Teens with Asthma Favor E-cigs, Hookah

June 7, 2019

Middle/high school students with asthma were found more likely to use 5 different tobacco products vs classmates without asthma.

This short slide show offers highlights of a study recently published in Morbity and Mortality Weekly Report titled "Tobacco Product Use Among Youths With and Without Lifetime Asthma -- Florida, 2016." Although reasons behind the findings are not explored, the results themselves should prompt clinicians in primary care to carefully assess young patients, and especially those with asthma or at risk for the disease, for use of any tobacco product type -- and to counsel on the dangers all of them pose to health and wellbeing.

The Siren Call of Tobacco. The increasing availability and expanding choice of tobacco products has complicated patterns of tobacco use among youth. Young people with asthma adopt health risk behaviors, including smoking, at rates similar to or higher than peers without asthma, compounding the challenge of disease management.

New Survey, More Students, More Products.¹Florida Department of Health analyzed data from the 2016 Florida Youth Tobacco Survey of middle/high school students with/without asthma; assessed use of 1 or more of 5 tobacco product types: Cigarettes, e-cigarettes, hookah, smokeless tobacco products, cigars.

"Use" Defined. Current use of tobacco products = Use on ≥1 days during the past 30 days. Any tobacco product use = Current use of ≥1 tobacco products. Multiple tobacco product use = Current use of ≥2 products.

Students with AsthmaTobacco Product Types Used. E-cigarettes were the most commonly used tobacco product type among middle and high school students with asthma.

Students with Asthma Use More. Current use of each tobacco product type was considerably higher among students with asthma than among those without asthma.

"But, e-cigarettes are Safer." Anonymous survey on tobacco product use among 3000 high school students included 4-item measure of nicotine dependence. Measure was previously validated in adults who vape.

Does Vaping Create Dependence? Mean e-cigarette dependence score 2.3 (range, 0-4). Higher dependence score associated with using liquid e-nicotine, concomitant cigarette smoking, *older current age, younger age at initiation of vaping, vaping more frequently.
Authors note more than ½ sample reported at least 1 symptom of dependence

Take Home Points

Current use of 5 different tobacco product types, use of multiple products found significantly higher in youth with asthma vs without asthma.

E-cigarettes were most commonly reported tobacco product type used by both middle/high school students with asthma.

High-school users of e-cigarettes exhibit elevated scores on nicotine-dependence measure; questions could be used to challenge beliefs that vaping is non-addictive.

Statewide targeted tobacco prevention programs could help reduce use of all forms of tobacco/nicotine among young people, especially among those with asthma

References:

1. Reid KM, Forrest JR, Porter L. Tobacco product use among youths with and without lifetime asthma - Florida, 2016. MMWR Morb Mortal Wkly Rep. 2018;67:599–601. DOI: http://dx.doi.org/10.15585/mmwr.mm6721a2.

2. Morean ME, Krishnan-Sarin S, O’Malley S. Assessing nicotine dependence in adolescent E-cigarette users: The 4-item Patient-Reported Outcomes Measurement Information System (PROMIS) Nicotine Dependence Item Bank for electronic cigarettes. Drug Alcohol Depend. 2018;188:60-63. doi: 10.1016/j.drugalcdep.2018.03.029. [Epub ahead of print]