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- Title
Demographics, Substance Use Behaviors, and Clinical Characteristics of Adolescents With e-Cigarette, or Vaping, Product Use–Associated Lung Injury (EVALI) in the United States in 2019.
- Authors
Adkins, Susan H.; Anderson, Kayla N.; Goodman, Alyson B.; Twentyman, Evelyn; Danielson, Melissa L.; Kimball, Anne; Click, Eleanor S.; Ko, Jean Y.; Evans, Mary E.; Weissman, David N.; Melstrom, Paul; Kiernan, Emily; Krishnasamy, Vikram; Rose, Dale A.; Jones, Christopher M.; King, Brian A.; Ellington, Sacha R.; Pollack, Lori A.; Wiltz, Jennifer L.
- Abstract
This cross-sectional study informs public health and clinical practice by describing differences in demographic characteristics, substance use behaviors, and clinical characteristics of e-cigarette, or vaping, product use–associated lung injury (EVALI) among adolescents compared with adults. Key Points: Question: Do adolescents with e-cigarette, or vaping, product use–associated lung injury (EVALI) differ from adults with EVALI? Findings: A total of 2155 patients were included in this cross-sectional study. Based on national surveillance data, adolescents with EVALI are more likely than adults with EVALI to report the use of informally sourced e-cigarette or vaping products that contain tetrahydrocannabinol and to have attention-deficit/hyperactivity disorder, asthma, and gastrointestinal and constitutional symptoms. Meaning: Public health and clinical efforts could include messaging to adolescents about the risks of tetrahydrocannabinol-containing e-cigarette or vaping products, especially those obtained from informal sources, and their association with EVALI. Importance: To date, limited information is available on the characteristics of adolescents with e-cigarette, or vaping, product use–associated lung injury (EVALI). Objective: To inform public health and clinical practice by describing differences in demographics, substance use behaviors, and clinical characteristics of EVALI among adolescents compared with adults. Design, Setting, and Participants: Surveillance data reported to the Centers for Disease Control and Prevention during the 2019 EVALI outbreak were used to calculate adjusted prevalence ratios (aPRs) with 95% CIs and to test differences between 360 hospitalized or deceased adolescents vs 859 young adults and 936 adults with EVALI (N = 2155). Main Outcomes and Measures: Demographics, substance use behaviors, and clinical characteristics. Results: Included in this cross-sectional study were 360 hospitalized or deceased adolescents (age range, 13-17 years; 67.9% male) vs 859 young adults (age range, 18-24 years; 72.4% male) and 936 adults (age range, 25-49 years; 65.6% male) with EVALI. Adolescents diagnosed as having EVALI reported using any nicotine-containing (62.4%), any tetrahydrocannabinol (THC)-containing (81.7%), and both (50.8%) types of e-cigarette or vaping products. Informal sources for obtaining nicotine-containing and THC-containing e-cigarette or vaping products were more commonly reported by adolescents (50.5% for nicotine and 96.5% for THC) than young adults (19.8% for nicotine [aPR, 2.49; 95% CI, 1.78-3.46] and 86.9% for THC [aPR, 1.11; 95% CI, 1.05-1.18]) or adults (24.3% for nicotine [aPR, 2.06; 95% CI, 1.49-2.84] and 75.1% for THC [aPR, 1.29; 95% CI, 1.19-1.40]). Mental, emotional, or behavioral disorders were commonly reported; a history of attention-deficit/hyperactivity disorder was almost 4 times more likely among adolescents (18.1%) than adults (4.9%) (aPR, 3.74; 95% CI, 1.92-7.26). A history of asthma was more likely to be reported among adolescents (43.6%) than adults (28.3%) (aPR, 1.53; 95% CI, 1.14-2.05). Gastrointestinal and constitutional symptoms were more common in adolescents (90.9% and 97.3%, respectively) than adults (75.3% and 94.5%, respectively) (aPR, 1.20; 95% CI, 1.13-1.28 and aPR, 1.03; 95% CI, 1.00-1.06, respectively). Because of missing data, percentages may not be able to be calculated from data provided. Conclusions and Relevance: Public health and clinical professionals should continue to provide information to adolescents about the association between EVALI and THC-containing e-cigarette or vaping product use, especially those products obtained through informal sources, and that the use of any e-cigarette or vaping product is unsafe. Compared with adults, it appears that adolescents with EVALI more frequently have a history of asthma and mental, emotional, or behavioral disorders, such as attention-deficit/hyperactivity disorder, and report nonspecific problems, including gastrointestinal and constitutional symptoms; therefore, obtaining a confidential substance use history that includes e-cigarette or vaping product use is recommended.
- Subjects
UNITED States; AGE distribution; CANNABINOIDS; CONFIDENCE intervals; LUNG injuries; NICOTINE; SMOKING; SUBSTANCE abuse; TEENAGERS' conduct of life; CROSS-sectional method; ELECTRONIC cigarettes; DESCRIPTIVE statistics; ADOLESCENCE
- Publication
JAMA Pediatrics, 2020, Vol 174, Issue 7, pe200756
- ISSN
2168-6203
- Publication type
Article
- DOI
10.1001/jamapediatrics.2020.0756