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Smoking, e-cigarettes and the effect on respiratory symptoms

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INTRODUCTION E-cigarettes have been steadily increasing in popularity, both as cessation methods for smoking and for recreational and social reasons. This increase in vaping may pose cardiovascular and respiratory risks. We aimed to assess respiratory symptoms in youth users of e-cigarettes and cigarettes. METHODS A retrospective survey design was utilized to assess Canadian youth aged 16–25 years. Participants were recruited from the Ontario Tobacco Research Unit Youth and Young Adult Research Registration Panel November 2020 to March
2021. A total of 3082 subjects completed the baseline survey. Of these, 2660 individuals who did not have asthma were included in the analysis. The exposure of interest was pack-equivalent years, a novel measure of vaping exposure equivalent conceptually to cigarette pack years incorporating number of puffs per day, number of days vaped per month, and number of years vaped. Respiratory symptoms were measured using the five-item Canadian Lung Health Test. Poisson regression analyses were performed while adjusting for demographic confounders, stratified by smoking status. A non-stratified model tested the interaction of status and vaping dose and the effect of vaping device used was assessed among ever vapers. Analyses controlled for demographic characteristics, use of cannabis and alcohol, and survey date.

This study also builds on previous results via the inclusion of a vaping-only group, as well as via the inclusion of youth participants, which allows for more specified results and interpretations. Though the specification of age may limit generalizability to the overall population, it also allows for increased accuracy and reliability in constructing prevention and treatment plans for youth. Additional studies that monitor exact number of cigarettes smoked and e-cigarette puffs among single users versus dual users are needed to confirm this. Those who vaped pod like devices reported higher levels of symptoms compared to ‘mod’-type devices after controlling for puff year. This finding is consistent with previous results wherein adolescents reported experiencing worse respiratory symptoms when using specific vape brands and products, particularly JUUL, a pod device with a nicotine-salt

liquid. As was expected, subjects with a longer history of vaping experienced more respiratory symptoms than newer vapers, as they have likely inhaled a larger number of total puffs.

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