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DEMOGRAPHIC, CLINICAL, AND BEHAVIORAL FACTORS ASSOCIATED WITH E-CIGARETTE USE IN A LARGE COHORT IN THE UNITED STATES

      TOPIC: Tobacco Cessation and Prevention
      TYPE: Original Investigations
      PURPOSE: The use of e-cigarettes is increasing, so a better understanding of the factors associated with e-cigarette use and the health effects of e-cigarettes is needed.
      METHODS: Study participants were Kaiser Permanente (KP) members from eight US regions who joined KP's biobank (KPRB) from September 2015 through December 2019 and completed a self-administered questionnaire assessing demographic and behavioral factors, including e-cigarette and traditional cigarette use. Medical history was obtained from electronic health records. We used multivariable polytomous logistic regression to estimate odds of current or former e-cigarette use compared to never use between groups according to member characteristics (age, sex, race/ethnicity, sexual orientation, and education), behavioral factors (traditional cigarette use, marijuana, alcohol, and physical activity), and clinical history (body mass index (BMI), asthma, hypertension, hyperlipidemia, COPD, CVD, stroke, heart attack, any cancer, and lung cancer); odds ratios (ORs) and 95% confidence intervals (CIs) were estimated and adjusted for the factors described above.
      RESULTS: Of 119,593 participants, 60% were female, 22% >70 years-old, 70% Non-Hispanic (NH) White, 10% Hispanic, 10% NH Asian, 6% NH Black, 2% American Indian/Alaska Native (AI/AN), and 2% other racial/ethnic groups. Overall, 1,594 (1%) reported current e-cigarette use and 5,603 (5%) former e-cigarette use. Individuals who were ages 18-25 years (OR=39.3; CI:29.2-52.9), men (OR=1.2; CI:1.1-1.3), gay or lesbian (OR=1.5; CI:1.3-1.7), NH Asian (OR=1.6, CI:1.3-1.9), and AI/AN (OR=1.5; CI:1.1-2.0) were more likely to be current e-cigarette users. Current e-cigarette use was also more common for current traditional cigarette users (OR=39.8; CI:33.7-47.1) and current marijuana users (OR=6.7; CI:5.6-8.1). Those with a history of lung cancer (OR=2.7; CI:1.4, 5.0), CVD (OR=1.4; CI:1.1-1.8), or COPD (OR=2.1; CI:1.7-2.5) were more likely to be current e-cigarette users. Current e-cigarette use was inversely associated with higher educational attainment (OR=0.4; CI:0.4-0.5 for a master degree or higher compared to no college degree), high levels of physical activity (OR=0.8; CI:0.7, 0.9), and history of hypertension treated with medication (OR=0.9; CI:0.7-0.98). There was no association between current e-cigarette use and alcohol, BMI, hyperlipidemia, history of heart attack, stroke, or asthma. Observed associations were similar for former e-cigarette users.
      CONCLUSIONS: E-cigarette users tended to be younger, non-white, and identify as gay or lesbian. Those with prior lung cancer, COPD, and CVD were also more likely to use e-cigarettes. Concurrent traditional cigarette and marijuana use was prevalent among e-cigarette users.
      CLINICAL IMPLICATIONS: Providers need to assess e-cigarette use in patients to better understand motivators of use and health outcomes.
      DISCLOSURES: No relevant relationships by Andrea Burnett-Hartman, source=Web Response
      No relevant relationships by Morgan Clennin, source=Web Response
      No relevant relationships by Heather Feigelson, source=Web Response
      No relevant relationships by Shauna Goldberg Scott, source=Web Response
      No relevant relationships by Mark Gray, source=Web Response
      No relevant relationships by Jason Lyons, source=Web Response
      No relevant relationships by John Powers, source=Web Response