Use of Electronic Cigarettes Among Cancer Survivors in the U.S

Vaping behavior among adolescent and young adult cancer survivors: A scoping review

Adolescent and young adult (AYA) cancer survivors are vulnerable to future health complications and engage in risky health behaviors. Vaping or electronic cigarette use is increasing among AYA, yet little is known about the prevalence in AYA cancer survivors and associated morbidities. The objective of this research was to analyze the current state of the literature on vaping among AYA cancer survivors with scoping review methodology. Eligibility criteria included any vaping among people aged 13-39 years with cancer or a history of cancer. Database searches from PubMed, Web of Science, PsycINFO, and Scopus yielded eight cross-sectional studies. Results suggest significant variability, with studies finding 2%-46% of AYA survivors have ever or currently vape. Medical (e.g., late effects), psychosocial (e.g., depression), and demographic correlates (e.g., younger age, male gender), as well as other risky health behaviors (e.g., cigarette smoking) were shown to be associated with vaping. Though the extant research is beginning the task of understanding comorbidities with vaping, few research has focused on those most vulnerable to vaping (survivors under age 18). More research is required to understand AYA survivors' vaping behavior to better understand the significance and implications regarding the growing incidence of vaping among this vulnerable population.

Characterizing risky alcohol use, cigarette smoking, e-cigarette use, and physical inactivity among cancer survivors in the USA-a cross-sectional study

PURPOSE

Unhealthy lifestyle behaviors are associated with inferior health outcomes among cancer survivors, including increased mortality. It is crucial to identify vulnerable subgroups, yet investigations have been limited. Thus, this study aimed to examine sociodemographic and clinical characteristics associated with risky health behaviors among cancer survivors.

METHODS

We used national, cross-sectional survey data (Health Information National Trends Survey, HINTS 2017-2020) for 2579 cancer survivors. We calculated the prevalence of risky alcohol use, current cigarette smoking, e-cigarette use, and not meeting physical activity guidelines. We performed weighted logistic regression to obtain multivariable-adjusted odds ratios (OR) for the association between each unhealthy behavior with sociodemographic and clinical characteristics.

RESULTS

Overall, 25% showed risky alcohol use, 12% were current cigarette smokers, 3% were current e-cigarette users, and 68% did not meet physical activity guidelines. Cancer survivors who were males, non-Hispanic Whites or African Americans, without a college education, not married and with comorbidities or psychological distress were more likely to have unhealthy behaviors. Those with lung disease or depression were 2 times as likely to smoke cigarette or e-cigarettes and those with psychological distress were 1.6 times as likely to be physically inactive. Moreover, risky drinkers (OR = 1.75, 95% CI = 1.22-2.52) and e-cigarette smokers (OR = 16.40, 95% CI 3.29-81.89) were more likely to be current cigarette smokers.

CONCLUSIONS

We identified vulnerable subpopulations of cancer survivors with multiple unhealthy lifestyle behaviors.

IMPLICATIONS FOR CANCER SURVIVORS

Our findings inform clinicians and program and policy makers of the subgroups of cancer survivors to target for multiple health behavior interventions.

Use of electronic cigarettes among African American cancer survivors

BACKGROUND

The use of electronic cigarettes (e-cigarettes) is increasing rapidly in the United States, although the negative health outcomes associated with these products are still unknown. Emerging research has examined the use of e-cigarettes in the cancer survivor population as a whole, yet none has focused on e-cigarette use in the African American (AA) cancer survivor population.

METHODS

The authors used data from the Detroit Research on Cancer Survivors cohort study, comprised of AA adult cancer survivors. Logistic regression models were used to evaluate factors potentially associated with e-cigarette ever use and current use.

RESULTS

Of 4443 cancer survivors who completed a baseline interview, 8.3% (n = 370) reported ever using e-cigarettes, and 16.5% (n = 61) of those reporting ever use also reported current use of e-cigarettes. Ever users and current users were on average younger than those who did not use e-cigarettes (57.5 vs. 61.2 years; p < .001). Current cigarette smokers were >20 times more likely (odds ratio, 20.75; 95% confidence interval, 12.84-33.55) and former smokers were almost 10 times more likely (odds ratio, 9.50; 95% confidence interval, 6.03-14.97) to have ever used e-cigarettes than never-smokers. Preliminary data suggested that ever use of e-cigarettes is associated with later stage at diagnosis for breast and colorectal cancers.

CONCLUSIONS

As the use of e-cigarettes increases in the general population, it is important to continue to monitor their use in cancer survivors and to gain more insight as it pertains to the AA cancer survivor population. Elucidation of the factors associated with e-cigarette use in this population may help inform comprehensive cancer survivorship recommendations and interventions.

Cardiotoxicity of Electronic Cigarettes and Heat-Not-Burn Tobacco Products-A Problem for the Modern Pediatric Cardiologist

Electronic nicotine delivery systems (ENDS) have become increasingly popular among adolescents, either as an alternative to conventional cigarettes (CCs) or as a newly acquired recreational habit. Although considered by most users as a safer option for nicotine intake, these devices pose significant health risks, resulting in multisystem damage. Heat-not-burn products, which, unlike ENDS, contain tobacco, are also alternatives to CCs that consumers use based on the idea that their safety profile is superior to that of cigarettes. Recent studies in the USA and EU show that adolescents are particularly prone to using these devices. Pediatric cardiologists, as well as other healthcare professionals, should be aware of the complications that may arise from acute and chronic consumption of these substances, considering the cardiovascular damage they elicit. This article summarized the known data about the impact of ENDS on the cardiovascular system, with emphasis on the pathophysiological and molecular changes that herald the onset of systemic lesions alongside the clinical cardiovascular manifestations in this scenario.

Patterns and associations of smoking and electronic cigarette use among survivors of tobacco related and non-tobacco related cancers: A nationally representative cross-sectional analysis

BACKGROUND

Tobacco-use among cancer survivors leads to preventable morbidity, mortality, and increased healthcare costs. We sought to explore the prevalence of smoking and e-cigarette use among survivors of tobacco and non-tobacco related cancers.

METHODS

A cross-sectional analysis was conducted using the 2015-2018 National Health Interview Survey. Our primary outcome was the prevalence of current cigarette smoking or e-cigarette use among adults with self-reported history of tobacco related or non-tobacco related cancer. Logistic regression analysis was to assess the association of reported cancer type with cigarette smoking or e-cigarette use. Secondary outcomes included yearly trends and dual use.

RESULTS

A total of 12,984 respondents reported a history of cancer, representing a weighted estimate of 5,060,059 individuals with a history of tobacco-related malignancy and 17,583,788 with a history of a tobacco and non-tobacco related cancer, respectively. Survivors of tobacco-related cancers had a significantly higher prevalence of current cigarette use (18.2 % vs 9.7 %, P < 0.0001), e-cigarette use (2.7 % vs 1.6 %, P < 0.0001) and similar rates of dual use. The prevalence of cigarette smoking among all survivors increased as time increased from the year of diagnosis up to 2 years post-diagnosis (P = 0.047). Odds of reporting current cigarette smoking use was higher for survivors of tobacco-related cancers, adjusted for sociodemographic factors (OR1.69, 95 % CI 1.44-1.99).

CONCLUSIONS

Survivors of tobacco-related cancers have a higher prevalence of current cigarette smoking and e-cigarette use compared to survivors of non-tobacco related cancers. There was a sequential increase in the prevalence of cigarette use during each subsequent year from the time of a new cancer diagnosis, underscoring the need for long term tobacco cessation support among newly diagnosed adults with cancer.

Perceptions of e-cigarette harm among cancer survivors: Findings from a nationally representative survey

BACKGROUND

The growth in e-cigarette use may be driven by the perception that they are a safer, healthier alternative to conventional cigarettes. However, their long-term health implications are not well known and use is discouraged by most cancer societies. It is currently unclear how cancer survivors perceive the risks associated with e-cigarette and how this may influence use in this population.

METHODS

A cross-sectional analysis was conducted using the Health Information National Trends Survey (HINTS) (Years 2017-2019). Our primary study outcome was the perception of harm associated with e-cigarettes compared to traditional cigarettes among adults with and without a self-reported history of cancer. We used logistic regression analyses assessing the association of a cancer history with the perception that e-cigarettes are as much or more harmful than cigarettes.

RESULTS

A total of 11,846 respondents (weighted population estimate 243,728,483) were included. Of these, 26.6% reported a history of cancer. The proportion of cancer survivors who perceived e-cigarettes to be as much or more harmful than conventional cigarettes was similar to non-cancer respondents (70.6% vs 68.3%, P = 0.35). There was no difference in perception of harm among cancer and non-cancer respondents, adjusted for sociodemographic factors (OR 0.82, 95% CI 0.6-1.1). Past (OR 9.06, 95% Cl 5.06-16.20) and never e-cigarette use (OR 23.40, 95% Cl 13.56-40.38) as well as having a history of cardiopulmonary disease (OR 1.28, 95% Cl 1.05-1.56) was associated with higher odds of perceiving e-cigarettes to be as much or more harmful.

CONCLUSION

Cancer survivors commonly perceive e-cigarettes to be as much or more harmful than traditional cigarettes though these findings are similar to perceptions among adults without a history of cancer. There is a strong association with avoidance of e-cigarette products among those who perceive them to be harmful.

Trends in frequency of e-cigarette use among cancer patients and survivors in the United States, 2014-2018

INTRODUCTION

Electronic cigarettes (e-cigarettes) have become increasingly popular in the United States, including among cancer survivors; however, the majority of prior studies do not report frequency of active e-cigarette usage.

METHODS

Using data from the National Health Interview Survey (2014-2018), frequency of active e-cigarette usage was estimated among cancer survivors reporting history of e-cigarette usage. Multivariable logistic regression analyses defined adjusted odds of active e-cigarette usage (either every day and some days vs. not at all) by year of survey and baseline demographic characteristics.

RESULTS

Among 1529 cancer survivors who reported ever using e-cigarettes, 1172 (76.7%) were not active users, while 145 (9.5%) and 212 (13.9%) actively used e-cigarettes every day or some days, respectively. Later year of survey was negatively associated with active e-cigarette usage (p < 0.001) as was Black race (as compared to white race, AOR 0.47, p = 0.02). Age 45-54 was positively associated with active usage (as compared to 18-34 years, AOR 1.58, p = 0.02). Notably, individuals who were former or current traditional cigarette smokers had greater odds of reporting active e-cigarette use (27.0%, AOR 4.39, p < 0.001, 23.4%, AOR 3.28, p = 0.002, respectively) as compared to never traditional cigarette smokers (7.6%).

CONCLUSIONS

The majority of cancer survivors who have ever used e-cigarettes do not appear to be actively using them. Rather, our findings suggest that the reported increasing popularity of e-cigarettes may be driven by a growing absolute proportion of individuals trying e-cigarettes over time. Those who were current or former traditional cigarette smokers were more likely to actively use e-cigarettes. Our findings can help inform current policies on e-cigarettes and contextualize studies on long-term effects of e-cigarettes among survivors of cancer.

Assessing Electronic Nicotine Delivery Systems Use at NCI-Designated Cancer Centers in the Cancer Moonshot-funded Cancer Center Cessation Initiative

Assessing tobacco product use and delivering tobacco dependence treatment is an essential part of cancer care; however, little is known about electronic nicotine delivery systems (ENDS) or e-cigarette use assessment in cancer treatment settings. Given the importance of tailoring tobacco treatment, it is critical to understand how ENDS use is assessed in the electronic health record (EHR) in cancer care settings. Two questionnaires were completed by tobacco treatment program leads at 42 NCI-Designated Cancer Centers in the Cancer Center Cessation Initiative (January 1 to June 30 and July 1 to December 31, 2019). Items assessed how often smoking status and ENDS use were recorded in the EHR. An open-ended item recorded the text and response categories of each center's ENDS assessment question. All 42 centers assessed smoking status at both time periods. Twenty-five centers (59.5%) assessed ENDS use in the first half of 2019, increasing to 30 (71.4%) in the last half of 2019. By the end of 2019, 17 centers assessed smoking status at every patient visit while six assessed ENDS use at every visit. A checkbox/drop-down menu rather than scripted text was used at 30 centers (73.2%) for assessing smoking status and at 18 centers (42.9%) for assessing ENDS use. Our findings underscore the gap in systematic ENDS use screening in cancer treatment settings. Requiring ENDS use measures in the EHR as part of quality measures and providing scripted text scripts to providers may increase rates of ENDS use assessment at more cancer centers. PREVENTION RELEVANCE: This study identifies a gap in the systematic assessment of ENDS use among patients seen at 42 NCI-Designated cancer centers. Requiring the systematic assessment of both ENDS use and use of other tobacco products can inform evidence-based treatment of tobacco dependence and lead to improved cancer treatment outcomes.

Cigarette, E-cigarette, Alcohol, and Marijuana Use by Cancer Diagnosis Status: A Longitudinal Analysis

Background:

Cancer is the second leading cause of death in the United States. Lifestyle choices such as substance abuse can impact a survivor’s health and overall quality of life.

Methods:

We used longitudinal data from the Wave 1-3 Population Assessment of Tobacco and Health data to examine sociodemographic characteristics and substance use behaviors (current cigarette, e-cigarette, alcohol, and marijuana use) by cancer diagnosis status. A generalized estimating equation model was used to examine the population-averaged effects of sociodemographic factors on substance use.

Results:

Among 1527 participants diagnosed with cancer, 14.5% used cigarettes, 3.8% used e-cigarettes, 49.1% used alcohol, and 4.2% used marijuana in the prior 30 days in Wave 1. While the prevalence of cigarette use among those with no cancer history decreased significantly between Wave 1 (21.9%) and Wave 3 (20.2%), it increased significantly among participants diagnosed with cancer from 14.5% to 16.0%. E-cigarette use decreased for both groups, whereas alcohol and marijuana use increased. Results showed that substance use among people diagnosed with cancer significantly varied by sociodemographic characteristics. Age, sex, race-ethnicity, education, income, and region of residence were significantly associated with substance use among patients diagnosed with cancer.

Conclusion:

Overall, substance use is lower among participants diagnosed with cancer than those with no cancer history. Substance use varies by sociodemographic characteristics among people diagnosed with cancer. More focus on substance use prevention among patients diagnosed with cancer could be beneficial in terms of improving the overall well-being of this population.

Tobacco and E-cigarette use among cancer survivors in the United States

Background

Limited information exist on tobacco and e-cigarette use patterns in cancer survivors. The purpose of this study is to report on use patterns in cancer survivors compared with non-cancer participants from the Population Assessment of Tobacco and Health (PATH) Study.

Methods

Sociodemographic data and tobacco product use were analyzed for 32,244 adult participants from the PATH Study in 2013–2014 by cancer status and age. Logistic regression examined the patterns of and factors associated with tobacco use by cancer status.

Results

Overall, cancer survivors represented 7.1% (n = 1,527) of participants, were older, and had a higher proportion of females and non-Hispanic whites than non-cancer participants. In cancer survivors, current and former cigarette smoking was reported in 12.7% and 32.9% respectively, compared with 18.5% and 19.0% in non-cancer adults. Current e-cigarette use was reported by 3.8% of survivors compared with 5.7% of non-cancer participants. Dual tobacco use was reported by 25.0% and poly use by 6.9% of cancer survivors who currently smoked. All other forms of current tobacco use were individually reported by <5% of survivors. Young adult cancer survivors (aged 18–44) reported the highest rates of current cigarette smoking (27.9%) and current e-cigarette use (11.8%). The effects of age, sex, race/ethnicity, education, and income on tobacco use status were comparable for cancer survivors and non-cancer participants. Cancer survivors who were younger, male, of lower educational attainment, and those diagnosed with a tobacco-related cancer were more likely to report current tobacco use.

Conclusions

Among cancer survivors, cigarette smoking remains the predominant form of tobacco use, although other tobacco/nicotine use and dual/poly use are common. The PATH Study provides detailed tobacco product use patterns in survivors, including their adoption of emerging alternative tobacco products.

Electronic Cigarette Use among Survivors of Smoking-Related Cancers in the United States

BACKGROUND

The prevalence of electronic cigarette (e-cigarette) use and its impact on smoking cessation among cancer survivors in the United States is largely unknown. We sought to estimate the prevalence of e-cigarette use and examine its associations with cigarette smoking and smoking quit attempts among smoking-related cancer survivors in the United States.

METHODS

We obtained data from the 2014-2017 annual cycles of the National Health Interview Survey for participants with self-reported history of smoking-related cancer(s). We calculated the prevalence of current e-cigarette use and utilized multinomial logistic regression in examining the independent association between e-cigarette use and cigarette smoking. Appropriate survey weights were applied in estimating the prevalence rates, relative risk ratios (RRR), ORs, and confidence intervals (CI).

RESULTS

Our sample comprised 3,162 smoking-related cancer survivors. The prevalence of current e-cigarette use was 3.18% (95% CI, 2.40-3.96). Current e-cigarette users were 83 times as likely as never users to be current cigarette smokers (RRR, 82.89; 95% CI, 16.54-415.37). Among those with a history of cigarette smoking, current e-cigarette users were 90% less likely to be former smokers (OR, 0.10; 95% CI, 0.05-0.18). No association was seen between current e-cigarette use and a smoking quit attempt in the prior year.

CONCLUSIONS

E-cigarette use among cigarette ever smokers was associated with a lower likelihood of being a former smoker/having quit smoking, and e-cigarette use was not associated with smoking quit attempts.

IMPACT

Our findings do not provide evidence that e-cigarette use facilitates smoking cessation among smoking-related cancer survivors.

Associations between e-cigarette and combustible cigarette use among U.S. cancer survivors: implications for research and practice

PURPOSE

Prior studies established significant associations between e-cigarette use and combustible cigarette smoking in the general population; however, little is known about such associations among cancer survivors. Thus, the current study examined possible associations between e-cigarette use and combustible cigarette smoking among U.S. cancer survivors.

METHODS

Cross-sectional data were drawn from the 2016 Behavioral Risk Factor Surveillance System Survey. Binary logistic regression was used to analyze the associations between e-cigarette user status and combustible cigarette-smoking status in a sample of 4680 cancer survivors, controlling for alcohol use and sociodemographic factors. Analyses were weighted for unequal probability of sample selection to reflect national cancer survivor population estimates.

RESULTS

Prevalence for current e-cigarette use and combustible cigarette smoking for cancer survivors was 2.57% and 16.16%, respectively. In the adjusted analyses, cancer survivors who reported current e-cigarette use, compared to never-users, had greater odds of being current combustible cigarette smokers (odds ratio [OR] = 11.81, 95% confidence interval [CI] = 5.38-25.93). Likewise, former e-cigarette users, compared to never-users, had greater odds of being current combustible cigarette smokers (OR = 15.90, 95% CI = 10.68-23.36).

CONCLUSION

Among cancer survivors in the USA, e-cigarette use had a positive and highly significant association with combustible cigarette smoking.

IMPLICATIONS FOR CANCER SURVIVORS

In order to prevent multiple and substitute use of nicotine-delivery products, prevention interventions and cessation programs designed for cancer survivors should specifically target both current combustible cigarette smokers and non-smokers who report former and current e-cigarette use.

Prevalence and correlates of dual tobacco use in cancer survivors

PURPOSE

Tobacco use in cancer survivors remains a significant problem, however, the use of non-cigarette tobacco products (NCTPs) in this population is less understood. This study examined prevalence and correlates of tobacco use among cancer survivors who were never, current, and former cigarette users. Tobacco-related behaviors and quitting attitudes were compared between survivors dually using cigarettes and electronic cigarettes (ECs) and cigarette-only users.

METHODS

In this cross-sectional study, patients at Mid-South cancer centers (n = 629; 50.4% never, 17.8% current, and 31.8% former cigarette users) responded to an anonymous questionnaire about tobacco-related behaviors and quitting attitudes.

RESULTS

Among current cigarette users, 27.7% reported using two or more tobacco products. Most commonly, 15.2% of cigarettes users were using ECs. Compared to cigarette only use, dual use of tobacco products was associated with male gender (p < 0.0001), being single (p = 0.009), and a lung cancer diagnosis (p < 0.0001). Dual users of cigarettes and ECs were more likely to report a readiness to quit cigarettes within 6 months (p = 0.0317) and that a physician recommended ECs as a quit resource (p = 0.0361) compared to cigarette-only users.

CONCLUSIONS

Results suggest that using more than one tobacco product is common among cancer survivor cigarette users. Dual use of cigarettes and ECs was associated with an increased readiness for cigarette cessation and a physician recommendation of ECs. Targeting potential dual use of tobacco products, particularly cigarettes and ECs, might be beneficial for cigarette cessation among cancer survivors.

Dual cigarette and e-cigarette use in cancer survivors: an analysis using Population Assessment of Tobacco Health (PATH) data

PURPOSE

Cancer survivors who smoke cigarettes face health risks from continued smoking. Some smokers use e-cigarettes to reduce combustible cigarette use, but research on whether cancer survivors do the same is limited. Research is needed to understand whether smokers who are cancer survivors use e-cigarettes at higher rates than smokers never diagnosed with cancer, to inform provider-patient discussions about e-cigarettes.

METHODS

Using cross-sectional data from current cigarette smokers in Wave 1 (2013-2014) of the Population Assessment of Tobacco Health (PATH) study, we compared cancer survivors (n = 433) and those without a prior cancer diagnosis (n = 10,872) on e-cigarette use and reasons for use.

RESULTS

Among smokers, 59.4% of cancer survivors and 63.2% of those without a cancer diagnosis had ever used e-cigarettes, and nearly one-quarter of both groups (23.1% and 22.3%, respectively) reported being current users. Multivariate results, however, suggest that cancer survivors might be more likely to be ever (OR = 1.28; p = .05) or current (OR = 1.25; p = .06) e-cigarette users compared to those never diagnosed, although results were marginally significant. The majority of both groups (> 71%) reported using e-cigarettes for perceived health-related reasons-including smoking reduction.

CONCLUSIONS

Our study found that among smokers, cancer survivors were using e-cigarettes at similar rates as never-diagnosed smokers and both groups used e-cigarettes largely for perceived health-related reasons.

IMPLICATIONS FOR CANCER SURVIVORS

Clinicians who treat cancer survivors may need to routinely ask their patients who smoke about e-cigarette use and address the limited research on the efficacy of e-cigarettes as a cessation aid as compared to other evidence-based options.

Misclassification of self-reported smoking in adult survivors of childhood cancer

We investigated misclassification rates, sensitivity, and specificity of self-reported cigarette smoking through serum cotinine concentration (liquid chromatography tandem mass spectrometry) among 287 adult survivors of childhood cancer. Overall, 2.5-6.7% and 19.7-36.9% of the self-reported never and past smokers had cotinine levels indicative of active smoking. Sensitivity and specificity of self-reported smoking were 57.5-67.1% and 96.6-99.2%. Misclassification was associated with younger age (OR = 3.2; 95% CI = 1.4-7.4), male (OR = 2.1; 95% CI = 1.1-4.0), and past (OR = 2.7; 95% CI = 1.3-5.8) or current (OR = 2.6; 95% CI = 1.0-6.6) marijuana use. After adjusting for tobacco-related variables, current marijuana use remained a significant risk for misclassification. Clinicians/researchers should consider bio-verification to measure smoking status among survivors.

Electronic cigarette use patterns and reasons for use among smokers recently diagnosed with cancer

Many patients with cancer use electronic cigarettes (e‐cigarettes), yet little is known about patterns and reasons for use. Using cross‐sectional baseline data from a randomized controlled trial, we aimed to describe prevalence and correlates of e‐cigarette use, frequency of use, and reasons for use among smokers recently diagnosed with cancer. Participants (n = 302) included adults (age ≥18 years) recently diagnosed with varied cancer types who smoked ≥1 cigarette within the past 30‐d from two US academic medical centers. Participants reported ever and current e‐cigarette use, and current e‐cigarette users reported days of e‐cigarette use and the main reason for use. We compared current, former, and never e‐cigarette users by sociodemographics, cancer type, medical comorbidities, smoking behaviors, attitudes, and emotional symptoms, and described use among current e‐cigarette users. Of smokers recently diagnosed with cancer, 49% (n = 149) reported ever e‐cigarette use and 19% (n = 56) reported current use. Of current e‐cigarette users, 29% (n = 16) reported daily use. Current e‐cigarette users did not differ from former and never e‐cigarette users by cancer type, smoking behaviors, or emotional symptoms. Women were more likely to be current users than never users, and current e‐cigarette users had less education than former users. Most current e‐cigarette users reported using them to help quit smoking (75%). One in five smokers with cancer report current e‐cigarette use, but most are not using e‐cigarettes daily. The majority report using e‐cigarettes to quit smoking. E‐cigarette use by patients with cancer appears to reflect a desire to quit smoking.

Use of Electronic Cigarettes Among U.S. Adults With Medical Comorbidities

INTRODUCTION

Electronic cigarette (e-cigarette) use is rising in the U.S. Smokers with comorbidities may increasingly use e-cigarettes if they believe e-cigarettes reduce smoking-related harm. This study examined e-cigarette use among adults with medical comorbidities.

METHODS

In 2016, this study analyzed 68,136 U.S. adults in the 2014 and 2015 National Health Interview Survey. Prevalent e-cigarette use by medical comorbidities and adjusted odds of e-cigarette use were calculated.

RESULTS

Among current cigarette smokers, ever use of e-cigarettes was more often reported by adults with one or more medical comorbidity versus those without comorbidity (18-24 years: 73.5% vs 61.4%; 25-44 years: 60.6% vs 54.3%; 45-64 years: 46.5% vs 40.3%; ≥65 years: 35.2% vs 19.4%; all p<0.05). Current smokers aged 25-64 years with one or more comorbidity reported current e-cigarette use more often than those without comorbidity (25-44 years, 17.8% vs 14.3%, p=0.03; 45-64 years, 15.9% vs 11.5%, p=0.02). Current smokers with chronic obstructive pulmonary disease, asthma, and cardiovascular disease had higher odds of ever e-cigarette use versus those without comorbidity. Current smokers with asthma and cardiovascular disease had higher odds of current e-cigarette use. Former smokers with chronic obstructive pulmonary disease had higher odds of ever and current e-cigarette use and former smokers with cancer had lower odds of current e-cigarette use.

CONCLUSIONS

E-cigarette use by current and former smokers with medical comorbidities is substantial, especially among individuals with chronic lung or cardiovascular disease. Clinicians should routinely ask these patients about e-cigarette use, actively consider all pathways to help their patients quit combustible cigarettes, and recommend evidence-based treatments.

Overview of Electronic Nicotine Delivery Systems: A Systematic Review

CONTEXT

Rapid developments in e-cigarettes, or electronic nicotine delivery systems (ENDS), and the evolution of the overall tobacco product marketplace warrant frequent evaluation of the published literature. The purpose of this article is to report updated findings from a comprehensive review of the published scientific literature on ENDS.

EVIDENCE ACQUISITION

The authors conducted a systematic review of published empirical research literature on ENDS through May 31, 2016, using a detailed search strategy in the PubMed electronic database, expert review, and additional targeted searches. Included studies presented empirical findings and were coded to at least one of nine topics: (1) Product Features; (2) Health Effects; (3) Consumer Perceptions; (4) Patterns of Use; (5) Potential to Induce Dependence; (6) Smoking Cessation; (7) Marketing and Communication; (8) Sales; and (9) Policies; reviews and commentaries were excluded. Data from included studies were extracted by multiple coders (October 2015 to August 2016) into a standardized form and synthesized qualitatively by topic.

EVIDENCE SYNTHESIS

There were 687 articles included in this systematic review. The majority of studies assessed patterns of ENDS use and consumer perceptions of ENDS, followed by studies examining health effects of vaping and product features.

CONCLUSIONS

Studies indicate that ENDS are increasing in use, particularly among current smokers, pose substantially less harm to smokers than cigarettes, are being used to reduce/quit smoking, and are widely available. More longitudinal studies and controlled trials are needed to evaluate the impact of ENDS on population-level tobacco use and determine the health effects of longer-term vaping.