions (i.e. more harmful to health and addictive, less socially acceptable) of cigarettes, cigars, and smokeless tobacco (p<0.05). Interview participants (50.0% exclusive e-cigarette use; 50.0% dual use) attributed previous failed e-cigarette quit attempts to their inability to cope with social influences, stress, and withdrawal symptoms. Although most expressed disinterest in quitting due to belief of eventually outgrowing e-cigarettes (among those reporting exclusive use) or unreadiness to abstain from nicotine (among those reporting dual use), many acknowledged the need for quitting interventions. Young adult e-cigarette cessation interventions should target risk perceptions, cessation barriers, and social influences/support.

Electronic cigarette use and cigarette smoking associated with inadequate sleep duration among U.S. young adults

ObjectiveNicotine use can influence inadequate sleep, but less is known about the associations of exclusive and dual use of electronic cigarettes (e-cigarettes) with combustible cigarettes in U.S. young adults. This study assessed the associations between current exclusive e-cigarette use, exclusive cigarette smoking, and dual e-cigarette and combustible cigarette use and inadequate sleep duration among U.S. young adults. MethodsWe performed a secondary analysis of 2020 Behavioral Risk Factor Surveillance System (BRFSS) data including 13,978 U.S. young adults ages 18–24 years. Inadequate sleep duration was assessed categorically using the National Sleep Foundation's age-specific recommendations that define <7 h as inadequate sleep. Weighted logistic regression models were performed while adjusting for participants' sex, race/ethnicity, education level, annual household income level, body mass index, current physical activity, mental health status, disability status, current alcohol use, and current smokeless tobacco use. ResultsConcerning use patterns, 11.8% of young adults were exclusive e-cigarette users, 4.7% were exclusive cigarette smokers, and 3.8% were dual e-cigarette and combustible cigarette users. Exclusive e-cigarette users (adjusted odds ratio [AOR] = 1.41, 95% confidence interval [CI] = 1.16–1.72), exclusive cigarette smokers (AOR = 1.63, 95%CI = 1.22–2.18), and dual product users (AOR = 2.03, 95%CI = 1.44–2.86) were at increased odds of having inadequate sleep duration compared to non-users, while adjusting for the covariates. Additionally, dual product users were at increased odds (AOR = 1.52, 95%CI = 1.06–2.19) of reporting inadequate sleep duration compared to exclusive e-cigarette users, while adjusting for the covariates. ConclusionsCurrent e-cigarette and cigarette use may influence inadequate sleep among U.S. young adults. Tobacco cessation efforts may encourage increased sleep health.

The association of current exclusive e-cigarette use and dual use of e-cigarettes and cigarettes with psychological distress among U.S. adults

This observational study examines the association of current e-cigarette use and dual use of e-cigarettes and cigarettes (dual use) with psychological distress among U.S. adults. We differentiate dual use based on the smoking frequency and compare the relationship between dual use and psychological distress to that of exclusive cigarette smoking with the same smoking frequency.Using data from the 2015–2018 National Health Interview Surveys, we analyzed adults aged 18+ (N = 55,780) who currently use e-cigarettes or/and cigarettes and have no history of using other tobacco products, and adults who never used any tobacco. Multinomial logistic regression models estimate the association of current e-cigarette use and dual use with psychological distress severity (no/mild, moderate, and severe).In the sample, 15.3% and 2.9% of adults experienced moderate and severe psychological distress. Compared to never tobacco users, current exclusive e-cigarette users and dual users who smoke daily had higher odds of moderate and severe psychological distress. Dual users who smoke nondaily had higher odds of moderate, but not severe psychological distress than never tobacco users. Compared to exclusive daily smokers, dual users with daily smoking had higher odds of moderate and severe psychological distress. Compared to exclusive nondaily smokers, dual users with nondaily smoking had higher odds of moderate but not severe psychological distress.Our findings suggest that exclusive e-cigarette use is associated with psychological distress severity. Dual use is associated with higher odds of psychological distress severity compared to never tobacco users and exclusive cigarette smoking, and this association differs by smoking frequency.