Electronic cigarette use and mental health: A Canadian population-based study

Pham, Tram; Williams, Jeanne V.A.; Bhattarai, Asmita; Dores, Ashley K.; Isherwood, Leah J.; Patten, Scott B.

doi:10.1016/j.jad.2019.09.026

Cited by 46 publications

(44 citation statements)

References 18 publications

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“…Data from the Canadian Community Health Survey have revealed adverse mental health to be associated with e-cigarette use in adolescents and adults. 41 Additionally, a recent survey of students at 2 Midwestern universities suggested that e-cigarette users were more likely to engage in illicit drug use; to have a history of posttraumatic stress disorder, attention-deficit/hyperactivity disorder, or anxiety; to have poorer self-esteem; and to have depressive symptoms. 42 A detailed psychosocial screening was an important part of the evaluation of EVALI and should be linked with appropriate outpatient referrals, including for chemical dependency management.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features of E-cigarette, or Vaping, Product Use–Associated Lung Injury in Teenagers

et al. 2020

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BACKGROUND: In the United States in 2019, there was an outbreak of electronic cigarette, or vaping, product use-associated lung injury (EVALI). The manifestations of EVALI in adolescents are not well characterized. We describe the diagnosis, evaluation, and management of EVALI in adolescents hospitalized at a tertiary care, university-affiliated children's hospital. METHODS:A multidisciplinary committee developed an EVALI algorithm on the basis of guidelines from the Centers for Disease Control and Prevention. A retrospective chart review was conducted on patients diagnosed with EVALI. Descriptive analyses included sociodemographic characteristics, clinical presentation, laboratory and imaging results, pulmonary function testing, oxygen requirements, and clinic follow-up.RESULTS: Thirteen hospitalized adolescents were diagnosed with confirmed or probable EVALI. The majority were female (54%) with a mean age of 15.9 years. Sixty-nine percent of patients presented with respiratory symptoms, whereas gastrointestinal symptoms were prominent in 85% of patients. Vaping D-9-tetrahydrocannabinol was reported in 92% of patients, and vaping nicotine was reported in 62% of patients. All had bilateral ground-glass opacities on the chest computed tomography (CT) scan. Treatment with glucocorticoids led to clinical improvement in 11 of 12 patients. Treatment with glucocorticoids led to improvement in both forced expiratory volume in 1 second and forced vital capacity (P , .05). Four patients required home oxygen on the basis of 6-minute walk test results.CONCLUSIONS: Diagnosis of EVALI should be suspected on the basis of vaping history and clinical presentation. Glucocorticoid treatment led to an improvement in symptoms and lung function. The 6-minute walk test may help determine oxygen needs at discharge. WHAT'S KNOWN ON THIS SUBJECT:The prevalence of electronic cigarette use has more than doubled among eighth-to 12thgraders over the past 2 years. An outbreak of electronic cigarette, or vaping, product use-associated lung injury (EVALI) linked to vaping D-9-tetrahydrocannabinol occurred this fall, and adolescents were among those affected.WHAT THIS STUDY ADDS: Many teenagers affected by EVALI were female, were Hispanic, and had multiple psychosocial stressors. Lung function deficits due to EVALI appear reversible with steroids. Six-minute walk test results may help identify adolescents who would benefit from home oxygen.

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Section: Discussionmentioning

confidence: 99%

Clinical Features of E-cigarette, or Vaping, Product Use–Associated Lung Injury in Teenagers

et al. 2020

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“…It is well accepted that smokers are more likely to experience depression compared to non-smokers [ 35 , 36 ], and a number of studies have found that e-cigarette users also are at greater risk for depression [ 4 , 5 , 6 , 37 ]. Separately, both vaping and depression have been independently associated with increased inflammation [ 11 , 12 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

E-Cigarette Use, Systemic Inflammation, and Depression

Farrell

Karey

et al. 2021

IJERPH

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Background: E-cigarette use (vaping) is an emerging public health problem. Depression has been found to be associated with e-cigarette use, and vaping and depression are each associated with elevated systemic inflammation. To date, the role of inflammation in the relationship between vaping and depression has not been explored. Objective: To assess the independent associations between e-cigarette use, depression, and inflammation, and to investigate whether the likelihood of depression among current e-cigarette users is associated with systemic inflammation. Methods: Nationally representative NHANES data from 2015–2018 were used (n = 4961). Systemic inflammation was defined as serum C-reactive protein (CRP) ≥ 8.0 mg/L. Depressed individuals were characterized by a score ≥ 10 on the Patient Health Questionnaire-9 (PHQ-9). Current e-cigarette users were defined as individuals who vaped at least once in the past 30 days and these individuals were stratified by use: exclusive users (reported smoking less than 100 combustible cigarettes in their lifetime), dual users (reported current use of electronic and combustible cigarettes), and e-cigarette users who were previous smokers. Bivariate analyses were used to assess independent associations between vaping, depression, and inflammation; and weighted logistic regression analyses adjusting for BMI, sex, and economic status were used to determine the odds ratios (ORs) for depression by e-cigarette category stratified by differential CRP levels. Results: Depression occurred in 16.7% of all e-cigarette users vs. 5.0% of those who never used e-cigarettes (p < 0.001). In adjusted analyses, the following elevated ORs were found: all current e-cigarette users with CRP <8 = 3.37 (95% CI: 2.06, 5.51) vs. CRP ≥8 = 6.70 (2.48, 18.11); exclusive e-cigarette users with CRP <8 = 1.91 (0.78, 4.69) vs. those with CRP ≥8 = 5.09 (1.44, 18.02); and dual users with CRP <8 = 4.31 (2.35, 7.89) vs. those with CRP ≥8 = 7.37 (1.85, 29.41). These ORs indicate that depression is associated with each category of e-cigarette use; however, we found this association did not vary by systemic inflammation level (interaction p-values > 0.05). Conclusion: While a pattern of greater ORs for depression among e-cigarette users with elevated CRP provides provocative findings that might suggest a potential role of inflammation in the association between vaping and depression, we failed to find evidence that inflammation clearly moderates this association. While it is possible that depression among e-cigarette users may be influenced by systemic inflammation, a reproduction of the current study is necessary among a larger cohort to elucidate the effect of inflammation on depression among e-cigarette users.

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“…Four cross-sectional studies 33,34,35,36 reported a positive association between e-cigarette use and self-reported depressive symptoms with wide-ranging ORs from 1.03 to 4.2.…”

Section: Resultsmentioning

confidence: 99%

“…Studies with poor definitions of smoking failed to account for quantity, duration since quitting and duration of ENDS use, dual and former use of cigarettes and ENDS. 12,13,16,17,33,36 Studies using data from the Population Assessment of Tobacco Health (PATH) and Behavioral Risk Factor Surveillance System datasets 13,16,20,22,47,48 and others, 34,31 respondents who ever used a cigarette, other tobacco product or ENDS, even once or twice, were regarded as former or current users. Those having ever experimented with cigarettes or e-cigarettes were therefore regarded in the same category as heavy smokers or daily e-cigarette users.…”

Section: Discussionmentioning

confidence: 99%

The Health Impact of Electronic Nicotine Delivery Systems: A Systematic Review

Hajat¹,

Stein²,

Shantikumar³

et al. 2020

Preprint

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Introduction The objective of this systematic review was to identify, report and critically appraise studies that have reported health outcomes from use of ENDS. Methods We conducted a systematic review of all published literature on the health impact of ENDS products from 1st January 2015 until February 1, 2020, following the PRISMA protocol, including across the databases, PubMed, Embase, Scopus and Google Scholar. Medical subject headings were used in the execution of PubMed searches. A category for the level of evidence was assigned blindly using the Centres for Evidence Based Medicine framework. A similar approach was adopted to evaluate methodological quality of each study utilizing the National Institutes for Health (NIH) Quality Assessment Tools. Results The database search identified 755 studies and a further 265 were identified from other sources and reference reviews of which 37 studies met the eligibility criteria. The majority of studies were of low strength for levels of evidence including 24 (65%) cross-sectional, 1(2.7%) case-control and six (16%) case studies. There were four (11%) cohort studies and only one (2.7%) RCT. There was only one (2.7%) meta-analysis or pooled study of observational study designs; there were no pooled results of randomized controlled trials. Of 37 studies, eight (22%) studies reported on benefits, two (2%) studies were neutral, reporting on both harm and benefits, the remaining 27 (73%) reported only on harms. The quality ratings were poor (20, 54%), fair (9, 24%) and good (8, 22%). In our review ENDS use has not been shown to be causative for any CVD outcomes and has been shown to be beneficial for hypertensive patients. Switching from cigarettes to e-cigarettes resulted in reduced exacerbations of COPD, with no evidence of long-term deterioration in lung function. There was a suggestion of short-term reductions in respiratory function in asthmatics, but no increased risk of asthma in ENDS users who were never smokers. Mental Health, cancer and mortality have not been adequately studied to form any consensus with regards to health outcomes from ENDS use. Conclusion This review found numerous gaps in the evidence base for the harms from ENDS and benefits of switching from cigarettes to ENDS. Studies are skewed towards those reporting on negative health impacts from ENDS. The evidence of significant harms to health outcomes from ENDS is lacking. There is a failure of study designs to be able to rigorously establish causation. There is some evidence of positive health outcomes in those switching from cigarettes to e-cigarettes but further studies would need to replicate the findings. We lack the information required to accurately and correctly weigh the health impact of increased uptake of ENDS against the vast majority of users whose main reason for ENDS use is to quit smoking. Only with this full picture can we ensure that we are totally informed about the net impact on health outcomes from ENDS.

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Electronic cigarette use and mental health: A Canadian population-based study

Cited by 46 publications

References 18 publications

Clinical Features of E-cigarette, or Vaping, Product Use–Associated Lung Injury in Teenagers

Clinical Features of E-cigarette, or Vaping, Product Use–Associated Lung Injury in Teenagers

E-Cigarette Use, Systemic Inflammation, and Depression

The Health Impact of Electronic Nicotine Delivery Systems: A Systematic Review

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