Michael J. Blaha
Electronic cigarettes, initially marketed as a tool to quit combustible cigarette smoking, are becoming increasingly popular among young adults who do not smoke combustible cigarettes, and these sole e-cigarette users may engage in more high-risk lifestyle behaviors than nonusers, according to a study published in the Annals of Internal Medicine.
“The main takeaway from this study is that while electronic cigarettes were introduced as smoking cessation aids, many are now using as their first tobacco product,” Michael J. Blaha, MD, MPH, director of clinical research at the Ciccarone Center for the Prevention of Heart Disease and professor of medicine at Johns Hopkins University, told Cardiology Today. “These ‘sole’ electronic cigarette users are mainly young people below the age of 35. So, while some people may be using electronic cigarettes as a way to quit smoking, many people are at risk for a new nicotine addiction using a new tobacco product. There is some data to suggest that these sole electronic cigarette users are at risk for traditional combustible cigarette smoking in the future, the so-called gateway effect. In fact, sole electronic cigarette users share many of the high-risk behaviors associated with picking up a smoking habit.”
To investigate age distribution, state-level prevalence, health perceptions and behaviors of sole e-cigarette users, researchers examined data from the 2016 Behavioral Risk Factor Surveillance System (in total, 261,541 never-smokers; 1,879 sole e-cigarette users; 259,662 nonusers; all aged at least 18 years). Never-smoker was defined as someone who had smoked fewer than 100 combustible cigarettes in a lifetime.
Sole e-cigarette smokers
Researchers found that 1.4% (95% CI, 1.3-1.5) of U.S. adults, which translates to 1.9 million people were sole e-cigarette smokers in 2016, with 17.7% of them being daily users (95% CI, 15.1-20.6).
Adults aged 18 to 24 years were the highest users (approximately 1.2 million) and, compared with nonusers, a larger proportion were men (65.5% vs. 43.6%).
Michigan had the highest prevalence of e-cigarette use (2.1%; 95% CI, 1.5-2.9), whereas Alaska had the lowest (0.4%; 95% CI, 0.2-1.1).
As for health behaviors, compared with nonusers, e-cigarette users were more likely to binge drink (13.1% vs. 26.3%), use marijuana (4.2% vs. 24.9%) and to report at least 1 day with mental distress during the past 30 days (44.6% vs. 61.6%).
Furthermore, sole e-cigarette users were more likely to engage in a high-risk lifestyle (defined as having participated in IV drug use, undergone treatment for an STD, exchanged money or drugs for sex, had anal sex without a condom or had at least four sexual partners in the past year) than nonusers (14.9% vs. 5.1%).
Potential CVD risk
In addition, because the CV toxicity within e-cigarettes is unknown and because they may serve as a gateway into smoking combustible cigarettes, the risk for potential CVD must be addressed, according to Blaha, a Cardiology Today Next Gen Innovator who is also affiliated with the American Heart Association Tobacco Regulation and Addiction Center in Dallas.
“There is a concern that electronic cigarettes may have some cardiovascular toxicity, and there is definitely concern that electronic cigarette use may lead to later smoking use (gateway effect), which is a known cardiovascular risk factor,” Blaha said. “Several components of electronic cigarettes may have cardiovascular toxicity — the high doses of nicotine, flavorings, the solvent in the e-liquid, fine particular matter and trace heavy-metal exposure from the heating coil. We need to understand if sole electronic cigarette users develop a permanent habit, if this is mediated by nicotine addiction and if there is a true gateway effect to future smoking or so-called ‘dual use.’ We need more toxicology studies of electronic cigarette vapor. While electronic cigarettes are almost surely safer than smoking, it is unclear if this is half as toxic, one-third as toxic and so on.” – by Melissa J. Webb
For more information:
Michael J. Blaha, MD, MPH, can be reached at firstname.lastname@example.org; Twitter: @MichaelJBlaha.
Disclosures: Blaha reports receiving grants from the AHA, FDA and NIH/NHLBI. Please see the study for all other authors’ relevant financial disclosures.