Background: The use of e-cigarettes and vaping products has trended steadily upwards over the last decade. In 2020, the National Youth Tobacco Survey reported a vaping prevalence of 20% in high school students and 5% in middle school students [1]. Vaping has been linked to several pathologic effects on the respiratory tract, including cell cytotoxicity, immune inhibition, oxidative stress, and impact on ciliary function [2]. The prevalence and effects of vaping and vaping exposure in people with CF is largely unknown. In this study, we aim to determine the prevalence of vaping and vaping exposure in children, adolescents, and young adults in the University of Alabama at Birmingham (UAB) pediatric and adult CF programs, and assess its impact on respiratory outcomes.
Methods: This is a retrospective observational study of patients with CF treated at the UAB Pediatric CF program. Self-reported data on vaping and vaping exposure were collected from CF patients age 11 year and older and from caregivers of pediatric CF patients of all ages. Surveys were administered separately to patients and caregivers on iPads during a routine clinic visit. Sociodemographic (age, sex, race/ethnicity, parental education, income, insurance) and clinical characteristics (CFTR modulator use, P. aeruginosa, encounter-based FEV1% predicted, BMI, and hospitalizations in the past 12 months) were obtained from the local CF registry.
Results: The preliminary analytic sample includes 87 patients, mean age 11.5 (SD 5.7) years, range of 0-20 years. The prevalence of vaping exposure in this sample was 25.3% (n=22) based on either patient or caregiver report. In the 38 patients-caregiver dyads, 18% (N=7) of patients endorsed vaping exposure despite their caregivers reporting no exposure. Patient with vaping exposure were more likely to be female (OR 3.4, p=0.017) and have concomitant tobacco smoke exposure (OR 9.4, p< 0.001). Each additional year of age was associated with a 20% increase in the odds of vaping exposure (OR 1.2, p< 0.001), whereas higher maternal education was associated with nearly 50% lower odds of vaping exposure (OR 0.54, p=0.024). Compared to unexposed counterparts, those with vaping exposure had 2.6% lower FEV1% (101.5 vs 104.1) and 50% higher odds of having 2 or more hospitalizations in the past year (13.6% vs 9.2%), although the associations did not reach statistical significance.
Conclusions: One in every four pediatric CF patients was exposed to vaping in the past year. Those with exposure were more likely to be older, female, and to have concomitant tobacco smoke exposure. A larger sample is needed to determine if vaping exposure has an impact on respiratory and nutritional outcomes.
Acknowledgements: This project is supported by funding from the CFF through a Fellowship Grant. We thank all of the patients and families with CF for their participation. Extended thanks to Heather Hawthorne for regulatory support, Dr. Solomon and TKC CF care team, and Dr. Gutierrez and the COA CF care team.
References: [1] Wang TW, Neff LJ, Park-Lee E, Ren C, Cullen KA, King BA. E-cigarette use among middle and high school students - United States, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(37):1310-1312. [2] Wills TA, Soneji SS, Choi K, Jaspers I, Tam EK. E-cigarette use and respiratory disorders: an integrative review of converging evidence from epidemiological and laboratory studies. Eur Respir J. 2021;57(1).
