Smoking prevalence has decreased over the last several decades in the United States. However, new generations of tobacco and non-tobacco products such as electronic cigarettes (e-cigarettes) are being increasingly used, particularly in the young adult population. E-cigarettes are battery-powered devices that heat a liquid in order to develop vaporized products, including nicotine and marijuana. While originally thought to be less harmful than traditional cigarettes, e-cigarettes have been shown to have significant consequences including hospitalization and mechanical ventilation. Beginning in July 2019, there have been reports of previously healthy, young individuals developing respiratory failure, with e-cigarette use being identified as an antecedent factor. This new entity, E-cigarette or Vaping Associated Lung Injury (EVALI) has resulted in bans in several states. While the prevalence of e-cigarette use, and the rise of EVALI has been studied in the general population, to our knowledge there is no existing data about the prevalence of e-cigarette use among young adults with chronic lung disease. Individuals with Cystic Fibrosis (CF) offer a unique perspective on the impact of e-cigarette use on the young adult population with lung disease. METHODS: We administered a voluntary survey for patients with CF seen at the Rhode Island Cystic Fibrosis Center, as well as for adolescent and young adult primary care patients seen in the Medicine-Pediatrics Primary Care Clinic. The survey addressed patient experience with cigarettes and e-cigarettes, perceptions of substance use, validated quality of life scales (CFQR for CF patients, RAND-SF36 for non-CF patients), and an assessment of social desirability in order to assess risk of bias. RESULTS: Preliminary results from this observational study demonstrate avoidance of tobacco products and smoking amongst patients with CF compared to an age-matched cohort of the general population (Table 1). CONCLUSIONS: Patients with CF overwhelmingly described e-cigarette use as likely to cause significant lung damage within a brief period of time. A small portion of CF patients had tried smoking in the past, but no patients were identified as having a recent smoking history. Patients without CF averaged higher quality of life measures. While feelings of anxiety, sadness, and isolation were roughly comparable between the groups, physical symptoms were notably more bothersome in the CF patient group. CLINICAL IMPLICATIONS: This study demonstrates different social behaviors among CF and non-CF individuals in regards to cigarette and e-cigarette use. Adult CF patients were specifically able to verbalize risks associated with recreational inhalational products implying that a targeted educational program about EVALI is likely not necessary.
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