Sex Differences in E-Cigarette Use and Related Health Effects

Abstract

Background: Electronic cigarettes (e-cigarettes) comprise a variety of products designed to deliver nicotine, flavorings, and other substances. To date, multiple epidemiological and experimental studies have reported a variety of health issues associated with their use, including respiratory toxicity, exacerbation of respiratory conditions, and behavioral and physiological effects. While some of these effects appear to be sex- and/or gender-related, only a portion of the research has been conducted considering these variables. In this review, we sought to summarize the available literature on sex-specific effects and sex and gender differences, including predictors and risk factors, effects on organ systems, and behavioral effects. Methods: We searched and selected articles from 2018–2023 that included sex as a variable or reported sex differences on e-cigarette-associated effects. Results: We found 115 relevant studies published since 2018 that reported sex differences in a variety of outcomes. The main differences reported were related to reasons for initiation, including smoking history, types of devices and flavoring, polysubstance use, physiological responses to nicotine and toxicants in e-liquids, exacerbation of lung disease, and behavioral factors such as anxiety, depression, sexuality, and bullying. Conclusions: The available literature supports the notion that both sex and gender influence the susceptibility to the negative effects of e-cigarette use. Future research needs to consider sex and gender variables when addressing e-cigarette toxicity and other health-related consequences.

Sensitivity of Mouse Lung Nuclear Receptors to Electronic Cigarette Aerosols and Influence of Sex Differences: A Pilot Study

“…This has contributed to a notable shift in the United States, particularly among teenagers and young adults, from traditional tobacco cigarettes to various forms of electronic cigarettes [ 2 , 3 ]. While some of these trends have followed sex-specific patterns [ 4 ], the biological and toxicological effects of the various chemicals contained in ENDS in the male and female lung remains poorly understood [ 5 ].…”

“…For example, recent research has shown that non-phthalate plasticizers can induce endocrine-disrupting effects by engaging mechanisms regulated by NRs [ 15 ]. For these reasons, significant emphasis in current ENDS research has been directed towards scrutinizing the constituents of e-liquids, with a notable gap in the investigation of substances potentially leaching directly from the ENDS devices to the e-liquids, and the specific effects in the male vs. female lung [ 4 ]. In addition, sex-related differences in lung toxicity and diseases have been thoroughly studied and reported across the life span [ 16 ], but research on sex-specific mechanisms of ENDS effects is limited despite reports of sex and gender influences on ENDS toxicity and use [ 4 ].…”