Original Article

CME Article: Use of e-Cigarettes and Development of Respiratory Conditions in Women of Childbearing Age

Authors: Tarang Parekh, MBBS, MSc, Constance Owens, MPH, Kathryn Fay, RN, MHA, Joseph Phillips, MHA, Panagiota Kitsantas, PhD

Abstract

Objective: Women of childbearing age are encouraged not to smoke because of well-documented adverse health outcomes. This study examines the association between e-cigarette use and respiratory conditions (asthma and chronic obstructive pulmonary disease [COPD]) among women of childbearing age.

Methods: The study used data from the Behavioral Risk Factor Surveillance System 2016–2017. The sample consisted of 131,965 women of childbearing age (18–44 years old). The main independent variable was smoking status and the primary outcomes were self-reported respiratory conditions such as asthma and COPD. Data were analyzed using descriptive statistics and multivariate logistic regression to assess the effects of e-cigarettes on asthma and COPD.

Results: In this sample of childbearing-age women, 2.79% were current e-cigarettes users with or without a history of combustible cigarette smoking and 3.02% were current dual users. Compared with nonsmokers, current e-cigarette users without a history of combustible cigarette smoking were associated with 74% higher odds of having asthma (adjusted odds ratio [AOR] 1.74, 95% confidence interval [CI] 1.29–2.35), whereas results were not significant for COPD. The odds of having COPD, however, were 3 times higher (AOR 3.28, 95% CI 2.62–4.12) for current e-cigarette users with a history of cigarette smoking, whereas current dual users showed 5 times higher odds (AOR 5.07, 95% CI 3.91–6.56) of COPD compared with nonsmokers.

Conclusion: Policies related to e-cigarettes need to be reevaluated and clearly communicated to improve prevention efforts for women of childbearing age.

 
Posted in: Asthma2

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References

1. Centers for Disease Control and Prevention. History of the Surgeon General’s reports on smoking and health. https://www.cdc.gov/tobacco/data_statistics/sgr/history/index.htm. Accessed June 16, 2020. 2. Centers for Disease Control and Prevention. Asthma surveillance data. https://www.cdc.gov/asthma/asthmadata.htm. Accessed June 16, 2020. 3. Centers for Disease Control and Prevention. Basics about COPD. https://www.cdc.gov/copd/basics-about.html#anchor_1510688265385. Accessed June 16, 2020. 4. Practice Committee of the American Society for Reproductive Medicine, Practice Committee of the American Society for Reproductive Medicine. Smoking and infertility: a committee opinion. Fertil Steril 2018;110:611–618. 5. Wong MK, Barra NG, Alfaidy N, et al. Adverse effects of perinatal nicotine exposure on reproductive outcomes. Reproduction 2015;150:R185–R193. 6. Grana R, Benowitz N, Glantz SA. E-cigarettes: a scientific review. Circulation 2014;129:1972–1986. 7. Chivers LL, Hand DJ, Priest JS, et al. E-cigarette use among women of reproductive age: impulsivity, cigarette smoking status, and other risk factors. Prev Med 2016;92:126–134. 8. Spindel ER, McEvoy CT. The Role of nicotine in the effects of maternal smoking during pregnancy on lung development and childhood respiratory disease. Implications for dangers of e-cigarettes. Am J Respir Crit Care Med 2016;193:486–494. 9. Garcia-Arcos I, Geraghty P, Baumlin N, et al. Chronic electronic cigarette exposure in mice induces features of COPD in a nicotine-dependent manner. Thorax 2016;71:1119–1129. 10. Shields PG, Berman M, Brasky TM, et al. A review of pulmonary toxicity of electronic cigarettes in the context of smoking: a focus on inflammation. Cancer Epidemiol Biomark Prev 2017;26:1175–1191. 11. Wang TW. Tobacco product use among middle and high school students—United States, 2011–2017. MMWR Morb Mortal Wkly Rep 2018;67:629–633. 12. Eltorai AE, Choi AR, Eltorai AS. Impact of electronic cigarettes on various organ systems. Respir Care 2019;64:328–336. 13. Parekh T, Pemmasani S, Desai R. Risk of stroke with e-cigarette and combustible cigarette use in young adults. Am J Prev Med 2020;58:446–452. 14. Hajek P. Electronic cigarettes for smoking cessation. Lancet 2013;382:1614–1616. 15. Glantz SA. The evidence of electronic cigarette risks is catching up with public perception. JAMA Netw Open 2019;2:e191032. 16. McMillen RC, Gottlieb MA, Shaefer RMW, et al. Trends in electronic cigarette use among U.S. adults: use is increasing in both smokers and nonsmokers. Nicotine Tob Res 2015;17:1195–1202. 17. US Department of Health and Human Services, Centers for Disease Control and Prevention. 2016 Surgeon General's report: e-Cigarette use among youth and young adults. A Report of the Surgeon General. https://www.cdc.gov/tobacco/data_statistics/sgr/e-cigarettes/index.htm. Accessed August 8, 2020. 18. Campaign for Tobacco-Free Kids, American Academy of Pediatrics, American Cancer Society Cancer Action Network, American Heart Association, American Lung Association and Truth Initiative. Federal judge rules FDA acted illegally in delaying required review of e-cigarettes, cigars. https://newsroom.heart.org/news/federal-judge-rules-fda-acted-illegally-in-delaying-required-review-of-e-cigarettes-cigars#:~:text=May%2016%2C%202019-,Federal%20Judge%20Rules%20FDA%20Acted%20Illegally%20in,Review%20of%20E%2DCigarettes%2C%20Cigars&text=Judge%20Grimm%20ruled%20that%20the,the%20obligations%20of%20the%20law.%E2%80%9D. Accessed June 16, 2020. 19. Centers for Disease Control and Prevention. About electronic cigarettes (ecigarettes). https://www.cdc.gov/tobacco/basic_information/e-cigarettes/about-e-cigarettes.html. Accessed June 16, 2020. 20. Ambrose BK, Rostron BL, Johnson SE, et al. Perceptions of the relative harm of cigarettes and e-cigarettes among U.S. youth. Am J Prev Med 2014;47(2 suppl 1):S53–S60. 21. Pepper JK, Brewer NT. Electronic nicotine delivery system (electronic cigarette) awareness, use, reactions and beliefs: a systematic review. Tob Control 2014;23:375–384. 22. Kahr MK, Padgett S, Shope CD, et al. A qualitative assessment of the perceived risks of electronic cigarette and hookah use in pregnancy. BMC Public Health 2015;15:1273. 23. Wigginton B, Gartner C, Rowlands IJ. Is it safe to vape? Analyzing online forums discussing e-cigarette use during pregnancy. Womens Health Issues 2017;27:93–99. 24. Wagner NJ, Camerota M, Propper C. Prevalence and perceptions of electronic cigatette use during pregnancy. Matern Child Health J 2017;21:1655–1661. 25. Kapaya M, D’Angelo DV, Tong VT, et al. Use of electronic vapor products before, during, and after pregnancy among women with a recent live birth—Oklahoma and Texas, 2015. MMWR Morb Mortal Wkly Rep 2019;68:189–194. 26. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System About BRFSS. https://www.cdc.gov/brfss/about/index.htm. Accessed March 11, 2020. 27. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System. 2016 summary data quality report. https://www.cdc.gov/brfss/annual_data/2016/pdf/2016-sdqr.pdf. Published June 29, 2017. Accessed June 16, 2020. 28. Centers for Disease Control and Prevention. The Behavioral Risk Factor Surveillance System. 2017 summary data quality report. https://www.cdc.gov/brfss/annual_data/2017/pdf/2017-sdqr-508.pdf. Published June 13, 2018. Accessed June 16, 2020. 29. Wheaton AG, Cunningham TJ, Ford ES, et al. Employment and activity limitations among adults with chronic obstructive pulmonary disease—United States, 2013. MMWR Morb Mortal Wkly Rep 2015;64:289–295. 30. Ford ES, Croft JB, Mannino DM, et al. COPD Surveillance—United States, 1999–2011. Chest 2013;144:284–305. 31. Mirbolouk M, Charkhchi P, Kianoush S, et al. Prevalence and distribution of e-cigarette use among U.S. adults: Behavioral Risk Factor Surveillance System, 2016. Ann Intern Med 2018;169:429–438. 32. Wills TA, Pagano I, Williams RJ, Tam EK. E-cigarette use and respiratory disorder in an adult sample. Drug Alcohol Depend 2019;194:363–370. 33. Centers for Disease Control and Prevention. LLCP 2016 Codebook Report. Overall version data weighted with _LLCPWT. Behavioral Risk Factor Surveillance System. https://www.cdc.gov/brfss/annual_data/2016/pdf/codebook16_llcp.pdf. Published August 3, 2017. Accessed February 5, 2020. 34. Centers for Disease Control and Prevention. LLCP 2017 Codebook Report. Overall version data weighted with _LLCPWT. Behavioral Risk Factor Surveillance System. https://www.cdc.gov/brfss/annual_data/2017/pdf/codebook17_llcp-v2-508.pdf. Published October 9, 2018. Accessed February 10, 2020. 35. Parekh T, Pemmasani S, Desai R. Marijuana use among young adults (18–44 years of age) and risk of stroke: a Behavioral Risk Factor Surveillance System Survey analysis. Stroke 2020;51:308–310. 36. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System: weighting BRFSS data. https://www.cdc.gov/brfss/annual_data/2016/pdf/weighting_the-data_webpage_content.pdf. Accessed June 16, 2020. 37. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System: weighting BRFSS data. https://www.cdc.gov/brfss/annual_data/2017/pdf/weighting-2017-508.pdf. Accessed June 16, 2020. 38. McConnell R, Barrington-Trimis JL, Wang K, et al. Electronic cigarette use and respiratory symptoms in adolescents. Am J Respir Crit Care Med 2017;195:1043–1049. 39. Viswam D, Trotter S, Burge PS, et al. Respiratory failure caused by lipoid pneumonia from vaping e-cigarettes. BMJ Case Rep 2018;2018:bcr2018224350. 40. Callahan-Lyon P. Electronic cigarettes: human health effects. Tob Control 2014;23(suppl 2):ii36–ii40. 41. Kosmider L, Sobczak A, Fik M, et al. Carbonyl compounds in electronic cigarette vapors: effects of nicotine solvent and battery output voltage. Nicotine Tob Res Off J Soc Res Nicotine Tob 2014;16:1319–1326. 42. Jensen RP, Luo W, Pankow JF, et al. Hidden formaldehyde in e-cigarette aerosols. N Engl J Med 2015;372:392–394. 43. Barrington-Trimis JL, Samet JM, McConnell R. Flavorings in electronic cigarettes: an unrecognized respiratory health hazard? JAMA 2014;312:2493–2494. 44. Staudt MR, Salit J, Kaner RJ, et al. Altered lung biology of healthy never smokers following acute inhalation of E-cigarettes. Respir Res 2018;19:78. 45. Toyooka S, Tsuda T, Gazdar AF. The TP53 gene, tobacco exposure, and lung cancer. Hum Mutat 2003;21:229–239. 46. Siu AL, U.S. Preventive Services Task Force. Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2015;163:622–634. 47. Drake P, Driscoll AK, Mathews TJ. Cigarette smoking during pregnancy: United States, 2016. https://www.cdc.gov/nchs/products/databriefs/db305.htm. Published February 2018. Accessed August 8, 2020. 48. Martin JA, Hamilton BE, Osterman MJK, et al. Births: Final Data for 2016. National Vital Statistics Reports, Vol 67, no. 1. Hyattsville, MD: National Center for Health Statistics. 2018. 49. England LJ, Anderson BL, Tong VTK, et al. Screening practices and attitudes of obstetricians-gynecologists toward new and emerging tobacco products. Am J Obstet Gynecol 2014;211:695.e1–695.e7. 50. Committee on Health Care for Underserved Women of American College Obstetricians and Gynecologists. ACOG Committee Opinion No. 511. Health care for pregnant and postpartum incarcerated women and adolescent females. Obstet Gynecol 2011;118:1198–1202. 51. Committee on Underserved Women, Committee on Obstetric Practice. Committee Opinion No. 721: smoking cessation during pregnancy. Obstet Gynecol 2017;130:e200–e204. 52. Hersh CP, DeMeo DL, Al-Ansari E, et al. Predictors of survival in severe, early onset COPD. Chest 2004;126:1443–1451. 53. Centers For Disease Control and Prevention. The Surgeon General’s 1990 Report on the Health Benefits of Smoking Cessation Executive Summary–INTRODUCTION, OVERVIEW, AND CONCLUSIONS. https://www.cdc.gov/mmwr/preview/mmwrhtml/00001801.htm. Accessed June 16, 2020. 54. Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study. JAMA 1994;272:1497–1505. 55. Kanner RE, Connett JE, Williams DE, et al. Effects of randomized assignment to a smoking cessation intervention and changes in smoking habits on respiratory symptoms in smokers with early chronic obstructive pulmonary disease: the Lung Health Study. Am J Med 1999;106:410–416. 56. Parekh T, Desai R. Response by Parekh and Desai to letter regarding article, “Marijuana Use Among Young Adults (18–44 Years of Age) and Risk of Stroke: A Behavioral Risk Factor Surveillance System Survey Analysis”. Stroke 2020;51:e92. 57. Parekh T, Desai R. Response: risk is not causation. Am J Prev Med 2020;58:896–897.