Elsevier

Preventive Medicine

Volume 105, December 2017, Pages 226-231
Preventive Medicine

E-cigarette use and asthma in a multiethnic sample of adolescents

https://doi.org/10.1016/j.ypmed.2017.09.023Get rights and content

Highlights

  • E-cigarette use is associated with a higher likelihood of asthma.

  • Findings are independent of cigarette smoking, marijuana use, and other covariates.

  • Native Hawaiians, other Pacific Islanders, Filipinos had higher rates of asthma.

  • Research on the health implications of e-cigarette use is needed.

Abstract

There is minimal evidence from epidemiological studies on how e-cigarette use is related to health indices in adolescence. We hypothesized that e-cigarette use would be associated with asthma, controlling for demographics and cigarette smoking. The hypothesis was tested with cross-sectional data from a statewide sample of school students. Surveys were administered in classrooms in 2015 to adolescents in 33 high schools throughout the State of Hawaii. The sample (N = 6089) was 50% female and mean age was 15.8 years. Data were obtained on demographics; ever use and current (past 30 days) use of e-cigarettes, combustible cigarettes, and marijuana; ever being diagnosed with asthma; and currently having asthma. Multinomial regression examined the association between e-cigarette use and asthma controlling for cigarette smoking, marijuana use, and six demographic covariates. Current e-cigarette use was associated with currently having (vs. never having) asthma (adjusted odds ratio [aOR] = 1.48, CI 1.26–1.74) and with previously having (vs. never having) asthma (aOR = 1.22, CI 1.07–1.40). This was independent of cigarette smoking, marijuana use, and other covariates. Smoking and marijuana were nonsignificant in the multivariate analysis. Blacks, Native Hawaiians, other Pacific Islanders, and Filipinos had higher rates of asthma compared with Asian Americans and Caucasians. We conclude that e-cigarette use by adolescents is independently associated with asthma. This finding is consistent with recent laboratory research on pulmonary effects from e-cigarette vapor. Implications for public health should be considered.

Section snippets

Background

The use of electronic cigarettes (e-cigarettes) among adolescents has increased substantially over the past five years. Recent US data show prevalence estimates for current e-cigarette use (i.e., any use in the last 30 days) of 14%–16% in high school populations (Jamal et al., 2017, Miech et al., 2017a). Similar prevalence estimates have been noted in other countries (Dutra and Glantz, 2014, Goniewicz et al., 2014a, Goniewicz et al., 2014b, White et al., 2015). However, there is little evidence

Procedure and participants

The HYRBS is administered every 2 years by the University of Hawaii to students in public middle and high schools throughout the state of Hawaii. The present research uses data from high school students (9th grade–12th grade) in the 2015 HYRBS. The 99-item survey was self-administered by students in classrooms, supervised by project staff, in 33 randomly selected high schools during the spring of 2015. Out of 43 high schools in Hawaii, participating schools were selected using a three-stage

Prevalence for substance use and asthma

Prevalence estimates (Table 1) showed 25% of the participants had ever smoked cigarettes and 10% had smoked in the past 30 days (i.e., current use). These estimates are comparable to national studies (Jamal et al., 2017, Miech et al., 2017a). In contrast, e-cigarette prevalence estimates of 45% for ever use and 25% for current use are both higher than national rates (Jamal et al., 2017, Miech et al., 2017a). Ever-use of marijuana was reported by 33% of the participants and a substantial

Discussion

This research investigated the association between e-cigarette use and asthma in a multiethnic sample of adolescents in Hawaii surveyed in 2015. Our analytic approach controlled for the correlation of e-cigarette use with cigarette smoking and with other variables that were significantly related to asthma in this population. E-cigarette use was associated with higher odds of asthma, independent of cigarette smoking, marijuana use, and the covariates, with an effect size comparable to that of

Conclusion

This research adds to knowledge about e-cigarette use and health indices among adolescents. E-cigarette use was shown to be significantly associated with asthma when controlling for several variables in the multivariate analysis. The findings provide a new perspective on e-cigarettes and suggest attention to possible respiratory effects from e-cigarette use and mechanisms of how e-cigarette use could affect health-related variables as well as behavioral variables (Cho and Paik, 2016, Lerner et

Acknowledgments

We thank the staff of the Hawaii Department of Health for assisting with access to the data and providing information for the analysis.

Contributors

RJS obtained the data set, conceptualized the manuscript, co-wrote the first draft, and reviewed drafts of the manuscript critically for important intellectual content. TAW assisted with conceptualizing the manuscript, performed the initial data analyses, co-wrote the first draft, and reviewed drafts of the manuscript critically for important intellectual content. EKT assisted with conceptualization of the manuscript and reviewed drafts of the manuscript critically for important intellectual

Funding

This research was supported by grants R01 CA153145 and P30 CA071789-16S2 from the National Cancer Institute (TAW). Dr. Choi's effort was supported by the Division of Intramural Research, National Institute on Minority Health and Health Disparities. The content is solely the responsibility of the authors and does not necessarily reflect the views of the National Institutes of Health.

Conflicts of interest

None.

Ethics approval

This study was approved by the Institutional Review Board for the University of Hawaii.

References (51)

  • J.L. Barrington-Trimis et al.

    E-cigarettes and future cigarette use

    Pediatrics

    (2016)
  • A.F. Beck et al.

    Role of financial and social hardships in asthma racial disparities

    Pediatrics

    (2014)
  • N.D. Brener et al.

    Reliability of the Youth Risk Behavior Survey questionnaire

    Am. J. Epidemiol.

    (1995)
  • R.D. Brook et al.

    Particulate matter air pollution and cardiovascular disease: an update to the scientific statement from the American Heart Association

    Circulation

    (2010)
  • Centers for Disease Control and Prevention

    Methodology of the youth risk behavior surveillance system — 2013

    MMWR Morb. Mortal. Wkly Rep.

    (2013)
  • Centers for Disease Control and Prevention

    Current Asthma Prevalence

    (2015)
  • J.H. Cho et al.

    Association between electronic cigarette use and asthma among high school students in South Korea

    PLoS One

    (2016)
  • J. Cohen et al.

    Applied multiple regression/correlation analysis for the behavioral sciences

    (1988)
  • J.C. Duke et al.

    Exposure to electronic cigarette television advertisements among youth and young adults

    Pediatrics

    (2014)
  • C. Edwards et al.

    A review of the literature on Native Hawaiian youth and drug use

    J. Ethn. Subst. Abus.

    (2010)
  • J. Gennuso et al.

    The relationship between asthma and obesity in urban minority children and adolescents

    Arch. Pediatr. Adolesc. Med.

    (1998)
  • K. Glanz et al.

    Ethnicity, sense of coherence, and tobacco use among adolescents

    Ann. Behav. Med.

    (2005)
  • M.L. Goniewicz et al.

    Levels of selected carcinogens and toxicants in vapour from electronic cigarettes

    Tob. Control.

    (2014)
  • R. Grana et al.

    E-cigarettes: a scientific review

    Circulation

    (2014)
  • J.H. Hwang et al.

    Electronic cigarette inhalation alters innate immunity and airway cytokines while increasing the virulence of colonizing bacteria

    J. Mol. Med.

    (2016)
  • Cited by (114)

    View all citing articles on Scopus
    View full text