Longitudinal Association Between Exclusive and Dual Use of Cigarettes and Electronic Nicotine Delivery Systems and Asthma Among U.S. Adolescents

Akash Patel, Steven Cook, Delvon T. Mattingly, Geoffrey D. Barnes, Douglas A. Arenberg, David T. Levy, Rafael Meza, Nancy L. Fleischer, Jana L. Hirschtick

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Purpose: Electronic Nicotine Delivery Systems (ENDS) use among adolescents has increased greatly over the past decade, but its impact on chronic respiratory health conditions, like asthma, is not fully understood. Methods: We examined data from Waves 1–5 (2013–2019) of the Population Assessment of Tobacco and Health Study using discrete time hazard models to analyze the association between time-varying tobacco product use and incident diagnosed asthma among adolescents aged 12–17 years at baseline. We lagged the time-varying exposure variable by one wave and categorized respondents by current use status (1+ days in the past 30 days): never or non-current, exclusive cigarette, exclusive ENDS, and dual cigarette and ENDS use. We also controlled for sociodemographic (age, sex, race/ethnicity, parental education) and other risk factors (urban/rural setting, secondhand smoke exposure, household combustible tobacco use, body mass index). Results: At baseline, over half the analytic sample (n = 9,141) was 15–17 years old (50.4%), female (50.2%), and non-Hispanic White (55.3%). Adolescents who exclusively smoked cigarettes had a statistically significant higher risk of incident diagnosed asthma at follow-up (adjusted Hazard Ratio (aHR): 1.68, 95% confidence interval (CI): 1.21–2.32) compared to those not currently using cigarettes or ENDS, but adolescents using ENDS exclusively (aHR: 1.25, 95% CI: 0.77–2.04) or in combination with cigarettes (aHR: 1.54, 95% CI: 0.92–2.57) did not. Discussion: Short-term exclusive cigarette use was associated with a higher risk of incident diagnosed asthma over five years of follow-up among adolescents. We did not find conclusive evidence for an association between exclusive ENDS or dual use and incident diagnosed asthma.

Original languageEnglish
Pages (from-to)437-444
Number of pages8
JournalJournal of Adolescent Health
Issue number3
StatePublished - Sep 2023

Bibliographical note

Publisher Copyright:
© 2023 Society for Adolescent Health and Medicine


  • Adolescence
  • Asthma
  • Electronic nicotine delivery systems
  • Epidemiology
  • Smoking
  • Tobacco

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Public Health, Environmental and Occupational Health
  • Psychiatry and Mental health


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