Estimating the Population Attributable Fraction of Asthma Due to Electronic Cigarette Use and Other Risk Factors Using Kentucky Behavioral Risk Factor Survey Data, 2016–2017

Abstract

Introduction: Electronic nicotine delivery systems ENDS have become popular in the United States among both new users of nicotine and those seeking less harmful alternatives to traditional cigarettes. Users often perceive ENDS as being less harmful than traditional cigarettes. This study investigated the relationship between use of ENDS and asthma in a representative sample of adults. Methods: For this cross-sectional study, we used data from the Kentucky Behavioral Risk Factor Surveillance System telephone survey data from 2016-2017. Using a weighted multivariable logistic regression analysis, we identified important covariates to adjust for to calculate the population attributable fraction (PAF) of asthma due to ENDS and other modifiable risk factors factors (cigarette use, obesity, education, and employment). The confidence intervals for the PAFs were estimated using bootstrap methods of variance estimation. Results: We found that 10.6% of those aged 18-30 reported currently had asthma. After adjusting for noted covariates, ENDS use did not significantly increase the odds of asthma. In the final PAF model, the PAF of asthma due to ENDS was 0.4% (95% CI:-5.41, 6.21). Conclusion: While these findings suggest only modest effects of ENDS use on asthma prevalence, future research including older age groups and more long-term users might produce different results.

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

“…Several investigators have concluded that EC could be associated with the development of pulmonary disorders, including asthma and might increase asthma severity and exacerbations [ 18 , 31 , 61 , 62 , 63 , 64 ]. Numerous cross-sectional studies with a large number of participants have described the significant association between EC use and even secondhand exposure and asthma diagnosis and severity [ 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 ], compared to the few studies which found no association [ 75 , 76 ], or even negative association between EC use and asthma [ 77 , 78 ]. A prospective cohort study also found that EC use was associated with an increased risk of developing respiratory disease, including asthma, independent of cigarette smoking [ 79 ].…”

Approaches to quantify the contribution of multiple anemia risk factors in children and women from cross-sectional national surveys

“…Although the interpretation of average AF involves reduction of cases after removal of other risk factors, which is different from traditional AF, average AF estimates appeared to be comparable to those using adjusted PR in our applications; the small differences observed are unlikely to affect programmatic decisions. These findings are timely as population-based evaluations of anemia are frequently conducted [2,5,6,21,38,[43][44][45] and require guidance PLOS GLOBAL PUBLIC HEALTH on best practice for these types of analyses to inform public health interventions to combat anemia [4].…”

Use of Electronic Nicotine Delivery Systems and Age of Asthma Onset Among US Adults and Youths

“… 12 , 13 , 14 , 15 Previous studies have examined the differences by biological sex of the age of asthma onset in adults 16 , 17 , 18 and youths, 19 , 20 but not with recent data. Several studies, 21 , 22 , 23 , 24 but not all, 25 , 26 have reported that ENDS use is associated with increased risk of asthma in adults 21 , 22 and youths 23 , 24 after controlling for other tobacco product (TP) use. While these studies have merit, there is a substantial gap in the field because prior studies have not examined the age of asthma onset with recent data or the association of P30D ENDS use with age of asthma onset for adults and for youths.…”