Introduction: The cardiovascular health effects of electronic nicotine delivery systems (ENDS) use are not well characterized, making it difficult to assess ENDS as a potential harm reduction tool for adults who use cigarettes. Aims and Methods: Using waves 1–5 of the Population Assessment of Tobacco and Health Study (2013–2019), we analyzed the risk of self-reported incident diagnosed myocardial infarction (MI; 280 incident cases) and stroke (186 incident cases) associated with ENDS and/or cigarette use among adults aged 40 + using discrete time survival models. We employed a time-varying exposure lagged by one wave, defined as exclusive or dual established use of ENDS and/or cigarettes every day or some days, and controlled for demographics, clinical factors, and past smoking history. Results: The analytic samples (MI = 11 031; stroke = 11 076) were predominantly female and non-Hispanic White with a mean age of 58 years. At baseline, 14.2% of respondents exclusively smoked cigarettes, 0.6% exclusively used ENDS, and 1.0% used both products. Incident MI and stroke were rare during follow-up (< 1% at each wave). Compared to no cigarette or ENDS use, exclusive cigarette use increased the risk of MI (aHR 1.99, 95% CI = 1.40–2.84) and stroke (aHR 2.26, 95% CI = 1.51–3.39), while exclusive ENDS use (MI: aHR 0.61, 95% CI = 0.12–3.04; stroke: aHR 1.74, 95% CI = 0.55–5.49) and dual use (MI: aHR 1.84, 95% CI = 0.64–5.30; stroke: aHR 1.12, 95% CI = 0.33–3.79) were not significantly associated with the risk of either outcome. Conclusions: Compared to non-use, exclusive cigarette use was associated with an increased risk of self-reported incident diagnosed cardiovascular disease over a 5-year period, while ENDS use was not associated with a statistically significant increase in the outcomes. Implications: Existing literature on the health effects of ENDS use has important limitations, including potential reverse causation and improper control for cigarette smoking. We accounted for these issues by using a prospective design and adjusting for current and former smoking status and cigarette pack-years. In this context, we did not find that ENDS use was associated with a statistically significant increase in self-reported incident diagnosed myocardial infarction or stroke over a 5-year period. While more studies are needed, this analysis provides an important foundation and key methodological considerations for future research on the health effects of ENDS use.

This study assessed the sociodemographic predictors of exclusive and dual use of the most frequently used nicotine/tobacco products, e-cigarettes, and combustible tobacco among adolescents. Cross-sectional data was from the 2017–2020 Monitoring the Future nationally representative study of eighth, tenth, and twelfth-grade students. We coded past 30 day nicotine/tobacco use into four mutually exclusive categories: no use, e-cigarette use only, combustible use (cigarette or cigar) only, and dual use (e-cigarette and combustible). We pooled the 2017–2020 data to examine the relationship between sex, race/ethnicity, parental education, and each product-use category using multinomial logistic regression, stratified by grade level. Among eighth (N = 11,189), tenth (N = 12,882), and twelfth graders (N = 11,385), exclusive e-cigarette use was the most prevalent pattern (6.4%, 13.2%, 13.8%, respectively), followed by dual use (2.7%, 4.5%, 8.9%), and exclusive combustible use (1.5%, 2.5%, 5.3%). eighth and tenth-grade adolescents whose highest parental education was a 4-year college degree or more had lower odds of exclusive combustible and dual use when compared to adolescents whose highest parental education was less than a high school degree. Research should continue to monitor the differential use of combustible tobacco products and e-cigarettes among adolescents from low socioeconomic status backgrounds or racial/ethnic minority households to inform ongoing and future interventions or policies.

The objective of this study was to determine the prevalence of ongoing Long COVID symptoms and related disability in a population-based cohort nearly two years after SARS-CoV-2 infection. Six domains of age-standardized disability (i.e., mobility, cognition, independent living, vision, hearing, self-care) were assessed by ongoing Long COVID status using cohort data from a population-based survey of adults with COVID-19 onset from March-December 2020 in Michigan. Baseline data were collected June 2020-October 2021 and follow-up data were collected January-November 2022. Associations between ongoing Long COVID and each domain of disability were also examined using adjusted modified Poisson regression models. Analyses were conducted 2024-2025. Nearly two years after initial infection, 24.0% of 1,547 respondents reported ongoing Long COVID symptoms. When comparing disability status four weeks prior to COVID-19 illness to the time of the follow-up survey, respondents with ongoing Long COVID symptoms had large increases in the prevalence of cognition (8.8% to 45.3%), mobility (12.7% to 40.0%), independent living (4.7% to 20.7%), and self-care (2.1% to 10.9%) disability, and more modest increases in the prevalence of vision and hearing disability. Respondents without ongoing Long COVID symptoms experienced smaller increases in disability prevalence. In regression models, ongoing Long COVID was associated with higher prevalence of all six disability domains. The ongoing burden of Long COVID and related disability is substantial and warrants increased attention by the public health and medical communities.

The use of electronic nicotine delivery systems (ENDS) among youth in the United States has increased rapidly in the past decade. Simultaneously, while youth cigarette smoking has declined considerably, youth are still more likely to use menthol cigarettes than any other age group. We used nationally representative data on 15–17-year-olds from the Population Assessment of Tobacco and Health (PATH) Study and the National Youth Tobacco Survey (NYTS) (2013–2017) to better understand current cigarette (by menthol flavoring) and ENDS use in the US. We calculated weighted population prevalence estimates across years for multiple patterns of current cigarette and ENDS use (i.e., exclusive menthol cigarette, exclusive non-menthol cigarette, exclusive ENDS, dual ENDS and menthol cigarette, and dual ENDS and non-menthol cigarette) by sex, race/ethnicity, parental education level, household income, and homeownership. Overall, both exclusive menthol and non-menthol cigarette use declined from 2013–2017. Exclusive ENDS use increased, particularly among youth who were non-Hispanic White or had a higher socioeconomic status (measured by parental education, household income, and homeownership). Dual use of ENDS with either menthol or non-menthol cigarettes did not change significantly. Monitoring changes in these sociodemographic patterns will help inform future youth tobacco prevention strategies.

Background: Cigar use among adults in the United States has remained relatively stable in the past decade and occupies a growing part of the tobacco marketplace as cigarette use has declined. While studies have established the detrimental respiratory health effects of cigarette use, the effects of cigar use need further characterization. In this study, we evaluate the prospective association between cigar use, with or without cigarettes, and asthma exacerbation. Methods: We used data from Waves 1–5 (2013–2019) of the Population Assessment of Tobacco and Health Study to run generalized estimating equation models examining the association between time-varying, one-wave-lagged cigarette and cigar use and self-reported asthma exacerbation among US adults (18+). We defined our exposure as non-established (reference), former, exclusive cigarette, exclusive cigar, and dual use. We defined an asthma exacerbation event as a reported asthma attack in the past 12 months necessitating oral or injected steroid medication or asthma symptoms disrupting sleep at least once a week in the past 30 days. We adjusted for age, sex, race and ethnicity, household income, health insurance, established electronic nicotine delivery systems use, cigarette pack-years, secondhand smoke exposure, obesity, and baseline asthma exacerbation. Results: Exclusive cigarette use (incidence rate ratio (IRR): 1.26, 95% confidence interval (CI): 1.03–1.54) and dual use (IRR: 1.41, 95% CI: 1.08–1.85) were associated with a higher rate of asthma exacerbation compared to non-established use, while former use (IRR: 1.01, 95% CI: 0.80–1.28) and exclusive cigar use (IRR: 0.70, 95% CI: 0.42–1.17) were not. Conclusion: We found no association between exclusive cigar use and self-reported asthma exacerbation. However, exclusive cigarette use and dual cigarette and cigar use were associated with higher incidence rates of self-reported asthma exacerbation compared to non-established use. Studies should evaluate strategies to improve cigarette and cigar smoking cessation among adults with asthma who continue to smoke.