Research BriefRisk of Stroke With E-Cigarette and Combustible Cigarette Use in Young Adults
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INTRODUCTION
The use of e-cigarettes has increased considerably among smokers and nonsmokers in the U.S. since 2010.1, 2, 3 The potential ingredients that contribute to an adverse cardiovascular state with e-cigarette smoking include nicotine, oxidants, aldehydes, particulates, and flavorants, as well as lead in certain disposable devices.4,5 A meta-analysis of 14 studies including 441 participants corroborates the acute adverse effects of e-cigarette use on heart rate and blood pressure.6 However, the
METHODS
This study analyzed data from the 2016–2017 Behavior Risk Factor Surveillance System (BRFSS) in 2019 to investigate the prevalence of e-cigarette and combustible cigarette-use among young adults aged 18–44 years. BRFSS is a national annual, cross-sectional health survey conducted jointly by the Centers for Disease Control and Prevention, all U.S. states, and participating territories.11 The authors assessed e-cigarette and combustible cigarette use and stroke using standard questions from the
RESULTS
This analysis included 161,529 participants aged 18–44 years (women, 53.1%; white, 50.6%; Hispanic, 23.9%; income ≥$50,000, 47.9%; unmarried, 50.3%). Of current sole e-cigarette users, most were aged 18–24 years (68.9%), and most current sole combustible cigarette users were aged 35–44 years (47.2%). Compared with nonsmoking, current sole e-cigarette-use and current dual use were associated with higher rates of college dropout or high school graduation, unmarried status, obesity, and binge
DISCUSSION
This cross-sectional study found significantly higher odds of stroke among current dual users compared with nonsmokers and current sole combustible cigarette users, respectively. Furthermore, current sole e-cigarette use was not associated with higher odds of stroke as compared with nonsmokers, although odds were lower compared with current sole combustible cigarette use. These findings have clear implications for physicians, public health agencies, and tobacco product regulation authorities.
CONCLUSIONS
These findings suggest higher odds of stroke in current sole combustible cigarette smokers or current dual users compared with nonsmokers aged 18–44 years. Sole e-cigarette use was not independently associated with stroke events in young adults. Switching from combustible cigarette smoking to e-cigarette use did not curtail risk of stroke in young adults. These findings emphasize the critical need to conduct longitudinal studies exploring the clear benefit and risks of current smoking-cessation
ACKNOWLEDGMENTS
The authors thank Alison Cuellar (George Mason University, Fairfax) for her comments on an earlier version of the manuscript.
All authors contributed equally and have reviewed and approved the final manuscript as submitted.
No financial disclosures were reported by the authors of this paper.
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