JAMA Netw Open. 2024;7(5):e2410740. doi:10.1001/jamanetworkopen.2024.10740
Key Points
Question Is the use of electronic nicotine delivery systems (ENDS) in the past 30 days associated with the age of asthma onset among adults (≥18 years) and youths (12-17 years) who never used cigarettes?
Findings This cohort study of 7766 adults and 17 023 youths from the Population Assessment of Tobacco and Health Study (2013-2021) found that adults who used ENDS in the past 30-days had an increased risk for asthma incidence at earlier ages vs adults who did not use ENDS in the past 30 days. This finding did not hold for youths.
Meaning These findings suggest that tobacco regulations, prevention, intervention campaigns, and cessation programs are needed to prevent early age of asthma onset among adults who use ENDS, to protect public health, and to help improve asthma screening guidelines.
Abstract
Importance The association of use of electronic nicotine delivery systems (ENDS) with the age of asthma onset is unknown.
Objective To explore the association of past 30-day ENDS use with the age of asthma onset in adults and youths who did not have asthma or chronic obstructive pulmonary disease and never used cigarettes.
Design, Setting, and Participants This cohort study was a secondary analysis of waves 1 to 6 of the US nationally representative Population of Tobacco and Health Study (2013-2021). Eligible participants included adults (≥18 years) and youths (12-17 years) who did not have asthma or chronic obstructive pulmonary disease at the first wave of participation. Data analysis was conducted from September 2022 to April 2024.
Exposure Past 30-day ENDS use at the first wave of participation in the study preceding the onset of asthma.
Main outcome and measures Lower and upper age limits were estimated using the age reported at the first wave of participation and the number of weeks between follow-up waves until asthma was first reported or censored. The association of past 30-day ENDS use with the age of asthma onset was estimated using weighted interval-censoring Cox regression. The cumulative hazard function for the age of asthma onset was estimated using interval-censoring survival analysis.
Results A total of 24 789 participants were included, with 7766 adults (4461 female [weighted percentage, 59.11%] and 3305 male [weighted percentage, 40.89%]), representing 80.0 million adults, and 17 023 youths (8514 female [weighted percentage, 50.60%] and 8496 male [weighted percentage 49.32%]), representing 33.9 million youths. By age 27 years, 6.2 per 1000 adults reported asthma incidence (hazard ratio [HR], 0.62%; 95% CI, 0.46%-0.75%). While controlling for covariates, there was a 252% increased risk of the onset of asthma at earlier ages for adults who used ENDS in the past 30 days vs adults who did not (adjusted HR, 3.52; 95% CI, 1.24-10.02). For youths, there was no association of ENDS use in the past 30 days with age of asthma onset (adjusted HR, 1.79; 95% CI, 0.67-4.77), which could be due to a lack of statistical power.
Conclusion and relevance In this cohort study, past 30-day ENDS use among adults was associated with earlier ages of asthma onset. These findings suggest that prevention and cessation programs directed to adults who use ENDS are needed to educate the public, protect public health, prevent adverse health outcomes, and motivate users to stop. Furthermore, modifying symptom-screening asthma guidelines, resulting in earlier asthma detection and treatment, may reduce morbidity and mortality due to asthma.