COLUMBUS, Ohio – Youths are at risk for lingering respiratory symptoms – including bronchitis symptoms and shortness of breath – after electronic cigarette (e-cigarette) use, regardless of whether they or others smoke around them. In this new report, researchers with the Center for Tobacco Research at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) and the Southern California Keck School of Medicine show that these negative health effects of e-cigarette use exist independent of cannabis or traditional cigarette use. Previously reported studies have looked primarily at dual-usage scenarios – for example, using e-cigarettes while also using cannabis or traditional cigarettes. Researchers say this data should be considered in ongoing regulatory decisions around the sale of e-cigarette products. “This study contributes to emerging evidence from human and toxicological studies that e-cigarette use is associated with increased risk for developing respiratory symptoms and it should be considered in the regulation of e-cigarettes to minimize the health impact of e-cigarette product use among young people,” said Alayna Tackett, PhD, a pediatric psychologist and researcher with the with Center for Tobacco Research at the OSUCCC – James. Tackett and colleagues at the Southern California Keck School of Medicine published their findings in the Aug. 15 issue of the journal Thorax.  Study methods and results E-cigarette use among youth has rapidly risen from an estimated 1.5% of high school students using these products, peaking at 25.7% in 2019. The most recent estimate (2022) is that 14.5% of high school students have vaped. It is also known that e-cigarette aerosol contains substances that harm the lungs, including flavorings and oxidant metals with known pulmonary toxicity. For this study, researchers wanted to understand how e-cigarette use impacted youth respiratory health. In 2014, they asked 2,097 youths (mean age of 17.3 years) from the Southern California Children’s Health Study to complete a school-based survey about e-cigarette, regular tobacco and cannabis use. Information about lifetime usage and most recent 30-day use of e-cigarettes, cannabis and cigarettes was collected using online surveys in three additional waves: 2015 (1,609 youths surveyed), 2017 (1,502 surveyed) and 2018 (1,637 surveyed). Participants were mostly white Hispanic and evenly split between male and female. In this study, bronchitic symptoms were defined as a daily cough for three months in a row or bronchitis in the previous 12 months, or congestion or phlegm other than when accompanied by a cold. Wheeze was defined as wheezing or whistling in the chest in the previous 12 months. Shortness of breath was defined as occurring in response to hurrying on level ground or walking up a slight hill.  The final analysis included 2,094 young people, almost half of whom were women. At wave 1, the only time this question was asked, 476 (23%) respondents reported a lifetime history of asthma.  Current wheeze and shortness of breath varied by wave, with bronchitic symptoms the most commonly reported symptom at each wave: 19.5%, 22.5%, 23.5% and 26%, respectively. Prevalence of past 30-day e-cigarette use was under 12% at waves 1 and 2 and 11% (at wave 3), but it increased to more than 15% at wave 4.  Past 30-day e-cigarette use was associated with an increased risk of wheeze, bronchitic symptoms, and shortness of breath after adjusting for personal use, and secondhand exposure to, cigarette and/or cannabis smoke. The odds of wheeze was 81% more likely among past 30-day e-cigarette users than among never users; of bronchitic symptoms twice as likely, and shortness of breath 78% more likely after accounting for survey wave, age, sex, race and parental education. &#x2028 Further adjustment for concurrent use of cigarettes and cannabis and secondhand exposure to e-cigarettes, cigarettes and/or cannabis slightly weakened all the observed associations.  These findings add to the growing literature of prospective research highlight that e-cigarette use is an independent risk factor for poor respiratory outcomes. But this is just one piece of a complex public health puzzle, said Tackett. “The tobacco industry has left a legacy of long-term adult combustible cigarette users who are now trying to quit with the aid of e-cigarette devices. We are still learning about the long-term impacts of e-cigarettes, but we know based on existing literature that they likely pose fewer health risks to individuals than combustible cigarettes,” said Tackett. “E-cigarettes are by no means risk-free, however, especially without careful regulation of flavorings and chemical additives that still exist in some products currently. Limiting the initiation of e-cigarette use by non-smokers is a critical public health goal, especially for younger generations who becoming addicted to e-cigarettes.” Coauthors in this study include Robert Urman, Jessica Barrington-Trimis, Feifei Liu, Hanna Hong, Mary-Ann Pentz, Talat Islam, Sandrah Eckel, Meghan Rebuli, Adam Leventhal, Jonathan Samet, Kiros Berhane and Rob McConnell, first author of the study. Funding support comes from the National Institutes of Health and Hastings Foundation. ### Media Contact:&#x2028Amanda Harper, Associate Director&#x2028614-685-5420 | Amanda.Harper2@osumc.edu