E-Cigarette Use Associated with Respiratory Symptoms in Adolescents

January 12, 2016

E-Cigarette Use Associated with Respiratory Symptoms in Adolescents

  1. Alain Joffe, MD, MPH, FAAP

Among adolescents who never smoked cigarettes, e-cigarette users were twice as likely to report recent respiratory symptoms as e-cigarette nonusers.

  1. Alain Joffe, MD, MPH, FAAP

The health effects of e-cigarettes are not yet clear. Investigators in Hong Kong studied the respiratory effects of e-cigarettes in 45,000 adolescents (mean age, 14.6 years; 51% male) who completed anonymous in-school surveys on tobacco and e-cigarette use. Students were classified with regard to tobacco smoking as follows: never, experimental (once or a few times), ex-, or current. They also indicated whether they had used e-cigarettes in the past 30 days and whether or not they had respiratory symptoms (cough/phlegm) for ≥3 consecutive months in the past 12 months.

In analyses adjusted for sex, age, perceived family affluence, secondhand smoke exposure, and school clustering, never-smokers (adjusted odds ratio, 2.06), ever-smokers (AOR, 1.39), and ex-smokers (AOR, 1.40) who used e-cigarettes were significantly more likely to report respiratory symptoms compared with non–e-cigarette users in the same tobacco smoking category. E-cigarette use was not significantly associated with the presence of respiratory symptoms among current or experimental smokers.


Although the data are self-reported, these results provide credible evidence that e-cigarette use does negatively impact the respiratory tract in adolescents. Lending further credence to the results, it seems biologically plausible that the effect would be most noticeable among those whose airways are not already irritated by cigarette smoke. These study findings support the World Health Organization's recommendation to regulate e-cigarette use.

Editor Disclosures at Time of Publication

  • Disclosures for Alain Joffe, MD, MPH, FAAP at time of publication Grant / Research support Consolidated Health Plans Editorial boards Adolescent Medicine: State of the Art Reviews; JAMA Pediatrics; Neinstein’s Textbook of Adolescent and Young Adult Health Care, Associate Editor


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