Electronic cigarette use patterns and chronic health conditions among people experiencing homelessness in MN: a statewide survey

Abstract

Background Adults experiencing homelessness have higher rates of disease and premature morbidity compared to the general population. Tobacco use is a primary contributing factor to these disparities; however, less is known regarding e-cigarette use patterns among adults experiencing homelessness and whether e-cigarettes are used in a manner that is narrowing or widening health disparities. This study aimed to describe the 1) prevalence and trends in e-cigarette use, 2) correlates of e-cigarettes use, and 3) rates of chronic health conditions by product use pattern in a community-based sample of adults experiencing homelessness. Methods Adults experiencing homelessness in Minnesota were surveyed by self-report in 2015 (n = 3672) and 2018 (n = 4181) regarding e-cigarette and combustible cigarette use, potential correlates of e-cigarette use, and self-reported chronic health conditions (i.e., asthma, hypertension, diabetes, and cancer). Results Frequency of use increased from 2015 to 2018 for combustible cigarettes (66.9% vs. 72.3%), e-cigarettes (11.4% vs. 14.5%), and dual combustible/e-cigarette use (10.2% vs. 12.9%). The strongest bivariate correlates of past 30-day e-cigarette use were younger age, non-binary gender identification, non-heterosexual orientation, identification as White/Caucasian, greater frequency of lifetime homelessness, substance use, lack of regular place for medical care, mental health diagnosis, criminal justice involvement, and combustible cigarette smoking. Dual users had significantly higher rates of asthma and cancer than both those using combustible cigarettes and those using neither combustible nor e-cigarettes. Conclusions During a time when cigarette smoking, e-cigarette use, and dual use were decreasing in the general population in Minnesota, rates increased in the homeless population. We observed that the rates of dual use were more than five times greater among homeless adults compared to the general population in 2018. Correlates of e-cigarette use were identified and should be used to identify subpopulations for intervention targeting. Mechanisms of the relationship between dual use and increased risks of health conditions deserve further study.

Electronic Cigarettes and Asthma: What Do We Know So Far?

“…Dual use, which is the most common usage pattern, is riskier than using either product alone [ 87 ]. Dual use, with even passive exposure to EC, was identified as significant predictor for asthma in two more cross-sectional studies [ 73 , 92 ] and one meta-analysis [ 93 ]. A recently published systematic review concluded that evidence up to now suggests that the side effects of ECs may be exaggerated in people with asthma [ 32 ].…”

“…Adolescents with asthma were more likely to be dependent on nicotine compared to their non-asthmatic counterparts [ 115 , 116 ]; they started smoking earlier because of curiosity about cigarettes and continued because it improved their stress and anxiety [ 116 ]. There is strong evidence that bad mental health is associated with EC in asthmatics as well as with tobacco cigarette and illicit substance use [ 92 , 96 , 110 ]. This population was at increased risk of dual use of conventional cigarettes and EC and those who used ECs presented higher tobacco cigarette smoking susceptibility [ 85 , 90 , 103 , 115 ].…”

“…Furthermore, dual users reported consuming a significantly greater number of cigarettes per day compared to cigarette only users and dual use was not associated with reduced exposure to cigarettes [ 95 ]. In addition to that, dual use showed the strongest association with lifetime asthma compared to other forms of EC use [ 71 , 92 ]. Moreover, in adults with asthma, current smokers were more likely to have tried ECs than former/never smokers [ 83 , 118 ], and smoking status was the most consistent predictor of EC use among all age groups [ 118 ].…”

Emergency Department Utilization, Hospital Admissions, and Office-Based Physician Visits Among Under-Resourced African American and Latino Older Adults

“…Also, in multivariate analysis, controlling for all other relevant variables, a higher number of hospital admissions was found among current smokers, participants with lower level of physical and mental health-related quality of life, and self-reported binge drinking. It is established that cigarette smoking exacerbates the severity of chronic illnesses and impairs successful symptoms management [72][73][74]. Knowing that racial and ethnic minority middle-aged and older adults are at greater risk for chronic disease morbidity than their non-Latino White counterparts, effective interventional studies must target racial and ethnic minority older smokers with co-morbidities [75].…”

E-Cigarette Use among Current Smokers Experiencing Homelessness

“…As the landscape of available tobacco products has evolved to include alternative tobacco and nicotine products, the patterns of tobacco use have also changed among PEH. Two-thirds of current smokers who experience homelessness report the use of alternative tobacco products, including blunts and cigarillos (little cigars) or electronic nicotine delivery systems, with e-cigarettes being the most common form [ 6 , 7 , 8 , 9 ]. The concurrent use of these products and cigarette smoking might suggest increased nicotine dependence; however, few studies have explored this among PEH.…”